Channel 4, Sundays at 8 pm, 16 to 30 June. Rating: ★★★★
In 2000, following a survey of 10 000 UK children aged between 5 and 15, the Office for National Statistics reported that 9.5% had a “mental health disorder”—psychopathology of sufficient severity and persistence to constitute a significant impact on the child's functioning or relationships. This landmark survey consolidated an increasing body of evidence signalling that mental health is an issue that significantly affects children, young people, and their families.
Only 10% of children with identifiable mental health problems receive a specialist service. The United Kingdom has 3.6 child and adolescent psychiatrists for every 100 000 children, compared with the EU average of 4.8. Less than 10% of the total mental health spend goes on people under 20, even though this group constitutes 25% of the population.
There is an overwhelming need to raise public and professional awareness. It is timely, therefore, that Channel 4 has produced a series that specifically considers the complex challenges that face child and adolescent mental health (CAMH) services. An added bonus is that Inside My Head includes some of the most responsible and moving coverage of psychiatric disorders yet seen on television.
The difficulties experienced by the four girls featured in the second and third programmes emphasised some important themes. Firstly, CAMH pathology often involves co-morbidity. All of the girls had two or more ICD-10 diagnoses, further complicating their inpatient management. The young people benefited from psychotherapy, music, and art therapy, as well as nursing and psychiatry. The strength of this multidisciplinary approach was clearly demonstrated—the whole team, irrespective of seniority, carefully explored and supported difficult decisions. The potential treatment resistance of the more severe pathologies, such as depression, anorexia, and obsessive-compulsive disorder, was explained. On a positive note, we saw that even severe problems, which merited admission into scarce, regional inpatient beds, could substantially recover, facilitated by CAMH's secret weapon—the healing potential of the patient's continuing brain development.
But it was the first programme, featuring 16 year old Michael, suspected of having schizophrenia, that, for once, fully deserved the description “real life drama.” It had all the necessary ingredients of plot and character. The plot involved the careful explanation of Michael's story, by narrative, personal account and family photographs. His first breakdown occurred suddenly, at the age of 14, followed by a two-year “nightmare” for him and his family, who experienced little support from health, education, or social services. We saw Michael trying to maintain normal function—going to school, doing his exams. Accompanying scenes of apparently untroubled peers—a boy and girl holding hands as they walked to school—lent added poignancy to Michael's increasing difficulties.
Michael's winning character was established by means of two ubiquitous documentary techniques—the video diary and his dialogue with the programme's unseen, yet heard, interviewer/camera operator. As the programme progressed, these techniques constructed our understanding of Michael—his wry smile and sense of humour, his maturity and his dignity—most of which remained, despite his increasing chaos. The camera and interviewer began to take on an almost therapeutic, containing function for Michael, as he revealed his private thoughts. His relationship with the camera perfectly encapsulated the phenomenon displayed by so many adolescents who are affected by major mental illness—their functioning, public “brave face” and their fearful, inner distress. In sensitively building up our relationship with Michael's character, it was inevitable that we experienced the full, frightening impact of his decline that was clearly draining his parents. As Michael withdrew from his family and the camera, he also withdrew from us.
His subsequent recovery, following a long overdue stay in hospital, further emphasised the need for more, better resourced CAMH services. Mental health commissioners who haven't already tuned in to this series should not miss the final episode.
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VIRGINIA WOODS-JACK/CHANNEL 4
Inside My Head: responsible and moving television