Description

Part of a 6-year revision of Tier 4

Child and Adolescent Mental Health Services (CAMHS)in the UK.

Practically speaking, this ethnography uses the portmanteau: FACTSTORY as a play on two words. 1. Fact as in evidentially true and 2. Story as something told and probably less factual. Its emergence came about as a result of the word Factory as a place of industry, monotonous isolation and toil. Somewhere apathetic of permutation and difference.

This auto-ethnography with its fancy sounding and meaningless post-modern bravado is a performance where the hero parallels the alienating culture experienced by most ‘crazy kidz’. The writing is mostly vain and ugly gonzo but recognisable to anyone who has encountered CAMHS and the locked doors of the post Utting age (with its extra bolt reserved for protectionist and liberationist ideals).3 It criticises identifiable child welfare and how every young person is squeezed into a limited model of service delivery perfected for the strap line: there are over fifteen varieties of broken adolescent in the UK, but only one type of adolescent unit in which to fix them!

This is a book written for and by hundreds of service users, their families and professionals experiencing the systemic structure known as Child and Adolescent Mental Health Services (CAMHS). As a ‘performative-auto-ethnography’ it employs episodes to examine how, as a single service model CAMHS is a symbolic fiction, genealogical typology and signifying discourse. How its storied archaeology is worthy of scrutiny and a parody of idealised modernist projects confronting children and families who find themselves experiencing unfit services and left wondering how a nation of our wealth has let down its kidz for the past 30 years? How admission to a 21st Century adolescent unit means enduring months of waiting, ill-defined treatment regimens and make-do facilities to undergo ‘salvation’. A redemptive end point whereby young people and their loved ones are supposedly equipped to face an increasingly uncertain world alongside professionals who fair no better. Low morale, crashing resilience and mental exhaustion constant reminders that CAMHS, as a Cinderella service in the economics of child-health care has always been an analogue single model service unable to meet the demands of an increasingly digital age. A tired tiered service easily outperformed by the new units and their semantics devised by the young people in this book.

This is a book written for and by hundreds of service users, their families and professionals experiencing the systemic structure known as Child and Adolescent Mental Health Services (CAMHS). As a ‘performative-auto-ethnography’ it employs episodes to examine how, as a single service model CAMHS is a symbolic fiction, genealogical typology and signifying discourse. How its storied archaeology is worthy of scrutiny and a parody of idealised modernist projects confronting children and families who find themselves experiencing unfit services and left wondering how a nation of our wealth has let down its kidz for the past 30 years?1 How admission to a 21st Century adolescent unit means enduring months of waiting, ill-defined treatment regimens and make-do facilities to undergo ‘salvation’. A redemptive end point whereby young people and their loved ones are supposedly equipped to face an increasingly uncertain world alongside professionals who fair no better. Low morale, crashing resilience and mental exhaustion constant reminders that CAMHS, as a Cinderella service in the

economics of child-health care has always been an analogue single model service unable to meet the demands of an increasingly digital age. A tired tiered service easily outperformed by the new units and 1 Kidz, I have an allergy to the word kidz because of its misspelling but force myself to use it out of ethnographic respect. In addition, I dislike the term crazy, but once again find strength in the generations of kidz who have insisted they ‘appear different’, ‘feel different’ and are ‘treated different’ because of their admission to Tier 4 CAMHS. This is a story of 15 young people who informed my practice and instructed me on the sensibilities of playing the game of CAMHS in-patient culture.

As metaphor for production, consumption and monotony the ‘Therapy Factory’ and its variations form the basis of my exploration about what CAMHS represented between 2002 – 2012 and now in August 2022. Yet even further back in 1986 when I was starting my nursing career Steinberg published his edited book about adolescent

units and it represented a first pre-CAMHS attempt at establishing and identifying adolescent inpatient mental health as a unique and unifiable culture. At the time, as a student nurse, I devoured its wise words and still have my treasured original edition, but it no longer embodies the values necessary to contend with an unforeseen digital

onslaught. Its tone unable to predict new child-focused practices relevant for kidz experiencing an algorithmic holocaust accounting for increasing schema of disappointed parents, inescapable digital parading and a media pointlessness dominating the mental welfare of most young people. My metaphoric storying of these new self-diagnosing ‘crazy kidz’ and their Therapy Factories represents a kickback against Planning Minister’s oversights, irrelevant Service Director’s and entangling yet, accepted techniques of underfunded social control. These kidz have learned that salvation is readily replaced by apathy, dignity by self-harm and morality by routine. In places like CAMHS, salvation becomes questionably more mysterious than any adult psychiatry and only brought home when families seek help and if lucky, admitted.

This is an unusual book based on over 6 years of auto-ethnographic research by the author and as such, could be of interest to anthropological type researchers, practitioners and professionals working within therapeutic residential settings. It offers a unique and personal insight into the strains of fixing an increasing number of young people who are finding themselves confronted by a hyper- digitalised moment of alienation. A perfect motif for assembling cultural data of 21st Century freakiness, ordering it into playful semiotic frames and offering an alternative ethnographic insight about the universal structures determining the performance of youthful madness.