Young people with psychological problems who are beyond the help of their GP are finding intensive help at a west London centre. Emma Parsons reports
Two years ago Sarah* could not eat or walk after she developed a psychosomatic illness that left her close to death.
The 10-year-old girl, who had previously played cricket for her county, had lost the ability to do even basic things like feed herself by the time she was referred to the Collingham Child and Family Centre in Kensington, London.
The centre takes children aged five to 13 with severe mental health and behavioural problems that are not improving despite help from the usual agencies.
They are admitted as in-patients for day or residential stays, which average five months, where they receive treatment for their illnesses, along with education and family therapy. They have usually been excluded from school and suffer from psychological problems such as depression, psychosis, anorexia and behavioural difficulties, and beyond the help of GPs, out-patient clinics, social services and education.
Sarah was admitted as an emergency case after years of examination by GPs, psychiatrists and consultants who could not agree whether her condition was a result of a physical or psychological illness.
“She looked like a prisoner of war skin and bone and hunched over like an old person,” says her mother. “Her hair was hanging over her face. She didn’t want anyone to look at her, she just growled at you.”
Sarah didn’t have anorexia and the inability to walk was not a result of physical weakness: these were physical symptoms of a psychological problem. She stayed at the unit for 51 weeks and is now discharged from all mental health services. She is back at school and leading a normal life.
“When families first arrive the children and their parents are usually at the end of their tether and have given up,” says manager Paul Byrne, who is a trained psychiatric nurse.
“They have usually been through the mill of different schools, doctors, social workers, prescription drugs and psychiatrists – they come to us when these avenues have been exhausted.”
The prognosis for these children if they don’t receive this type of care is long-term mental health problems, family breakdown, exclusion from mainstream education, and in the case of Sarah muscle wastage and even death if she had continued to not eat.
“I’m rather pleased she got so ill because if she hadn’t she would not have got to Collingham, and if she hadn’t she would never have got better,” adds Sarah’s mother. “What they do at Collingham is quite remarkable.”
There are eight such units in the UK with a total of 100 beds. The Collingham centre has 14 beds and is always full.
“The value in the service is the money we save agencies in the long-term, stopping people from having a life time of interventions,” adds Byrne. “I don’t believe this sort of work can be replicated in an out-patient setting. There’s a small core group of children who need to be in residential care.”
Crucial to the success of the treatment is the involvement of parents or carers at weekly meetings.
“We insist the parents attend weekly sessions with their child at the unit to talk about progress and how we can help address the problems that have arisen,” adds Byrne. “It’s very rare we reach the point where a child’s treatment is deemed unsuccessful. If that happens it’s often because the parents have not attended the weekly therapy sessions.”
The centre is run by the Central and North West London NHS Foundation Trust and part-funded by Kensington and Chelsea Council. Referrals are made by child and family mental health out-patient teams, with the involvement of the local child psychiatrist, and can come from across London and the south east England.
Work with the child includes behavioural and cognitive behavioural therapy, play therapy, relaxation and creative therapy groups, social skills training, school reintegration programmes and speech and language assessment.
The unit motivates children by rewarding them for successes. An awards ceremony is held each week and every child is rewarded and praised for achieving a goal.
“When they arrive the children are often very low and feel like they have failed in some way and our priority is to boost their confidence,” says Janette Steel, head teacher of Chelsea Children’s Hospital School, which provides educational services at the unit. She has worked at the centre with Byrne for over 15 years.
“We try to set them goals we know they are able to achieve – this can be something as basic as staying in a classroom for at least five minutes during the lesson.”
A child’s progress is followed up six months after they have left and research shows if they are placed in a suitable educational setting and the recommendations from the placement are followed they have a successful future, adds Steel. “The majority of the children who come here go back to mainstream schooling and end up leading normal lives.”
Sarah is now in secondary school, enjoys going out with her friends and takes part in cross-country running. Her mother says her stay at Collingham saved her life.
*name has been changed
More about Collingham Centre
This article appeared in the 29 May issue under the headline “Beating the blues in Chelsea”