‘I’ve cut myself... I had to be punished’

The ambulance service answered immediately, but when they spoke to Ashley she insisted she was all right. I was told that since the cuts were not life-threatening I should take her to the accident and emergency department myself. So, like a mad woman, I drove her, still bleeding and dressed only in her pyjamas and the rug, the 40 minutes to our local hospital.

Mercifully, A & E was almost empty and my daughter was seen immediately by a nurse. We tried to take her pyjamas off so they could look at her cuts but they were stuck to her with congealed blood so I put her into the shower.

She had cut herself all the way up the insides of her arms, the whole way down her legs from groin to ankles. There were also deep scores, and I have no idea how she managed this, all over her back. She told me she had used a razor blade.

They gave us a room to wait in and two nurses came to wash and clean the cuts. It took them more than an hour. A doctor arrived, and then a paediatric specialist.

This wonderful woman now sat down on the bed with Ashley and asked her questions. She was absolutely calm and gentle, but devastatingly matter-of-fact:

“Can you tell me why you’re here, Ashley?”

“I’ve cut myself.”

“And can you tell me why you did it? Was it you, or was it someone else who told you to do it?”

“Someone else.”

“Who was it?”

“Anna.”

“Who is Anna?”

“The voice inside my head.”

“I see.” The doctor did not turn a hair to this, just carried on calmly writing her notes. “And why did she tell you to do it?”

“She said I had to be punished.”

It transpired that over the weekend Ashley had got into trouble at her friend’s house, where she had got drunk. To her mortification, she had thrown up on the floor of her friend’s bedroom.

Through the doctor’s skilful questioning we learned that “Anna”, Ashley’s alter ego (a phenomenon commonly experienced by children who have anorexic and self-harming difficulties) had demanded that she punish herself for this misdemeanour; and had in fact demanded far more extensive cutting.

If the sight of so much blood had not made her feel too faint and nauseated to carry on, Ashley would have continued to cut herself all over the backs of her legs and arms, and over her chest.

“And what else does Anna tell you to do? Has she ever told you to kill yourself?”

“Yes.”

“And have you ever tried to do that?”

“Yes.”

There was a pause as the doctor put down her pen.

“Well, we are in charge here,” she said, “not Anna.”

I do not know what was more devastating to me at this point: that my beautiful, clever, creative, charming 15-year old daughter had already attempted suicide (she now revealed that she had once tried to hang herself); or that the doctor knew with such precision exactly what questions to ask. She had clearly heard Ashley’s story many times before.

MY DAUGHTER first became ill with depression two years ago when she was 13. She had just started boarding school, which she loved, when she hit puberty. All seemed well. My husband and I, both working professionals, were only too happy to believe she was safe and thriving in her new school.

If had not been for an exceptionally perceptive and persistent local GP, we might have missed the signs altogether. The withdrawal, the grumpiness, the general lack of communication, all seemed, to us — her family — like “normal” teenage behaviour. It was not.

Unbeknown to us, she had started both to fool about with food and to self harm, albeit on a relatively minor scale. We were forced by the GP to recognise that Ashley was not just being a teenager; she was really ill.

We took her away from school and reluctantly put her on anti-depressants. They told us that the medication would take two to three weeks to take effect. Miraculously, 2½ weeks later, she was back to her old self. It was like watching someone surface from the bottom of a well.

It was not to last.

One of the most pernicious features of mental illness is how hard it can be to detect. They do not look “ill”. They have no spots, no fever, no rash, no broken limbs. They walk, talk and make sense (most of the time). It is all in the mind; and one of the things the mind wants most to do is to conceal.

The person my daughter was most adept at concealing her condition from was me. My marriage to Ashley’s father was slowly and painfully breaking down and she was trying protect me from her own pain.

Cutting releases endorphins into the body. Unless you get to it early, it becomes an addiction just like any other. We were incredibly lucky to find an art therapist for Ashley who saw her every week and was able to teach her coping mechanisms to use when the urge to cut came on her.

For a time they worked. She went back to school and appeared to be doing well. She seemed to have made an almost full recovery. Alas, she had not.

The day after Ashley was admitted into hospital, a representative from the Child and Adolescent Mental Health Services (CAMHS) came to assess her. We were seen together and separately. Ashley seemed glazed much of the time: she answered the questions that were put to her coherently, but fidgeted anxiously throughout, and picked at her cuts.

When she went to the bathroom she tried to cut herself again (there had been a razor in the wash bag I had brought her — my own terrible oversight). We agreed that she should stay in hospital another night under observation.

It was clear by now that she could not be left alone, so the CAMHS representative asked for a psychiatric nurse to come to look after her. When none could be found at such short notice I agreed to stay with Ashley overnight. I slept on my coat on the floor beside her bed.

The following day a second CAMHS representative arrived to continue the assessment. She provided me with an action plan of how I was to take care of Ashley when she came home. I was to find a box into which all the “sharps” — kitchen knives, razor blades and so on — could be locked away; she was to sleep in my bed with me; she must not be allowed even to go the bathroom on her own.

As I listened to this kind, well-intentioned woman sitting beside my daughter’s hospital bed I realised there was no way on earth I was going to be able to keep Ashley safe. Even if my husband had still been living with us — he had walked out a week before Christmas — it would have been impossible.

Ashley was not only covered in cuts but I could see that bruises were now appearing all over her legs where, on that same Sunday night, she had pounded at herself with a potato masher. If she wanted to self harm, she was going to find a way to do it. Painful though it was, I refused even to consider taking her home.

So now what? The hospital where Ashley had been admitted did not have a psychiatric ward, so one would have to be found for her elsewhere. I was warned it could be in Scotland or Cornwall, hundreds of miles from home.

Fair enough. At this stage I was not going to be fussy. All I wanted was for Ashley to be kept safe, and be helped to get better.

But there was not a bed anywhere. Not one. Not a single bed, either private or NHS, to be had in a psychiatric ward anywhere in the country.

At this point, in desperation, I decided I needed to take the situation into my own hands. I spent the next day, and the next, on the phone to every friend I knew who had been in a similar situation, to everyone I knew in the medical profession, including her therapist and psychiatrist from two years previously, asking for advice.

I did not want Ashley to be treated privately — our health insurance would have covered only 45 days. Aside from that I believed, and still do, that only the NHS could give her the care she needed in the long term. But at the time the private route seemed to be my only option.

Eventually I found a London clinic willing to admit her. I went back to CAMHS and said I had found a bed, but they told me that although the NHS did lease beds in private hospitals — and was often obliged to do so, owing to cuts in NHS mental health funding — they would not accept this particular clinic because it mixed children and adults in the same wards. Although I did not think so at the time, this proved to be the right decision.

In the interim Ashley stayed on the same paediatric ward under 24-hour watch by agency psychiatric nurses. It took a week, perhaps the longest week of my life, but a bed was finally found.

There have been other moments of respite. My neighbour not only cooked supper for me when I got home exhausted but also took it upon herself to deal with Ashley’s bloodied bedclothes so I would not have to see them. Her 21-year-old son cleaned the rest of our cottage for me.

A friend of Ashley sat up for a whole night in hospital beside her so that I could get some rest. My valiant 82-year-old mother dropped everything and just arrived to be with me. A dear friend, unwell herself, turned up on the doorstep with cake. And Doris, a psychiatric nurse, volunteered for the same shift every day so that Ashley would have continuity.

I WILL never know the exact reasons why my daughter became so ill. Almost certainly she has a genetic predisposition. There have been other contributors to the deadly cocktail: social pressures — Facebook, her peers, school, exams and so on — have all played their part.

When I was at school, self-harming, anorexia and depression were practically unknown; today they are endemic, particularly among girls. Something in our society is terribly, terribly wrong that this should be so.

So much lip service is paid to the pressures we put our children under: social media, access to pornography, online bullying, the stress of exams. It is going to require hard, radical, imaginative, courageous thinking to take the pressure off our children, to give them back their childhoods and their sanity.

If I were ruler of the world I would abolish Facebook, homework and all exams for the under-18s. Sadly, I am not, so all I can do is to add my voice to the general cry.

What to do if you're worried

The charity YoungMinds advises that although self-harm is rarely a failed suicide attempt, it is a sign that the child is coping with difficult feelings and probably needs help.

Self-harm can also lead to infection, permanent damage and even accidental death. It is therefore important to seek professional advice.

Start by going to your GP. You can see the GP yourself if your child does not want to go. You should also ask your GP what to do if your child’s cuts get infected. Your GP may refer you and your child to Child and Adolescent Mental Health Services.

You can also look for counselling for your child. You do not need to see the GP first for many youth counselling services.

If you are worried your child’s life is at risk from self-harming, call 999 or take them to A&E.

Source: youngminds.org.uk

Surge of 25% in youngsters who want to hurt themselves

The number of 10 to 19-year-olds who were admitted to hospital after harming themselves rose by 25% in the year to 2014 across England, Wales and Northern Ireland, according to NHS figures. Many others cut themselves but do not end up in hospital.

A separate study conducted by charities including YoungMinds, ChildLine and YouthNet found that half of children aged 11 to 14 have either tried to harm themselves or know someone who has.

Experts say that feeling under stress at school and at home, a pressure to live up to unattainable ideals propagated by social media and increased exposure to harmful images are behind the increase.

Last month 15-year-old Toni Connell committed suicide after posting videos online revealing secrets about herself. One of the placards that she held up to the camera read: “My secrets — self harm help.”

“There is constant stress at school, bullying, sexual pressures and a whole online world that is new,” said Lucie Russell, director of campaigns at the YoungMinds charity.

“This is the first generation of children that really live their life in a public domain and are under pressure to create a ‘brand me’ of ‘I’m happy, I look great, here’s me’. ”

The advice to parents is to keep communications open, not to judge or react with anger if their children are self-harming and to seek advice from a mental health charity and a GP.

A reduction in spending on children’s mental health services means that schools do not have as much expert medical help as they received in the past, according to some charities. They believe all teachers should be trained in how best to respond.

“Teachers of any subject may get pupils coming to them for support and they need to be able to give that child the right support,” said Rob Milne, the pastoral deputy head at King’s College School in Wimbledon, southwest London.

Over the past year the school has introduced a series of programmes to help provide their pupils with “true grit” lessons in “emotional resilience”. Staff are offered courses in mental health first aid.

Many self-harming children make a full recovery when the right help is available. Caroline Strathearn was 13 when she began locking herself in her bedroom in Humberside and cutting her arms. Now 27 and married with two children, she does not countenance self-harming even when she is at her lowest.

“It’s not about saying, ‘I’m going to stop’ — it doesn’t work like that. You have to make your life better... It took a very long time to move on from self-harming — it’s not something you just get over in a couple of days,” she said.

Strathearn became an occupational therapist, wanting to help others who were struggling and did not know where to turn. “I learnt to be compassionate towards myself and to realise there were other, better ways of coping with my negative thoughts,” she said.

Strathearn is taking on the Mind 3000s challenge to raise £50,000 for Mind, the mental health charity. Support her at www.mind.org.uk/caroline

For more information, visit mind.org.uk and youngminds.org.uk

Francesca Angelini