Warning: This report contains references to self-harm and suicide.
Nicole Renshaw’s first job of the day is to head to the children’s ward.
"It’s a long walk to the ward and you get time to think about what you’re going to see there," she says.
Nicole is a mental health nurse and is doing a routine and increasingly frequent part of her job – seeing children who have arrived in hospital after they have self-harmed.
Before the pandemic, A&E attendances by children with psychiatric conditions had tripled in the last 10 years. Now, month on month, the numbers arriving at hospital are continuing to rise.
Nicole works for the Children and Adolescent Mental Health Service (CAMHS) at Pennine Care NHS Trust. It is her job to assess the children who have been admitted.
Most have self-harmed, and some have tried to take their own life. She must decide if it is safe for them to go home or whether they need to remain in hospital. It is a decision based on a careful and delicate conversation with the youngster involved.
"Often children will self-harm or harm themselves in other ways to deal with stressful situations," Nicole explained.
Lying on a bed in the children’s ward is 14-year-old Laura. She was brought to A&E after trying to harm herself.
She is wearing a T-shirt from her favourite TV show and is watching the cartoon Scooby-Doo. There is a bandage on her arm and she is connected to a drip. Her mum is sitting by her side looking anxious.
Nicole takes Laura and her mum into a room and the youngster opens up about what is on her mind. School, home life, lockdown, not eating – it is all too much, she says.
"I’ve not really gone out as much. I’ve not really gotten away," she says. "School is getting on top of me – it’s not the people, it’s just the work."
Nicole tries to give Laura something to live for. "Do you want to go to college?" she asks. "To uni? I want you to hold on for that, because it can be done."
‘I just want her back’
Laura’s mum is worried. The pain and fear is etched on her face. She says her daughter has not been herself for a while now.
"She doesn’t come out of her room, she doesn’t eat much. She needs help, professional help. I go through depression as well, it comes and goes so I know what she’s going through."
She adds: "I just want her back to how she used to be, smiling, laughing, joking."
A safety plan is made including locking away medication, knives or anything else that Laura could use to harm herself. Laura is discharged later that day and asked to see Nicole again in seven days’ time.
"The referrals we’re seeing now – the level of distress and mental health problems as a result of the pandemic – are unprecedented," says mental health nurse and service manager Lindsey Baucutt.
"We’re not used to seeing what we’re seeing, and I don’t think it’s for the short term. I think this is here for years to come now."
It has been seven days since another teenager arrived at hospital having self-harmed. Summer is a 14-year-old schoolgirl who loves dancing and drama. But she has been struggling during lockdown and is now harming herself severely.
Summer explains that her mood can swing from high to low. "Yesterday in English I was happy and then in Spanish I just cried my eyes out," she says.
She has been self-harming for two years. "When I look back, I wish I didn’t do it," she says. "These are going to be scars now. I regret it."
It is thought around a quarter of all children Summer’s age have self-harmed.
A surge in referrals
The CAMHS team is dealing with a surge in referrals – self-harm, suicide attempts, anxiety – a grim but growing list of troubles.
"There is going to be a section of people in our society who are kind of surviving through this now and are in total survival mode," said the trust’s lead clinical psychologist, Dr Chantal Basson.
"And as we come out of the pandemic, we’re more likely to see the mental health impact on those young people and families.
"I think we might be feeling the tremors, but I think the impact may well yet to be seen."
If you have been affected by any of the issues in this article you can contact the Samaritans on 116 123, or Mind on 0300 123 3393.