Jo

Brief Outline: Jo found out that her younger daughter was harming herself when she had a mental health crisis aged 19. Jo’s experiences of her daughter’s illness have influenced her professional treatment of young people who self-harm.

Background: Jo, 53, is married with two daughters aged 25 and 22. She is a nurse. Ethnic background: White British.

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Jo says being the parent of a child who self-harms is horrendous – you worry that it’s all your fault, that you can’t deal with it, and that people will stigmatise you. Family life is turned upside down. Her daughter first took tablets while she was at school but Jo only found out about this later, when her daughter was aged 19. She had been having difficulties with someone at work, a relationship had ended and a school friend had died by suicide in a mental health unit. She broke down and said she wanted to kill herself. Her behaviour was very erratic and she was hearing voices telling her to hurt herself. Jo was shocked to see cuts on her arms and feet and thought she might need to be sectioned. She took her straight to the GP, who prescribed some medication and involved the mental health team. Her daughter is still under the care of mental health services, but has no definite diagnosis. Jo says she would feel a lot better if she knew what the diagnosis was. Her daughter‘s mental health improved and she went off to university, but had a second crisis. Jo looked after her at home with the help of the home treatment team, who were very supportive. Her daughter is now back at university and doing very well. Jo has been impressed by the help offered by the university student support service.

Jo found caring for her daughter’s wounds a positive experience in some ways because it enabled her to be ‘a mother, a rescuer, a professional, a carer, something nice in her life’. When her daughter was suffering from acute mental health problems Jo had to be very vigilant, hiding anything which could be used for self-harm and sometimes locking her daughter in her room. On one occasion her daughter told her she had taken some tablets but was very distressed at the prospect of going to hospital. Jo had professional experience of how young people who have overdosed are often treated in emergency departments, so she decided to keep her at home after checking that the pills she had taken were not likely to cause serious damage. She was also worried about the risk of suicide if her daughter became a psychiatric inpatient, especially as her daughter’s friend had died in this way, but admits that the strain of looking after her at home when nothing seemed to make her better was almost unbearable. She told the home treatment team that she couldn’t cope any more but they reacted by saying it was good she was able to express this and gave her a leaflet about carer support.

Jo felt that her elder daughter was pushed aside when her younger daughter was in crisis; she was often sent to stay with friends to keep her out of the turmoil. Jo says that during the second crisis her elder daughter was much more able to support her (Jo) in looking after herself (though Jo felt guilty because a daughter shouldn’t have to do that). Jo’s husband works away from home a lot, so didn’t fully appreciate the impact on the family during the first episode. During the second crisis he was more involved and was able to support Jo by giving her some respite from 24 hour care. She says it was good to have another adult around, both for her and for her daughter, to get an objective perspective. He tends to joke with their daughter whereas Jo asks about her feelings. Jo and her husband include their daughter in various activities, to distract her from her problems, dissipate her energy, and re-establish her self-esteem. They have not told their daughter’s grandparents, but Jo’s sibling is a medical professional and has given her advice on health issues. She has some good friends who have offered support and with whom she can talk about her daughter’s troubles, but she says it can be very lonely.

Jo’s experiences of the professionals caring for her daughter varied. Her GP was fantastic, and supported Jo, giving her sick certification so that she could have time off work to look after her daughter. She felt less supported by the key worker from the community mental health team who first treated her daughter. She tried to share some observations about her daughter but was told this was a breach of confidentiality and should be reported as a data protection risk. She was given details of a carers charity, but no practical help for contacting them. She says that at the time she didn’t want written information, but would have liked to be put in touch with someone who had been through similar experiences. The out of hours home treatment team for her daughter’s more recent episode have been good at talking to Jo and listening to her concerns.

Through having a daughter who has self-harmed, Jo is able to understand the needs of young people whom she sees in her professional capacity as a nurse. She is non-judgemental, gives them advice on caring for their wounds and provides them with pain relief. She has compiled an information sheet about self-harm and sources of support which is given to patients.

Jo acknowledges that for clinicians, treating people who harm themselves can be time consuming and demoralising, but she says healthcare professionals should be caring without being maudlin or sycophantic, and should remember that patients have a right to be cared for in a civil way. Her message to other parents and carers is ‘Don’t be ashamed. It’s not your fault and it’s not your child’s fault either. It’s just what happens, it’s what binds your family together, and you have a choice to either accept it and get on with it, or not accept it, in which case the whole thing gets worse. Try not to blame yourself’.

Jo’s daughter felt worthless after being bullied at school She said she self-harmed partly to punish herself and partly to relieve the tension.

She seemed a perfectly happy teenager. She had a bit of an issue with bullying at her secondary school and we involved the school and the school were, I felt, very supportive but she said that the school didn’t fulfil their obligations actually in school, but again, I only found that out afterwards. And she dates it back to that time that was when she started feeling different, ostracised, that she wanted to punish herself, that nobody understood her and that she had very poor self-esteem and self-worthlessness and things like that.

And does she say why she does it?

She says she does it partly because she feels she has to do it because she has to hurt herself to punish herself. She has said that voices tell her, but part of it also seems to be it relieving something that’s fermenting, something that’s bubbling up inside her, agitation, not stress, anxiety, catastrophe, whatever it is and it often dissipates after that. It never quite goes, went away but there would be a release in that she would almost say, “Look what I’ve done.” And show me and we would then go into a slightly more normal interaction where I could physically care for her wounds and so there was a positive experience for me that I felt I was being a mother, a rescuer, a professional, a carer, something nice in her life. 

Jo blamed herself for her daughter’s problems.

It’s it’s horrendous and you feel it’s all your fault. I think being a mum or a dad is full of guilt anyway and then, when you find out that, first of all, your child has problems that you can’t cure or control or take care of but also then that part of that problem is that they they do this to themselves, it just makes it immeasurably worse. You you you worry that it’s your fault. You worry that you can’t deal with it. You worry that people will stigmatise you for it. Do you talk to people about it or do you keep it quiet? Sometimes my daughter didn’t even want to tell me she’d done it, at the time, and then would tell me subsequently and it’s a it’s a big shock.

But what I was having to try and control was my culpability in the whole thing, that I didn’t want to be blamed any more than I felt I was being blamed already.

And I don’t know who was blaming me because the only person that blamed me was myself but I just felt it was all my fault and it was then all my fault that family life was awful and it was all, it was just everything was all my fault all the time. So that was what it was.

And she tells me that I should have realised but I had no idea at all at the time. Sometimes, when I look back now I think were there any warning signs because I think, you know, still as a mother, you want to find a reason and you want to see, is it where I’ve gone wrong? Did I not wean her early enough? Did I not give her the right foods? Did I nappy train her too early? There’s always something you can as-, you know, blame yourself about. 

Jo’s GP was ‘very welcoming and supportive’, for both Jo and her daughter

On the occasion with the first sort of cycle, as I tend, the first episode, when I went down to the doctor’s surgery that Monday morning at eight o’clock, and I stood in front of the receptionist and I must have looked like a bag of rags and I said to her, “I think my daughter needs a mental health section.” And she sort of lent across the counter and touched my arm and said, “Do you want to come at quarter past eight?” So I literally, came home, dragged her out of bed and marched her down to the doctors and the GP that we saw has a little special interest in mental health, although she’s a woman GP so she tends to get the woman’s things, she was fantastic. And she was also very good in that she supported me and, at one time, gave me some sick certification from work so that I could have some time because I was trying to work but be at home. So I was maybe saying to my colleagues at work, “Look, if I come in and work first thing in the morning and [my daughter] is going to be asleep because her antidepressants are knocking.”

Yeah. It’s all right.

“If my daughter is going to be asleep and the antidepressants are knocking her out and my other daughter is going to be here, we can keep her locked in her room.” Which sounds really Victorian, “Until I can get home at lunchtime and then my husband will be home at six so I can come back at six.” And I was run ragged because I was trying to do a full time senior job and do community mental health caring for my daughter. So I found the GP very supportive. She was also very supportive in that she would ring the house, which maybe she wasn’t supposed to do.

But to see how we were doing. She was very discreet with [my daughter], sorry, she was very discreet with my daughter in the surgery. She would let us use a side door so that we didn’t have to go through the waiting room. 

Jo worked in hospitals and knew sometimes young people who take overdoses are treated badly. She decided to keep her daughter at home after making sure she was not medically at risk.

[Jo checked with a doctor that the number of tablets her daughter had taken was not dangerous. The doctor said ‘You could keep her at home’.]

Should I have done that or should I, at that point, have taken her to A and E, let her be seen by the on-call mental health worker? Perhaps I should have done but again, as the mother you want to try to protect your child and, having worked in A and E departments, kids that go in that have taken overdoses are often treated really badly and yes, they get the activated charcoal but then they’re perhaps not as, because often they’re distressed and they’re crying or they’re maybe drunk, they don’t always get the care that they might benefit from in an acute situation that the rowdy, noisy drunk.

That’s having a fight with another rowdy, noisy drunk in the corner has. And, you know, I’ve actually seen that from a professional perspective and it’s not something I wanted my daughter to experience. So I felt it was appropriate to try and keep her at home.

Jo’s friend had many qualities which were helpful to Jo.

Yes, one in particular, who I know I knew first of all in a professional capacity and then she disclosed to me the issues that her child was having and, actually, I suppose, in the great scheme of things, it was a lot worse for her because the child was actually put into a unit and was away for a couple of years. But emerged and has her own life and we have talked much and long and hard about, “Is it us as mothers? Is it our fault? Is this what we’re doing? Is it our responsibility? Is it the way we weaned them or did we give them too much weaning or not enough love or?” Who knows? Who knows what makes the mixture of personality and behaviour but I found her very helpful, sympathetic without being maudlin, objective and sometimes cynically humorous, which you needed, but, at the same time, I always felt that if I’d ended up in A and E at three o’clock in the morning, if I had rung her she would have come out of her bed and brought me whatever I needed or done whatever I needed. 

Jo’s daughter is doing well with ongoing mental health service support. She now has more insight.

Yes and she’s having on going mental health service support now and she’s doing very well in her own life and looking after herself very well but I think both she and I acknowledge that the line between mental health and unhealth can be a really fine line, you know. The power as an individual lies in knowing when you’re not going back across into the health part over the line as often as you would like to. We all have days when things are not so good and you stub your toe or you’re overdrawn or somebody takes your parking space and you go, “Oh I’m so depressed.” But that’s not what you mean. You mean, “Today I’m not in such a good place.” But if you’re insightful about it, it’s about knowing when you’re always in the bad place and that’s when you need to do something about it and I think, you know, maybe it’s something that we’re just more aware of now.