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Child mental health: is it in crisis?
Child mental health: is it in crisis?

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2.1 The case study of Lily

The case study of Lily that you look at next is based on a real-life young person who accessed child and adolescent mental health services (CAMHS). All key details have been changed to ensure this young person and their family cannot be identified.

Case study: Lily

A picture of ‘Lily’, a teenager who, based on her facial expression, appears to be distressed.
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A picture of ‘Lily’, a teenager who, based on her facial expression, appears to be distressed.

Lily is 14 years old and lives at home with her mother and father. She is worried that her family, especially her mother (June), will die in a natural disaster, like an earthquake or volcanic eruption – events that are very unlikely in the UK. These are topics her class began studying in geography last term. She has had problems attending school for many weeks now. Lily gets very angry with her parents and has a ‘meltdown’ when they try to force her to go to school and she has been in effect home-schooled for almost a whole term. Lily’s school is insisting on a return-to-school plan and her parents are finding it hard to agree about this.

Activity 2 Lily and returning to school

Timing: Allow about 45 minutes

Part 1

Watch the following video of Lily with her parents.

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Transcript

[Text on screen: I can’t go to school]
MRS WRIGHT (ON PHONE)
It’s been ten days since Lily made an appearance in school. Her attendance was poor before half-term, but now not turning up at all makes it even more concerning. Do you think she’ll be coming in today?
JUNE
Honestly, Mrs. Wright, we try every day. Every morning’s a battle at our house. She just point blank refuses to budge, and we can’t force her. We can’t drag her into the car.
MRS WRIGHT (ON PHONE)
We’re getting to the point where the school has to take further action. We can’t allow her to continue not attending.
JUNE
We really are doing our best. We’re out of ideas. She gets so upset.
DAVE
And she says she’s got a stomach ache, and she doesn’t look well when she’s like this. I mean, we’ve got an appointment with the GP next week. And she’s been doing her work online. Can she not carry on doing that for now?
MRS WRIGHT (ON PHONE)
Yes, I’ll send her the work, but you must understand we need to work out some return to school plan that means Lily is going to be back in school full time.
DAVE
Yes, OK. That woman. She doesn’t know what it’s like to have to fight with a teenager every morning. Doesn’t she understand we’re trying to do our best?
JUNE
She’s only doing what she has to. Besides, Lily should be going to school. She’s ruining her chances. I just don’t understand what’s wrong with her.
DAVE
Well, I don’t know what all the fuss is about. I used to bunk off school. Didn’t do me too much harm. Look, she just needs a bit of time. She got over it before. It just took a bit of patience.
JUNE
Dave, last time she was six. It was when she changed teachers and I could be in class with her so she could get over it. She’s 14 now.
DAVE
Are you sure that she’s not being bullied? Or maybe she’s got into a situation that she doesn’t know how to cope with or handle? Maybe with a lad or something.
JUNE
I’ve asked and asked her. She swears she’s not. And I asked some of the other mums, and they say nobody said there’s been anything going on. She says we’re all going to die in some sudden disaster if she’s trapped in school. It’s ridiculous. She’s ruining her life.
DAVE
It happens. There are flash floods somewhere every year. It’s global warming. I don’t blame her for worrying.
JUNE
We need to sort this out. She can’t just not go to school.
DAVE
What do you suggest? We can’t bundle a 14-year-old into a car. Oh, Lil! You’re not dressed! The school’s been on to us again. We’ve got to get you there.
LILY
I’m not going.
JUNE
Come on, Lily. We can’t carry on like this. You know you’ve got to go back, and the longer you leave it, the harder it is.
LILY
You don’t understand. I’m not going. I don’t feel well. I’ve got a stomach ache.
JUNE
You’re missing out on your education. You’re ruining your chances. You’re supposed to be choosing your exam subjects in a couple of weeks.
LILY
I’m doing the work online.
JUNE
It’s not the same as being in the class with your teachers. What about your friends?
LILY
They don’t care. I’ve said, I’m not going.
DAVE
Lil, your mum’s just trying to help. We’re worried. Look, when is that doctor’s appointment?
JUNE
Not until next Wednesday. But no one has a stomach ache every school day and not at weekends.
DAVE
Look, that’s not fair, June.
LILY
I have got a stomach ache. I’m not going to school. I hate it!
JUNE
But you’d have to go back eventually. Me and your dad will end up getting into trouble. Can’t you at least try for us?
LILY
I’ve told you, I’m not going. I’m not going. I’m not going! Why can’t you leave me alone? I’m not going to school, and you can’t make me. I hate you!
End transcript
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Interactive feature not available in single page view (see it in standard view).

Observing her body language and listening to what she says, note down the ways in which you can tell that Lily is distressed.

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Discussion

Lily’s body language suggests she is distressed, based on her clutching a hot water bottle and her pained expressions. She also expresses her distress when stating, ‘You don’t understand, I’m not going. I don’t feel well, I’ve got stomach ache’ and ‘I’m not going to school, I hate it’.

Part 2

Spend less than 10 minutes thinking about what your initial response is to the statement below and then pick from one of the five options to indicate whether you agree that forcing Lily back to school is the right course of action.

Lily is experiencing difficulties but should return to school in-person imminently.

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a. 

Paternalism


b. 

Autonomy


The correct answer is a.

a. 

Autonomy


b. 

Paternalism


The correct answer is a.

a. 

Paternalism


b. 

Autonomy


The correct answer is b.

a. 

Paternalism


b. 

Autonomy


The correct answer is a.

a. 

Autonomy


b. 

Paternalism


The correct answer is b.

a. 

Paternalism


b. 

Autonomy


The correct answer is b.

In the next section, the case study of Lily will continue and you will consider the sources of support available.