It was 4am on a medium-secure psychiatric unit. I was awoken by the sound of gasps and bangs. When I opened my bedroom door I noticed the noise was coming from the bedroom next door, which contained one of my former classmates from the Pupil Referral Unit (PRU) I was sent to after being excluded from school. We had both ended up on the same ward a few years ago for different reasons.
I opened his door. He was hanging from a bed sheet wrapped around his toilet door. I shouted for the staff to help and proceeded to hold him by his legs to relieve the pressure on his neck. After finally getting him down, I ran to the nursing station and woke up a staff member who took charge of the situation.
The following day, I spoke to my former classmate and asked him what was going through his mind at the time. He said he “had enough of life” and believed that things would never get better for “people like us”. He added: “Our destiny is death or to be in places like this forever.”
A few weeks later he was discharged from hospital and within weeks of him living in the community, I was informed that he had unfortunately died of a ‘drug-induced seizure’ as a result of an overdose. I spent weeks on end reflecting on my last conversation with him and thinking about the pathway that we had, from playing as teenagers to being together on a mental health ward, years later.
When I think back, my first day in a PRU felt like a warehouse for young people who, like me, were kicked out of school. Like me, everyone seemed to have some sort of mental health and/or cognitive developmental disorder. Everyone was from an ethnic minority background and everyone clearly had behavioural problems. Almost all of my classmates came from a deprived background, dysfunctional households or a children’s care home.
The PRU was the first time I was exposed to cannabis. The educational programme included toast in the morning, followed by basic English/maths and shoplifting at the local convenience store at lunchtime with my peers.
Break-times were used almost exclusively to smoke a spliff, or to have a fight to settle a dispute with a fellow classmate, openly in front of staff. It’s safe to say that this wasn’t the best environment for troubled teenagers, in my case as young as 14-years-old.
Back then, most of us were either already involved in, or becoming exposed to, gangs and criminality. This was evident during any sporting activity as the shorts worn by the young people exposed their ankle monitors (tags).
Long after leaving the PRU, I would still see my former classmates. The same faces would appear in younger offender institutions, psychiatric units or in photographs on t-shirts, or on social media with ‘Rest In Peace’ written underneath.
Though my exclusion from school was a regular occurrence, the exclusion went beyond education. Me and my peers were also excluded from society and from positive interpersonal relationships or opportunities, in general.
The debate I’m often left pondering on is whether this social isolation is as a result of our actions as individuals or whether the actions are a result of the social isolation. This is a complex question, one which considering the number of factors involved, could support either argument.
According to Public Health England, 86 percent of gang members are identified as having an antisocial personality disorder. It states that 67 percent have alcohol dependence, 59 percent anxiety disorder, 58 percent a drug dependence while 34 percent have attempted suicide. It also notes that 25 percent have been diagnosed with psychosis and 20 percent with depression.
The lifestyles adopted by people involved with gangs are seen to be destructive to communities and society in general. While I accept this assertion, we also must acknowledge that these behaviours are, in most cases, self-destructive.
When we speak about early intervention in mental health, a good place to start would be the PRUs, which many would agree are a precursor to a life of institutionalisation, misery and social isolation. The impact goes beyond the individual and affects communities, resources, victims and families.
There are much earlier interventions that can take place before young people even end up in a PRU. However, this doesn’t reduce the pressing need for interventions for teenagers within these institutionalised settings. And they need to happen before things get worse.
About the Author
Rafik Hamaizia is the Expert by Experience Lead for Cygnet Healthcare. Rafik, aged 25, has been a service user in a variety of mental health settings. His role within the Cygnet Healthcare is to work alongside the Executive Board of Directors to shape and improve service user involvement, co-production and patient experience structures on both strategic and local levels. In 2017 he was given the Cygnet Healthcare Special Recognition Award by Universal Health Services. He has participated in over 100 Care Quality Commission inspections and develops guidance with the National Institute for Health and Care Excellence (NICE). He is currently studying for an MSc in Mental Health Recovery and Social Inclusion at the University of Hertfordshire. Rafik is also the founding member of the Joint Thinking Initiative, a not-for-profit, service user led organisation, focusing on improving mental health care through co-production.