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Community Care's Changing Minds campaign has highlighted the lack of services for children and young people experiencing mental distress. And while the shortage of appropriate care can be a disaster for the young person, it often puts their families under unbearable strain.

James Howarth's 17-year-old daughter Anna developed psychotic symptoms after her stepmother died at Christmas. "They had been very close. They used to sit round the table and talk like sisters," he explains. "Anna felt guilty that she hadn't always been at home or helped enough around the house. There was nothing you could do to convince her that she wasn't selfish." Over the following weeks Anna began drinking alcohol and smoking cannabis to block out her distress.


Anna's mental state worsened and she started hearing voices. Howarth went with her to the local GPs' surgery, but they did not take her symptoms seriously. "I told them she believed the TV was telling her to kill herself. They didn't really understand at all. They said she was depressed. One doctor did spend a long time talking to Anna. She said 'you have to be the woman of the house now and help your dad out'. It just made her feel even more guilty." After several consultations, the GP reluctantly agreed to refer Anna to an adolescent mental health unit and she was given an appointment in three months' time.

Anna's mental condition deteriorated to the point where she was running round the house at night banging on doors and windows and cackling dementedly. "She was obsessed with stealing the car and flying to America. I was taking a lot of time off work because it wasn't safe to leave her alone."

In desperation, Howarth telephoned the nearest adult psychiatric ward. "I left a message on the consultant's voicemail and just listed her symptoms. He called me back straight away and said it sounded like serious psychosis. He gave her an appointment within three days and put her on anti-psychotic medication. It stabilised her and made things a bit more bearable."

Although relieved that at last someone was taking Anna's condition seriously, Howarth was less than impressed by the efficiency of the psychiatrists. "She saw different doctors on each appointment and they each asked the same questions and made handwritten notes. They were very quick to draw the conclusion that it was a drug-induced psychosis."

After being treated by the adult department for a month, Anna's appointment with the adolescent mental health unit eventually came up. She was admitted immediately as a voluntary in-patient.

"The adolescent psychiatrist really talked to her. She said Anna should have been referred immediately as a priority case. They can't say for sure what's wrong with her. It could be drugs, it could be her emotional state, it could be lots of things."

Since her admission to the adolescent unit, Anna has made good progress and is now at home two or three days a week and beginning to attend college again. For Howarth, it is difficult not to be bitter about the inaction of the GPs. "If she could have been referred as a priority case we could all have been spared three months of grief," he says.

Even when GPs do refer families to specialist services, the response is not always helpful. Elizabeth Webster, the mother of James, a 22-year-old diagnosed as suffering from schizophrenia, had numerous consultations with professionals throughout her son's childhood.

"James would get into a rage and run round the house wrecking things. Once, when he was about 13, he didn't like the way I was making gravy and started throwing flower pots through the window. If we had friends round he would just grab anything and smash it on the floor.

"He was given so many different diagnoses. None got anywhere near the root of the problem. Once, they said they would take him in for observation but that never happened. There was never enough time for us to give a full picture of what was going on. Psychiatrists seem to think that seeing a family for half an hour every two months and making notes is going to help.

"The only person in eight years who recognised the seriousness of the problem was a policeman who came to the house one night when James was smashing things up. He asked whether we had thought of having him sectioned. No one else ever said anything about mental illness."

With hindsight, Webster identifies much of James' behaviour as pre-psychotic. His disturbed sleep pattern for example - he used to be up all night playing loud music, trying to drown out voices in his head.


Full-blown psychosis developed at the age of 17, after the family moved home in an attempt to ease James's fears that he was being followed around the village. He was taken away in handcuffs in the middle of the night.

The impact on the family was severe. "You blame yourself and search for reasons. We fell into the trap of blaming each other. We got over that but lots of families don't and break up."

Webster fears her younger son Peter has been permanently affected by the anxiety in the house. "Children either become very anxious and over-involved like Peter, or they go the other way and distance themselves from the family. It is very hard when you are always tired and when you are almost totally preoccupied by the other son."

Because environmental factors have a role in the onset of schizophrenia, Webster believes an early diagnosis might have saved him from becoming so ill. "If it had crossed anybody's mind that it could be an organic illness, we should have been told. If we had known that was a possibility, there are a lot of things we would have done differently to avoid stress, like not moving house or changing schools."

James is now on clozapine, one of the most highly rated of the new atypical anti-psychotic drugs. "With my son, it's like an electric switch. He goes to college, does voluntary work and lives in a flat. He's entirely rational and beginning to get some insight into the fact that he has an illness," says Webster.

"It all hinges on getting a psychiatrist who will work in partnership with the family. The psychiatrist he has now regards us as expert witnesses. But there aren't many who can work like that. Everyone else thought that they knew best and wouldn't listen to us. People assumed we were putting too much pressure on him, but we weren't at all. People make all kinds of incorrect assumptions," she says.

Peter Wilson, director of Young Minds, believes support for parents of children with mental health problems is vital. "If a child is psychotic the impact is going to be very serious. But there is a whole range of problems that can impact enormously on the family. Parents tend to be overwhelmed and feel it's their fault in some way."

In line with the experiences of many families, Wilson believes many GPs downplay parents' concerns about their children's mental health. "There's a tendency to under-diagnose and say the parents are worrying too much. At one level GPs don't want to know. They only have five or 10 minutes. If they do look at the problem, an enormous amount of help and support is needed and there's the question of who to refer the family to. There just aren't enough services."

But he adds: "Parents can make all the difference depending on how they react to the child. If the child is anorexic or a violent delinquent you're going to get absolutely furious sometimes. If you actually hit the child or throw them out of the house it all starts to spiral. If parents are given the opportunity to share feelings, and talk to someone with experience it helps get things into perspective."

Young Minds operates a parents' helpline providing information about local services and a call-back service. Wilson says: "We can only offer a one-off consultation with a mental health professional but it is an enormously important service. An hour on the phone can help people deal with what's going on." The helpline is running below capacity because its six-year lottery grant has come to an end.

Young Minds parents' helpline is 0800 0182138. All service users' names in this article have been changed.