My sister Lucy was the same age as Sarah Lawson when she was admitted to Homefield hospital in Worthing, West Sussex. Like Sarah, my sister suffered several years of mental ill-health. Eventually, she too was diagnosed with manic depression, the very illness that destroyed Sarah's will to live, and led her father to assist in her suicide because, in his words, "life seemed too cruel".
Euthanasia of an elderly relative with a terminal illness remains controversial, but is more understandable. For a father to help his youthful daughter die might seem unnatural and heinous. But any family that has been touched by the distress caused by mental illness will know the misery and desperation that seemed to reduce the Lawsons' options to that one dreadful act. Today, my sister is alive and reasonably well; by many standards, my family has been fortunate. But there have been many dark times when my mother told me, with a resignation that belied her pain, that she would not be surprised if Lucy committed suicide, so diminished was her life by mental illness and its treatment. "And, you know, part of me thinks," she would sometimes say, "that it wouldn't be such a terrible thing if she did."
Wrapped up in the tragedy of Sarah Lawson's death are several smaller tragedies. Foremost is that depression is an entirely survivable illness, with a reasonable prognosis, given proper care. Yet the Lawsons felt that Sarah's treatment had failed, so that death became the only possible relief for their unhappiness. Then Sarah was ejected from Homefield psychiatric hospital after being accused of smoking cannabis, even though she was known to be a suicide risk. (Post-mortem tests after her father helped her to kill herself later established that there was no trace of the drug in her body.)
Sarah's case illustrates the inadequacies of our approach to mental illness and lack of resources devoted to mental health, as does Lucy's. Lucy was not suicidal when she was admitted to Homefield in 1990; she was homicidal. In the course of her first psychotic episode, she showed up at my parents' house in the night and explained that things had gone so wrong in the world that she was going to have to wipe out the world's population - starting with our parents. Despite the threat, she did not offer violence. Bewildered and frightened, my father kept Lucy talking while my mother slipped out and called their GP. He duly arrived, in his pyjamas, with two nervous-looking policemen. My sister was persuaded to accompany them to hospital - Homefield. Once there and "sectioned" (detained under the Mental Health Act), Lucy was sedated.
The last I had seen of her had been several weeks before. She had seemed normal enough, although I could see that she was on a very short fuse. She had dropped out of university the year before, and I vaguely knew that a full-time cannabis habit had not exactly helped her studies. Since then she had dossed around in Brighton, doing little and using whatever recreational drugs came her way. My parents were not allowed to see her at Homefield; nor were they briefed by a psychiatrist. They had some contact with a psychiatric nurse who hinted that Lucy's drug use was suspected as a factor in her breakdown, but he also made it clear that they basically considered her a spoilt child and a nuisance. No psychiatric diagnosis was mentioned. Lucy told me that she was encouraged to discharge herself, after being given a firm talking-to about the need to stop using drugs and sort herself out - which would involve no contact with our parents for six months.
There may have been medical reasons for these decisions but my parents were kept at bay for reasons of patient confidentiality. According to the mental health charity Mind, while the shift to care in the community has had benefits for patients, its reduction of in-patient beds has placed pressure on hospitals to discharge swiftly - creating a "revolving door" policy where people are shunted out as soon as they've stabilised sufficiently not to be an immediate threat to themselves. Lucy was given an appointment at the hospital after her discharge, which she failed to keep (of course); there was no other follow-up.
Where Lucy used dope, Sarah had a history of alcohol abuse. It is commonplace for young people with mental health problems to misuse drugs and/or alcohol. Yet the Mental Health Foundation research charity's recent report, Turned Upside Down, found that many young people who come into contact with mental health services are brushed off as "untreatable" because of their drug or alcohol problems.
Six months after Lucy's breakdown, our parents re-established contact and found her living in some squalor and far from well, though short of psychotic. They felt completely unsupported by the mental health services - implicitly criticised and deliberately snubbed. Feeling desperate, they summoned their middle-class resources and managed to persuade Lucy to see a private psychiatrist. He initially diagnosed schizophrenia, and prescribed an anti-psychotic drug - although he admitted that it was hard to be certain about her condition and that the only diagnostic proof would be whether the drug worked.
Few psychiatrists would be so frank: the diagnostic manual (DSM-IV) is held up as a bible of absolute truth, even though its technique amounts to little more than ticking off boxes describing symptoms that may overlap from one illness to another. Mental illness is notoriously hard to diagnose, yet the manual gives psychiatrists the "scientific" authority they need to prescribe powerful psychoactive drugs. Meanwhile, the talking cures - therapy, analysis and counselling - are out of fashion, largely because much energy has been expended on discrediting their scientific validity.
Medical psychiatrists will respond that anti-schizophrenic drugs are improving all the time, but they remain blunt instruments, closing down much more brain activity than the purely psychotic. Lucy was coshed: it would have been surprising if the drug hadn't worked, in the sense that it rendered her semi-stupified.
After a few sessions she ceased to see the psychiatrist but the diagnosis stuck, and Lucy stayed on that anti-schizophrenic medication, with just sporadic contact with community psychiatric nurses, for more than five years. It was only in 1996, following a further psychotic episode (resulting probably from a drug binge) and another, longer period in another hospital, that Lucy's life begin to shift. The hospital psychiatrist interviewed our parents at length about Lucy's history, and confided immediately that he saw "no sign of schizophrenia". While our parents noted the change of ethos, the Sane campaign reports that the new clinical protocols, snappily summarised as the "care programme approach", call for a patient's carers and family to be consulted.
In due course, Lucy was rediagnosed with a manic-depressive disorder and put on lithium - a much more tolerable regime. For the first time in years, Lucy said, she began "to feel like a person worth taking care of". Lithium is one of the most effective drugs in the psychiatrist's pharmacy: properly monitored, it has very few side-effects and enables hundreds of thousands of manic-depressives to live lives that are as close to their potential as can be. It has transformed Lucy's life, although she and we, her family, bitterly regret those blighted, wasted years. It is not likely that any of us will soon forget the despair that made us half expect, if not actively wish for, her suicide. If only Sarah had been as lucky as Lucy.
• Some names have been changed.
