Who is to blame for our son’s death? — (The Telegraph)

SSRI Ed note: Suicidal boy given antidepressants including paroxetine and antipsychotics, he gets worse through teens, doc cuts him off meds cold turkey, he hangs himself.

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The Telegraph

Cassandra Jardine

12:01AM BST 30 Jul 2007

Tim Whattler: although he had friends, he would lash out at other children

The parents of Tim Whattler, who committed suicide aged 17, believe he was fatally let down by the system of care for autism sufferers. Cassandra Jardine reports

Tim Whattler was a handsome, sporty 10-year-old when his life started to go badly wrong.

“He loved maths and science,” says his father, Dean, an engineer. “He had a high IQ and learnt very quickly because he had a photographic memory.

“But he also had a form of autism, so his behaviour annoyed his teachers. When they told him off, he didn’t understand their facial expressions and just grinned. If they said, ‘Can you get your maths book out?’ he would do nothing because he knew that of course he could get his maths book out.”

Constantly in trouble, Tim was 10 when he became noticeably depressed.

One morning, his parents found him curled up in the snow outside their home in Bromley, Kent.

He had lain down by the dustbins, hoping never to wake up. That was the beginning of a seven-year battle for help that culminated in Tim’s death in February last year.

Dean and Elizabeth Whattler have file after file of correspondence relating to the care of their only child. Everything is intact, like Tim’s bedroom, while they decide what to do, following an inquest in May which returned a puzzling verdict.

“The coroner said Tim’s death was preventable, yet he did not place any blame on the psychiatric unit where he died, just six hours after he was admitted,” says his mother.

“If his death could have been prevented, who exactly is to blame?”

One answer might be the system of care for vulnerable young people to which he was entrusted, and in which the nurses and doctors didn’t have all his notes, so were unaware that he had recently tried to kill himself.

That system might also be blamed for his state of mind on the Friday he died.

With suicide the second most common cause of death in the 15-to-24 age group, many families are affected by the game of “dodge the bill” played out between some health, education and social services departments.

The bureaucracy can drive parents to act in ways that they know are not in their child’s best interests, just to get some help.

Tim, who was born in 1988, was a normal, happy child until he was three-and-a-half.

“That summer we were on a beach in America,” his father recalls. “But when Elizabeth handed Tim a sandwich, he flipped it on to the sand and looked at it.”

From then on he became increasingly difficult and, although he had friends, would lash out at other children.

When Tim was six, a consultant told the couple their son’s anxiety on the long-haul flight might have triggered the abrupt onset of his bizarre behaviour, but said it would have emerged anyway. It took a long time to get a diagnosis from the Phoenix Centre, a behaviour management clinic in Bromley, where there is a two-and-a-half-year waiting list to see a child psychiatrist.

When their son was eight, the Whattlers were told Tim had Asperger’s syndrome, a high-functioning type of autism that affected his ability to communicate, but not his use of language.

Dean was not surprised. He had long suspected that his own father, a ship’s pilot, had Asperger’s, which affects one in 300, a third of the total number with autism. Elizabeth also believed Tim had ADHD – attention-deficit hyperactivity disorder – but it was several more years before that, too, was diagnosed.

After his night in the snow, 10-year-old Tim was put on anti-depressants.

A special school was thought appropriate but none was available near Bromley, so he was sent to Somerset. In later suicide notes, Tim cited leaving home as a root of his problems, but his parents felt he was happy at Farleigh College, a special-needs school where he was a boarder, until it changed premises when he was 13.

“Children with Asperger’s hate change; suddenly Tim had to deal with a new building, a much smaller bedroom and a new carer,” says Elizabeth.

His mental health deteriorated. Since there was no suitable unit near the family home in Bromley, Tim was sent home and put on Seroxat, a drug that has been claimed to increase suicidal tendencies in some cases. Because he wasn’t at school, he was bored.

He was then placed in a residential psychiatric unit in Epsom full of anorexic girls, where his weight dropped to six stone (people with Asperger’s tend to mirror those around them). “When we complained, it was suggested that we were to blame for his problems,” says Elizabeth.

They removed him. For four years Elizabeth kept Tim safe by never leaving him unobserved and giving him the constant cuddles he craved. She took him to the adult cookery classes she teaches, found sports to occupy him and arranged lessons in Mandarin to challenge him.

“But he had to spend most of his time with me,” she says, “which must have increased his feelings of isolation from his peers. One day, I went into the hall and found him hanging from the staircase with his judo belt round his neck.

“He was still alive and Dean was able to revive him, but we felt he needed professional help.”

After that, Tim was sent to a residential psychiatric unit for adolescents in south-west London, where he experimented with cannabis, then on to a more secure unit in Orpington that Elizabeth describes as “totally Dickensian”.

“The children were put in a concrete courtyard every day during the summer holidays, with no stimulation or organised activities. Loud pop music played continually. Sensory problems are common in those with Asperger’s syndrome. Tim found it hard to take,” she says.

Another unit was found for him in the West Country when he was 16, where he was enrolled on a “land-based studies” course, more suitable for someone with learning difficulties than a boy with an IQ of 140.

Soon after, against the Whattlers’ wishes, he was moved from 24-hour care into a flat on his own. His doctor (the latest of many, each with different views on treatment) stopped his anti-depressant and anti-psychotic medications. She felt Tim would not be able to administer them himself.

The week before he died, Tim spent half-term with his parents. It was a happy time, they say, and they discussed how, once he had turned 18, Tim could return to his own place in Bromley.

“Although we wanted him at home, we had been told we would get no support if he was with us,” Dean explains.

Tim dreaded returning to the West Country. Two days later, having attempted to hang himself with a kettle lead, he was sent to Rydon House, a psychiatric unit in Taunton. He was not considered to be in an anxious state as his heart rate wasn’t raised – not surprising, says Elizabeth, since people with Asperger’s live in a state of constant anxiety.

Three days later, he was transferred to Beech Court psychiatric unit in Somerset.

He told staff he hoped to get better but, despite his suicidal tendencies, his shoelaces were not removed, nor was his razor. He promptly cut himself 75 times.

He was given a room containing at least 10 ligature points (knobs and taps from which he could have hung himself), one that was located far from the nursing station. Had he been allowed to see the room, his father says he would have immediately pointed out its unsuitability.

That evening, when Dean arrived to check on his son, the staff didn’t know where Tim was and went to find him. He heard an alarm go off.

“I saw his body as it was removed from the unit,” he says. “Tim had hanged himself from the knob on his wardrobe door.”

The Whattlers behave with extraordinary control, but there is no disguising their devastation at the waste of their son’s life – one of 200 patients a year who kill themselves in supposedly safe psychiatric units.

“He should never have died where he did, when he did,” says his mother. “He was sent to that unit to be kept safe.”

He needed understanding, routine, familiar people and constant activity. He got constant change, little understanding from so-called experts, spasmodic education and medication that may have exacerbated his problems.

Such complaints are common, says Carol Povey of the National Autistic Society.

“Depression is not an inevitable part of an autistic spectrum disorder. It is often induced by environment. Medication sometimes helps, but it is better to look at the reasons for depression and treat those first. Services are patchy throughout the UK. It’s not just a funding issue, though the shunting of responsibility between health, education and local authorities is part of it.

“There’s also a lack of understanding. These disorders are different and more complex than learning disabilities. Only 15 per cent of people on the autistic spectrum currently have full-time jobs but many more could, with the right help.”

The Whattlers feel robbed not only of their son but also of what they consider a fair hearing. At the inquest, there was no jury, important evidence was not presented, and neither they nor the expert who wrote an independent report were allowed to speak. They may bring a civil case.

Nothing will bring Tim back, but they would like his death to alert others to shortcomings in children’s psychiatric services.