55. Saving the early intervention service, till later.


An uneasy meeting at a fancy dress party.

It’s official. Children cost too much. Childcare costs more than a mortgage. If you have children they might stop you going to work, and they eat a lot too. Shouldn’t people be told this sooner? Worse than that, children don’t come with any kind of guarantee, and more of them seem to be going wrong. If Toyota had made them there’d be a recall. And soon a Commons Committee on young people’s mental health will start its proceedings.

Though there are rumours that mental health problems among teenagers have increased, there has not been a proper survey since 2004, when the world was very different. It’s hard to believe, but they didn’t even have Instagram in those days, let alone Whatsapp. People wore top hats and tail coats and travelled by horse, particularly the women.

There are lots of theoretical reasons why it’s got worse to be a teenager. Legal highs are widely available, the Harry Potter series came to an end, and no-one is far enough beyond suspicion to take over hosting Jim’ll Fix It, unless Desmond Tutu can be persuaded. Large numbers of youngsters have been sent to remote labour camps, or universities as they are now known. Employment opportunities as footballers and TV presenters, the only jobs worth having, have largely dried up.

Sadly, if a generation of teenagers became psychotic or depressed, no-one would really notice. Part of the blame belongs to British psychiatry and its strange tradition of age discrimination. For some reason we have different specialists for young, adult and older people, as though they were totally different forms of life – like eggs, caterpillars and butterflies respectively.

There’s a kind of reason for that, in that young people don’t really get the same kind of mental illnesses as adults. Psychotic conditions are very rare in children, or so we thought. ‘Early intervention’ services were an attempt to plug the gap, at least for older teenagers who seemed to be showing signs of schizophrenia. Early intervention was a laudable aspiration, but didn’t get much beyond that, since there was no litmus test for psychosis. The services were overwhelmed to an extent, by the numbers of children with emotional disorders, such as so-called ‘borderline’ personality; problems that,in a sense, flow from children being treated as commodities instead of people.

To cut a long story short, another tonne of anti-psychotics wended its way to the sewerage system, some of it via people. The early intervention services have been pruned back rather savagely, before they had a chance to flower. Doubtless the Commons Health Committee will come to regret this. In the meantime, services for teenagers are largely restricted to a skateboard area and free condoms at the library, for those who are brave enough.

When the large mental hospitals were closed down, some people warned that community services would be much easier to cut. It’s to do with visibility. Some of the asylum hospitals were the size of aircraft carriers; quite likely some of them had their own Harrier Squadron. They certainly had farms, ballrooms and cricket pitches. Everyone has noticed they’ve gone.

The coalition government has been quite tough on aircraft carriers, and luckily there won’t be one to send to the Crimea. But having a carrier with no aircraft to go on top is a major embarrassment. It’s like a Christmas cake without the marzipan, let alone the little decorative church and snowman. Similarly, having a hospital full of closed wards looks a bit wasteful. But if a care assistant only comes half as often, for half as long, or doesn’t visit at all, no-one really notices.

And if your psychotherapist turns out to have one years training at a community college, rather than the 25 year apprenticeship in Vienna and the multiple doctorates you’d expected, it’s hardly a big deal to anyone. Low tech services have a soft underbelly, as do many of the people who work in them – too much driving about eating petrol station sandwiches.

As the community mental health services are scythed back, we hear only a few muffled squawks from politicians. Nick Clegg (deputy prime minister and Britain’s answer to Al Gore) popped up in January, stating that mental health must be given parity with physical health. ‘We have got to take this out of the shadows’, he said. And we can expect a further survey on teenagers’ mental health, probably conducted by social media. But does the government have any coherent plan for teenagers, or are they considered, as a Bond villain might say, ‘expendable’? After all, they don’t vote and they don’t pay much tax. As a species, humans have a reasonable life expectancy at birth, which is a miracle, considering we ride bicycles, but perhaps this is set to change. It’s a bit ominous that youngsters are now being told that world war one was a useful outing.

With the demise of early intervention teams, there should be a move for adult and child psychiatrists to work together more closely, but I see no signs of this. They just drive a totally different kind of Audi.

During vacations I always got a child psychiatrist to cover my work, which he did brilliantly. I doubt whether I’d fare so well with his patients, unless he wanted half of them put on depot injections, and a tonne of complaint letters from parents. And I’m not sure if they still have sandpits to play in, so I wouldn’t know whether to bring my own bucket and spade.

Maybe a reverse takeover is in order, where children’s services take over and everyone is regarded as a child. This is perhaps the only way that children can get treated equitably. The danger is Ofsted staging a coup and taking over the government. And everyone would have to have a CRB check, just to meet anyone else at all. Treating everyone like children has worked well in lots of countries – you know who you are, nanny states.  Perhaps Nick Clegg could consider this. Otherwise, teenagers, like Hank B Marvin, are just going to have to ‘stay in the shadows’.


34. Calling International Rescue. Discreetly.


After an extensive rebranding exercise, the chief executive is announcing a brilliant new name for the mental health service. ‘We are going to call it…’Emotional Rescue’…’  The applause is more muted than expected and there is muttering. Someone whispers to let him know it was a Rolling Stones album, and not one of the better ones, flirting a little too closely with Disco.

David Miliband has made a similar mistake in agreeing to be head of International Rescue. Doesn’t he realise he or his brother must spend half their time in space, monitoring all the radio frequencies, just in case there is a distress call?

Imagine just popping out into space for a cigarette and while you aren’t watching there is an earthquake or motorway pile up. How let-down would people feel? This never happened to the Tracey brothers –  puppets never need the bathroom.

The notion of being rescued, of someone watching over us, is a favourite one in fiction, popular culture (superheros) and religion (saviours). The gold standard for benign oversight is the catholic concept of the guardian angel. The nuns taught us we had one each.

Could that explain why some people seem very lucky? And might some guardian angels be better than others? Is each one newly created for each human, or are they deployed like the police, in a largely reactive role? Do they have a team leader, like social services, who will be vilified in the celestial media in case of a guardianship faux pas?

Do they confine their advice to moral matters, or would they for instance, stop you from buying shoes a size too small because they were in the sale, or attempting to hit a 3 wood out of a fairway bunker?

Might they have served other people in the past, like Kevin Costner’s character, Frank, in The Bodyguard? Don’t forget, last time Frank had a day off, Reagan was shot.

What a shame the real life Whitney Houston didn’t have such a person looking after her. Celebs seem to get much worse mental health care than ordinary folk. Perhaps it’s because they are surrounded by sycophants and parasites, rather than loyal and heroic servants.

Think about it. Say what you want about the NHS, we would never have gone round and given someone with severe insomnia a propofol injection, as happened to poor Michael Jackson, not even on a weekend shift.

I shudder to think what might have happened if Michael Jackson had been an NHS patient. In the USA a doctor was tried and convicted of involuntary manslaughter. In the NHS there would have been a serious incident inquiry lasting years and finally releasing a 9000 page report, criticising practically everyone involved, with particularly scathing mentions for Martin Bashir for his interviews, and Paul McCartney, for disputing  whether ‘the girl is mine’.

So many missed opportunities to prevent a tragedy. All those cosmetic operations. The accusations about children. That tea party when Bubbles took things too far. The controversial version of ‘They don’t Care about Us’. Where was the inter – agency working? Where was the properly completed Risk Assessment?

Where should celebrities turn when their lives get out of control? If they are lucky enough to be in a government or large corporation, there are people who can look out for them. In particular, people who can manage publicity and pull strings. There are lawyers and personal assistants, special advisors, coaches and trainers. Imagine having someone who comments on your actions very favourably and sends a glowing account to the media. How long would it take you to believe your own publicity? Not long in the case of people already prone to narcissism.

However many people there are in a ‘support network’ there is often no-one there when you really need them. Michael Jackson even had a full time personal physician present in his house, yet still died.

It takes a massive effort to be there for someone 24/7, which is why we invented the guardian angel, and why Trusts use grandiose titles like Crisis Teams to describe one bloke and two phones.

People who have the so-called borderline personality like to test the rescue services, both metaphorically and literally. You find out who your friends are when things go wrong, so why not test them out in advance, like a fire drill, by putting yourself in danger? Is David Miliband listening or not? This should get his attention…

Maybe NHS Trusts should set up special teams to protect celebs from the evil clutches of corporations and private healthcare.

At present, celebs with problems seem routinely directed toward spells in what gets called ‘rehab’. This means being admitted to an expensive private clinic, focussing on detoxification and abstinence programs for addiction.

No-one ever criticises such approaches as misguided or ineffective. When a movie character says, ‘I’m checking you into Rehab right now,’ no-one ever responds, ‘but the outcome after a year is no better than a control group who just see a counsellor’. It’s just not drama.

Residential drug misuse services are seldom provided in the NHS, because the cost benefit analysis for such treatment is very unfavourable. Perhaps showbiz types take a different perspective. They want a proper emotional rescue, not cosy chats, pottery and yoga.

Celebs never seem to get a social worker or CPN or get to attend the allotment project. They never seem to get taken shopping, by health care assistants, or make mosaics from broken car window glass.

There is an increasingly large gap between inpatient services like rehab clinics, and the next rung down, which is an appointment once a week in converted premises above Poundland. There is very little mental health care provided within the night-time economy, just the usual haunts – police station and A and E.

It’s comforting to imagine that an outfit like the A team or International Rescue would come and help you if you hit a downward spiral. That is perhaps why the ambucopter service attracts a lot of charitable support. It’s there when you need it – you hope. But should we have to put money in a pub collecting box to pay for the ambucopter, when we are paying £3.15 for a pint, most of which goes in tax?

Since tax on alcohol amounts to nine billion pounds annually, almost 2% of total revenue, perhaps we really could afford more Emotional Rescue, and even buy the phrase off Mick and Keith.

Just in case the Crisis Team needs more staff at night, i.e. more than one.

Just in case David Miliband is in the space station jacuzzi.

Just in case the nuns were wrong, and your angel can’t really fly.