Systematic Breakdown

My sister was hospitalised last month under Section 2 of the Mental Health Act. She was already known to social services; this was her ninth detention in 17 years. Each crisis follows the same pattern: detention for up to 28 days, release into the community with little follow-up support, no formal diagnosis, and no real oversight of her progress or managing of her condition. Different reasons have been given for her release. Sometimes they said that R. had withdrawn from social services or refused a formal diagnosis. Sometimes it was because of staff shortages.

R. has a son, born in 2007. When he was four, he was diagnosed with autism. His fifteen years of life sometimes resemble a saddening, and often maddening, tale of missed chances and lost opportunities. The state is supposed to provide a safety net, but J. and his mother, among the most vulnerable and least supported members of society, have too often fallen through it.

Despite her multiple hospitalisations, R. remained without a social worker of her own when last detained. Even when she and J. both had social workers, there was little to no collaboration or overlap in their case files. Adult and children’s social services have become increasingly and dangerously separate. Crucial questions around parenting capability often go unasked, and input from other family members is often overlooked unless a legal challenge is made.

J. had previously been under various orders and plans, but a Child Protection Plan – made when a child is judged to be at risk of significant harm – wasn’t sought until September 2021. A CPP allows social services and the family to work together to identify the risks to a child, and what needs to be done to ensure their safety. A parent cannot close a child’s case at social services while they are under a CPP without the consent of the local authority.

R. was already unwell and heading for another period in hospital. Social services were informed and, last month, she failed a mental health assessment. J. was placed in my care. His behaviour was erratic, which I put down to the distress of having to witness his mother being taken to hospital. I voiced my concerns to his social worker, who told me his behaviour was normal for children with autism. But it wasn’t normal for J.

On his tablet I found videos of beheadings that he’d downloaded, incredibly explicit footage that most adults could not bear to watch. His social media interactions included efforts to ingratiate himself into gang culture. His attempts to leave the house when nobody was looking suddenly made sense – he wasn’t running away, he was intending to join up with these gangs.

Trying to get him an urgent mental health assessment, I was passed from his GP to Child and Adolescent Mental Health Services, back to his GP, back to CAMHS, to the out of hours emergency social services, to CAMHS once more, to 111 and then back to CAMHS. Only after J. attacked his social worker, and I took him to A&E, was it accepted that he was clearly unwell. Neither of us had really slept in three days.

Even then, he had to wait eleven hours to be admitted to the paediatric ward because they were concerned he was still showing signs of aggression. Of course he was: he’d been left in a windowless room for eleven hours. He had been out of school for two years because of bullying and health issues, isolated from almost everyone, and watching his mother’s mental health deteriorate with no intervention. He had lost his uncle and his grandfather in quick succession and, like all of us, was navigating a pandemic that everyone had found mentally exhausting.

When family members are forced to take up the slack left by a failing system, the emotions can be overwhelming. I feel a horrible sense of guilt. I know I have done the right thing, but I’m still haunted by his face when he had to be restrained. I feel broken. And I’m angry.

I’m angry at his mother, my sister, though I know that she herself is sick. I’m angry with adult social services for failing her. I’m angry with the Children’s Disability Service for failing my nephew. I’m angry with CAMHS for abandoning me for 24 hours to deal with a vulnerable child whose mental health was deteriorating rapidly. I’m angry with the hospital for leaving him in a miserable cold cubicle for eleven hours.

I’m angry with all the social workers who ignored my concerns, saying that my nephew’s behaviour was typical for children with autism. I’m angry with my family for ignoring my warnings and leaving me to deal with my sister and her son alone.

I’m angry with myself for not recognising his suffering earlier. The sweet boy who would talk to me about the history of Germany or the Russian Revolution has turned into a deeply troubled teenager who believes that I am a voice in his head, and that the dark and disturbing world he has retreated into in his mind is his reality. I hope he can be pulled back. I don’t know how to forgive myself if it’s too late.

But, mostly, I’m angry at the government. J. is not the only child to have been let down. Earlier this year it was reported that coroners had issued reports to prevent future deaths in at least fourteen cases involving CAMHS in the last five years. Mental health referrals for adolescents were up 134 per cent in 2021 compared to the start of the pandemic, which saw children locked away in isolation for almost a year. Psychiatric waiting lists have increased from weeks to months. There is a chronic shortage of social workers. Teachers report being unable to cope with the mental health crisis among their students. Nearly £1 billion has been cut from government funding for the Early Intervention Grant. CAMHS has seen a 23.5 per cent decrease in spending per person between 2015 and 2021.

A speech by the new president of the Association of Directors of Children’s Services lays bare the state of children’s mental health provision in this country:

access to and costs of suitable placements for children in care are unsustainable, all whilst the largest providers make ‘materially higher profits’ … in the last two years we have seen a huge increase in poor mental health and wellbeing amongst children which makes it even more bizarre that the number of bed nights available to treat the most seriously traumatised children has declined rapidly during the same period … Would I go as far as to say children are being failed? yes, I would.

There have been individual and departmental failings along the way for both my sister and my nephew, but they are part of a larger story: the systematic breakdown of the public services safety net. Austerity is killing our children.