Intensive healthcare for our most severely ill young people seems poorly designed for addressing the causes of their distress, but not doing so may only be storing up larger problems further down the line.
I’ve spent part of half term in a Psychiatric Intensive Care Unit for young people. It’s the place they seem to put young people when there are not enough resources to keep them elsewhere without harm coming to them or others.
The PICU I visited basically seems to be a holding pen. There’s a system where young people are watched either continuously – some have to be accompanied to the toilet, for instance – are on one-to-ones with care workers or are on five-minute or 15-minute checks. Those on five-minute and 15-minute checks are left to their own devices when there is an ‘incident’, which happens fairly often.
All the furniture is like the stuff you get in soft play areas. No corners. Young people have various privileges withdrawn if they are involved in incidents. For example, they might get their sheets or shelving unit taken away. Sheets are a particular hazard as they may be used as ligatures. There’s a school on site and an astro-turf area with high fences where the patients sometimes exercise. Otherwise there’s not much to do except watch tv and wait. Wait until you can get back to a slightly less intensive care unit.
There doesn’t seem to be any form of therapy going on, no attempt to discover the causes of anxiety or self-harm or eating disorders or whatever it might be. I’m not entirely sure what the point of it is, except to take out the more disruptive patients from other units and scare them into never wanting to go back.
Such is mental healthcare in the 21st century and, given the lack of beds, those inside such units are perhaps the lucky ones. People get shunted around a system which is on the point of collapse, notes are lost or not communicated, medication delayed in the transfer process and young people feel no sense of control and get angry. At least it’s hard to die in such places. Is that really the best we can do, though?
I guess it is what you’d expect in a severely under-resourced system. Everyone is overstretched these days – parents, the NHS, social care…No wonder young people are slipping through the cracks. It’s not that the parents and the mental health services are doing a bad job. They are just exhausted by the tidal wave of stuff they are having to deal with and the infrastructure is not there.
Until we put care front and centre in the economy it can only continue like this. It’s a vital issue for employers too, and not only because they employ parents who are struggling with the system. The level of mental ill health among young people, particularly girls, is huge. Employers may be beginning to wake up to the impact of mental ill health in the workplace. There is, I think, much more to come. Young people want something more positive than the society we have created. We need to do better.