Abandoned at 18: the young people denied mental health support because they are ‘adults’

When does a child become an adult? The answer to this question is in many ways muddier than it was. Over the last decades, the traditional landmarks of adulthood in the west – a job, a marriage, a home of one’s own and a child – have been delayed or have disappeared. Legally, though, the answer is still clearcut: 18.

Jessica, 19, lives in south Wales and hopes to go to college to study childcare. She likes to spend her time chatting with friends in Costa or on the phone; she loves dancing and singing, and she plays the ukulele. She used to enjoy hanging out at her local youth club, having pizza and playing games, but since turning 18, she has had to leave. At times, her voice is soft and playful and she sounds younger than her age; at others, her tone has an edge of irony and she sounds far older. She has spent the past few years in mental health services, and says of her experiences: “You’re in a sea of your own because you’re so young and naive.”

The story Jessica tells is heartbreaking. After some traumatic experiences at the age of 13, she began self-harming, she says, because she felt she could control that physical pain, unlike the emotional agony in which she was drowning. She had panic attacks and was referred to Child and Adolescent Mental Health Services (CAMHS) in her mid-teens; at 17, she had two admissions of a few weeks each to a CAMHS psychiatric unit. When she was discharged, she became a patient with the CAMHS intensive treatment team, whom she saw three times a week for therapy, activities and supportive chats. It was working: her self-harm reduced, she felt safer, and she was making progress towards recovery.

Then she turned 18.

The CAMHS team continued caring for her for a further three months, to bridge the waiting time until she could be seen by Adult Mental Health Services (AMHS), who told her (against the recommendations of her previous clinicians) that her care would be reduced from three times a week to once. She had an introductory session and was told she would be phoned back, but the call never came. Her mother chased it up, and was told that the clinician she had seen once had moved on, so Jessica was put on another waiting list and told to expect a delay of “six to 18 months”, she says.

All the painstaking progress she had made was undone in an instant. “It all just fell apart. I had gone from having help three times a week from people who know me, whom I trusted, to nothing at all. It felt as if the world had been ripped from underneath my feet, and I was falling into a deep hole. My self-harming behaviours increased, and I attempted suicide. I felt helpless, alone and scared of what I was going to do to myself.” After less than a month with no treatment, Jessica was sectioned on an adult psychiatric ward, where she was the youngest patient by 10 years. She stayed there for five months.

Eighteen. Is there a more tumultuous period in a person’s life? It is a time of such tremendous change: the end of school and the structure it provides, the beginning of work or university or whatever comes next, of adult life and the freedom it promises; the fears and exhilaration of leaving home or the fears and disappointment of being left behind. The loss of people and places, the coming of the new and unknown. A moment of such volatility and vulnerability that it is comparable to infancy.

For a healthy 18-year-old, this change can bring uncertainty and anxiety, yes, but also excitement. For an 18-year-old with severe mental health problems, it can mean deterioration and danger. If you had to pick the worst moment in a troubled young person’s life to withdraw the help they have been receiving and to thrust them into an unfamiliar system where they do not know when or even if they will get the help they need, the age of 18 may well be it.

Yet that is exactly how most mental health services are structured.

Full story: Guardian

Author: Philip Challinor
Posted on: 20th March 2019