Teen’s Struggle for Normalcy Raises Questions About Mental Health System’s Efficacy

Mia, aged 14, frequently gazes from her bedroom window, which overlooks a nearby residential building. Due to the absence of an elevator, her sole method of exiting her second-floor apartment involves descending the stairs by sliding on her bottom. For years, Mia has not experienced a sense of normalcy, having felt like an outsider for most of her life. This overwhelming feeling culminated a few months prior in a suicide attempt, resulting in paraplegia—the inability to move her lower body—and requiring her to use a wheelchair. Mia states, “I can’t change the past now,” adding, “it feels spiteful that I can only look at the future, and that I have no clue what is going to happen.” This teenager’s experience, and indeed a significant portion of her existence, resonates with numerous families who have encountered difficulties navigating the strained mental health system, often leading them to believe their worries were minimized or disregarded. An examination by the BBC of official data from the NHS indicates that over 50% of young individuals receiving psychiatric assistance conclude their treatment without any health improvement. Concurrently, a recent report from the charity Mind reveals that the proportion of young people reporting poor mental health increased from one in nine to one in five between 2017 and 2023. Mind also noted that in the previous year, only one-third of these individuals could access treatment. Christina, Mia’s mother, initially sought assistance for her daughter at age five, when Mia had established a precise morning routine, involving dressing in a specific sequence and spending as long as two hours in the bathroom. Within a few months, Mia received a diagnosis of obsessive-compulsive disorder (OCD). However, her family believed this diagnosis was incorrect, and her situation did not improve. Mia recollects, “When you’re a seven-year-old child and you can’t properly understand why you feel so different and so isolated, it’s obviously going to impact you growing up.” She further states, “There’s never truly [been] anywhere that I feel I belong.” Mia and her mother grew convinced that Mia was on the autism spectrum, prompting Christina to request an evaluation at the children’s mental health service in Islington, north London. On two distinct occasions, Mia’s scores in preliminary screenings were insufficient to warrant a formal assessment. Her mother suspects the assessment was designed primarily for diagnosing boys, a point the service provider acknowledges, stating they have since enhanced their methods to align with a greater national comprehension of how autism manifests in girls. As Mia continued to face challenges, including difficulty forming friendships, Christina sought assistance from her primary school’s special educational needs teacher, her local social work department, and mental health services, urgently seeking help. Christina recounts, “I was ignored and made to feel like a neurotic mum – nobody was listening.” She added, “I felt they didn’t understand her needs. I don’t think they knew how to support her.” Near the conclusion of her initial year in secondary school, Christina received communication from a teacher indicating the school’s belief that Mia was autistic. Subsequently, an assessment was conducted, confirming the diagnosis. This provided educational benefits, with Mia receiving additional assistance during examinations and with homework. However, according to Christina, it did not result in a substantial change in psychiatric support. The assistance Mia obtained throughout the years was intermittent. This included an infrequent eight-week course of Cognitive Behavioural Therapy (CBT), followed by periods of no treatment for several months, and then sessions with a new therapist. Christina noted that appointments were sometimes cancelled due to the therapist’s illness or job changes, which left Mia with a sense that minimal progress was occurring. Whittington Health stated that the care it delivered to Mia was “in line with national guidance.” The organization added, “Such care is inherently complex and we regret that her difficulties continued to escalate.” An NHS England spokesperson also commented, “Our thoughts are with Mia and her family. The NHS is determined to improve children’s mental health and autism services… because we know there are some people waiting too long for care.” The Care Quality Commission, tasked with overseeing NHS hospitals, reports that mental health services face challenges with staffing, including securing an appropriate combination of personnel, “all of which are having an impact on capacity, and the availability and regularity of appointments.” The commission urged the NHS to “actively involve parents in their child’s care decisions,” further noting that “addressing their concerns promptly is critical to safety.” Christina expresses a strong desire that this recommendation had been implemented considerably sooner. During the summer of 2023, as Mia’s health worsened, she received a prescription for anti-depressants. Christina was angered upon learning that the medication might cause weight gain, as her daughter subsequently developed an eating disorder. Mia also began making suicide attempts; on one occasion, her mother had to physically restrain her for her safety. In March, two days after her therapist canceled an appointment, Mia attempted to end her life, resulting in severe spinal injuries. She stated, “I felt I was falling behind with school, with friends. I felt like I was falling behind in the world, really, and sometimes it feels like it’s really hard to stay afloat.” Following her suicide attempt, Mia recounts that for approximately one month, she was unable to move or sit upright. She explains, “I was in constant pain. I was on medication, just to not cry. And then I had to relearn a lot – basic things like sitting up and eventually standing, even though it’s still very much assisted. And I had to relearn certain motor skills. And then I had to adjust to life in a wheelchair and managing being paraplegic and feeling like it’s never going to get any better.” Data released monthly by NHS England indicates that mental health services frequently encounter difficulties in delivering appropriate care to young individuals. Since April 2023, psychiatric services have evaluated the effects of 94,802 treatments provided to young people to monitor changes in their mental health. The findings reveal: Cumulatively, 54% of the recorded scores indicated either no progress or a decline. In response to the BBC’s examination of this data, NHS England commented: “Not everyone can get better and stabilising symptoms gives opportunities to re-assess patient needs and look at new options. If you are struggling with your mental health do come forward for help.” Mia performs a series of daily exercises aimed at strengthening her muscles and preserving movement. A high-achieving student, she profoundly misses attending school. The mental health service is currently providing her with various therapies, which she perceives as arriving “far too late.” Nevertheless, a new obstacle has emerged. Mia’s apartment building lacks an elevator, and a petition to install a stairlift has been held up for months due to the housing association’s concerns about potential fire hazards. To attend therapy or hospital visits, Mia must descend two flights of stairs by sliding on her bottom, while her mother transports her wheelchair. Southern Housing, the owner of the building, informed the BBC that it possesses no adapted residences suitable for Mia’s requirements, and that their fire safety expert is collaborating with a lift surveyor and Islington Council’s occupational therapy team “to investigate whether this is possible.” Islington Council stated: “Mia has a dedicated social worker and the council is working hard to make Mia’s current home more suitable. We have offered three alternative accessible properties, which unfortunately, have not met the family’s specific needs. We are committed to continuing the search.” Mia’s well-organized bedroom has become her sanctuary. However, she anticipates eventually gaining the self-assurance to engage with the external environment. She advises, “No matter how odd or strange you feel for feeling and thinking the thoughts you do, the most helpful thing you can do for yourself is to speak to someone else. If you never tell anyone, they’ll never be able to help.” She concludes, “One day, I’m going to be proud of myself. That’s what I’m looking towards, a place where I can be proud at how much I’ve overcome.” BBC Action Line: Individuals impacted by the subjects in this report can discover available support here. Copyright 2024 BBC. All rights reserved. The BBC disclaims responsibility for the content of external websites. Information regarding our external linking policy is available for review.