A recent judgment made about a 17-year-old girl detained in a secure unit under a Detention and Training Order made by the Youth Court is disturbing. The likelihood of the girl committing suicide was almost a certainty – and the plan of the local authority and the NHS lacked any detail in how this should be addressed.
A psychiatrist diagnosed a range of issues, most of which will be familiar to those working in early years. Insecure attachment disorder, emotionally unstable personality disorder, attention deficit hyperactivity disorder, conduct disorder and borderline learning difficulties. This is an extraordinary list and in many ways difficult to comprehend. But what seems particularly baffling is the psychiatrist’s view that this did not meet the criteria for a psychiatric diagnosis of mental illness. And then in a subsequent report, the psychiatrist said these conditions did not impair the functioning of the girl’s mind such that she could not make sound decisions.
The court-appointed guardian noted in her report, ‘My visit to her had been pleasant […] She was full of smiles and laughs. Within 15 minutes, however, she was beyond herself – repeatedly banging her head and face against the wall. This […] came out of nowhere. I have never seen or heard anything like it in my 32 years of practice.’
This situation raises many questions, one being how do we develop a more humane way of describing children’s emotions – one which does not just categorise them? It is so easy to lose sight of the human being in the course of this, to stigmatise and condemn.
Children lose control of their emotions, act in threatening and troubling ways, and can hurt themselves. And what they typically need is a known, trustworthy and loving adult who can calm, explain and restore. These are the fundamentals of mental health.
The foundation for this is typically set in the early years. We don’t know the detail of what happened to this girl in her early years, but the psychiatrist identified attachment issues. Repairing the consequences of insecure attachments later in life is difficult. As a society generally and professionals in particular, we need to act when we have the most chance of getting it right.
John Simmonds is director of policy, research and development at CoramBAAF