Walk in, walk tall
They'll grow out of it," people say. But passing adolescent phases can all too easily become permanent torments - or worse. Bulimia, anorexia, drug abuse, self-harm, violence, worries about sexual orientation, academic failure - every secondary school has a casualty list. And some of these young victims never do "grow out of it".
Suicide is one of the most common causes of death among young people. Between 1991 and 1993 the suicide rate for 15 to 24-year-olds was 14.5 per 100,000 (exceeded only by accidents). Five times as many young men kill themselves as young women, and the rate is increasing sharply.* In addition, research suggests that in any year 20,000 young people will be admitted to hospital with self-inflicted injuries.
And yet adolescent mental welfare is the Cinderella of the health service, a situation that seems unlikely to change. For example, new funding for the Care in the Community programme has no ring-fenced provision for young people aged 14 to 21. But effective intervention is possible and not prohibitively expensive. One model for such intervention is the Brent Adolescent Centre.
Founded by Dr Moses Laufer in 1967, the centre offers psychotherapeutic treatment to around 190 patients a year. With an annual budget of just pound;170,000, it employs a number of experienced practitioners alongside Dr Laufer, author of a number of works on adolescent breakdown, and its director, Dr Maxim de Sauma, a child and adolescent psychoanalyst. The great attraction of the centre is that it is a walk-in facility: young people can refer themselves. As young people in its target age group of 14-21 are often in conflict with the adults - parents, teachers, doctors and social workers - who would usually have to refer them, this is crucial.
Adolescence is a time of unique fragility, when the combination of sexual maturity and imminent departure from the parental home can shatter a child's sense of self and worth. The Brent Centre has helped hundreds of people to move on into adult life or, if they are too ill, to seek help in hospital.
After an interview, patients sign up for as many weekly or fortnightly sessions as are needed; the treatment can last for two or three years. The centre cannot always help the most extreme cases, but it has an impressive record.
Young people who might otherwise end up in a psychiatric unit, with all the disruption and trauma that institutionalisation brings, can be seen at the centre while continuing to lead a relatively normal life. They and others who might be depressed or suicidal will be helped to understand their problems and build a healthier, more realistic outlook on life. It's a subtle and sometimes lengthy process - what Freud called the "talking cure".
What are "normal" adolescent problems? Is a suicide attempt "just" a cry for help? When adolescents try to kill the maturing body which seems to have aroused terrifying thoughts and feelings, says Dr Laufer, they are trying to still processes they cannot control. Extinction can appeal as a release from pain. At that point, young people become severely at risk. How can adults help?
Behind every young person who takes their first unhappy steps through the doors of the Brent Adolescent Centre lies a tangled history of family and school dysfunction.
Consider the case of "Tim", a large, unkempt young man of 19. His therapist is convinced he is psychotic. He cuts his arms, uses drugs heavily, broke his wrist at a rave, threatens his family and says the only reason he has not killed himself is that "until recently, I was already dead". In desperation, he referred himself to his nearest hospital where a consultant prescribed Prozac and told him to come back in seven weeks.
Tim's family are frightened and have thrown him out, so he often sleeps on the streets. His therapist is the only person who listens to him. She does not believe he will live seven weeks without hospital care. Tim came to the centre very late - the best help for him was a call to the hospital. Other cases (see box) show how early intervention can pay off and prevent misery.
Adult compassion and advice can shed light into troubling shadows; talking it through can really shrink it down to size. By developing the capacity to reflect upon their thoughts and actions, young people can lead themselves out of impulsive, destructive patterns, and get on with growing up. But they need help, and the Brent Adolescent Centre shows how it can be delivered.
The Brent Centre is to launch an appeal for funds to develop new services to help sexually abused girls, self-harmers, suicidal adolescents, and families of disturbed adolescents. More details from Brent Adolescent Centre, Johnston House, 51 Winchester Avenue, London NW6 7TT. Tel: 0171 328 0918
* Source: Key Data on Adolescence by John Coleman, published by TSA