Mental illness in the young is often not recognised or treated promptly. But early intervention can rescue a child's schooling. Wendy Wallace hears an instructive story of depression and recovery.
Elaine Bentley is setting off for school to get her GCSE results the morning she talks to The TES. But after what she and her family have been through in the past year, exam results hold no terrors for her. "I'm looking forward to whatever I get," she says serenely, sitting cross-legged on her bed while her dog Sally sleeps fitfully in a basket on the floor.
That 16-year-old Elaine took GCSEs at all was a surprise to her mother, her psychiatrist and even Elaine herself. But her descent last year into nervous breakdown could not have been predicted at the beginning of her secondary school career. A bright and sociable girl from a supportive family (and with a mother who is a special needs teacher), she won a place at a selective school near her home which other children cross London to attend. Initially, there were no problems. "I thought it was really good," she says. "Both my parents had been there and I made friends quickly. The first year was OK."
During her second and third year in the school, Elaine was bullied by another girl. Her confidence suffered and by year 10 she was increasingly sacrificing her natural inclinations to a desire to be in with the in-crowd. "I dropped my friends to be with the really popular ones, who were always bitching about other girls." By the beginning of Year 11, with the high-achieving school upping the pressure, Elaine was buckling. She couldn't eat and describes herself in retrospect as "always crying, unhappy and in a bad mood". But neither she nor her family realised she was mentally ill. "I've always been a worrier and it just happened gradually, beginning with the bullying," she says. "I began to think it was a way of life for me, always having to do what other people wanted, and being the one in the middle."
She began to behave obsessively. "I'd be tucked up in bed, all nice and cosy," says the sweet-faced teenager, with a teddy on one side of her and a make-up bag on the other, "and I'd have to get up and wash my hands, or check that my bag was ready for school, or that the door was locked." Clamorous voices in her head told her that she or members of her family would die if she didn't carry out certain instructions. On a residential trip away from home last autumn (not connected with school), elaine suffered her first full-blown panic attack. "Everyone was smoking cannabis and I thought I'd have a little bit to look good. Afterwards I felt as if I was dying and falling - everything went black. I went to hospital and they said it was the effects of the spliff and to sleep it off, but the next day I had a similar feeling, as if I was in a bubble and very distant."
When she came home, her mother took her to the GP. "I'd been worried about her for six months," says Sarah Bentley. "I knew teenagers were up and down, but I had a feeling there was more to it than that. She was very morbid, obsessed with death and in a very high state of anxiety. She was hearing men's voices in her head, telling her to do things -for example, that if she didn't draw the curtains somebody would come in and kill her, or me. I'd hear her arguing with them. But even I didn't realise how ill she was, or to what extent the voices were ruling her life."
Elaine at this point had some luck. Although the provision of adolescent mental health services is generally poor, with some 16-year-olds having to use adult services and others referred to child guidance clinics with long waiting lists, she was referred to a local service set up specifically to meet the needs of teenagers in mental health crisis. Within a fortnight of her visit to the family doctor, she saw consultant adolescent psychiatrist Dr Tony Kaplan at SAFE (Service for Adolescents and Families in Enfield) and was diagnosed as suffering from depression and obsessive compulsive disorder. "I explain-ed to him about the obsessions and he explained what it was," says Elaine. "It was such a relief to know it was something, and that so many people got it."
But things got worse for Elaine before they got better. After opening up about her state of mind to Dr Kaplan, she had another severe panic attack the following weekend in a shopping centre and ended up in casualty once more believing she was dying. She became too afraid to leave the house, and stopped going to school at all in October last year. "It was a nightmare," says Sarah Bentley. "She was sleeping with me in my bed and wouldn't do anything without my being around. She wouldn't see anyone or speak to anyone. Fear of panic attacks caused agoraphobia and every other phobia."
But Elaine kept up the weekly visits to her psychiatrist, and begin to take the anti-depressant prescribed for her. "I'd always go thinking 'I'm not going to talk, there's nothing wrong with me.'" But Dr Kaplan got me to open up. He understood all of it, and was always really paying attention. It was a nice room, and quiet. I'd talk to the floor if I was feeling down, or look at the trees out of the window. I told him I was never happy. We talked about friends, about school and went back and back to when I was a little girl.
"He made me understand what was wrong with me - that everyone feels depressed and thinks they're fat and that people don't like them. But some people need more help in dealing with it. He kept asking 'Why? Why?', and in the end you found an answer."
Elaine saw Dr Kaplan for four months; her family also received support. Through a combination of medication, counselling, relaxation techniques and cognitive therapy she made slow but steady progress. Getting the dog was another part of her healing process. Abandoned to the RSPCA, Sally was also depressed, says Elaine, and became her constant companion, helping her to overcome her agoraphobia.
By February, Elaine was able to begin attending school for a couple of hours in the mornings. "At first I was embarrassed to go back because depression is for old people," she says. "But people in my class were really understanding. People who I'd thought were really sad were the nicest ones." Now, it is hard to reconcile this calm, lucid young woman with the distressed child she and her mother describe. No longer in therapy, Elaine is on a reduced dose of her medication and planning to study psychology and geography A-levels at an FE college.
Later in the day, Elaine discovers that, with the help of her mother's home tutoring, she has passed all eight of her GCSEs. "I feel the best I've ever felt," she says. "I've learned to like myself, I don't have to rely so much on my mum and I know who my real friends are. Now I feel I can help other people when they're down."
But elaine did not feel well-supported by her school during her illness. "My form teacher phoned to see how I was," she says. "But I don't think teachers there believed in pressure. They thought you were too clever to get ill."
Sarah Bentley sees the school reflecting wider social attitudes towards mental illness. "If a child has a physical illness, everybody finds it easy to visit and phone and send flowers," she says. "But people are terrified of mental illness and depression. It seemed as if the school wasn't interested. I think there could have been a bit more pastoral care. I just wish more people knew how to cope with and be with people who are that ill."
As the Mental Health Foundation's wide-ranging report on young people published in June makes clear, mental illness in children is not rare. At any one time, a fifth of all children and adolescents up to the age of 20 experience psychological problems, says the report's author, Helen Kay. Rates of recorded problems are rising and although most children experiencing difficulties can be made much better with early intervention, services are over-stretched and patchy.
The SAFE project in Enfield - held up by the Mental Health Foundation as an example of good practice - has been established for more than four years. One measure of its usefulness is a substantial fall in the number of young people arriving at the local hospital as attempted suicide cases. "We have found we make a pretty good difference, a significant difference," says Dr Tony Kaplan.
The Mental Health Foundation inquiry group, which took evidence from more than 1,000 sources, makes recommendations aimed at improving the mental health of all children. High on the list are "high morale schools" with positive policies for behaviour, attitudes and anti-bullying. The report calls for schools to educate "the whole child", and to intervene earlier with children experiencing mental health problems.
Elaine's mother Sarah Bentley was already tuned into children's emotions from her work in special needs at a London primary school. But she has learned a lot in the last year, she says: "I'm far more sensitive to children now, and I can see danger signs. There's an awful lot going on with children emotionally and not enough people able to help them."
* 'Bright Futures - promoting children and young peoples' mental health',price pound;22.50, is published by The Mental Health Foundation, 20-21 Cornwall Terrace, London NW1 4QL Tel: 0171 535 7400. The names of the mother and daughter have been changed.