Today is a typical example. When she wakes up, Julie is often not the brightest star in the sky - a fact of teenage life. At the moment we are experimenting with having her home one or two nights during the week, so that means that one or two mornings a week she now leaves from our house to go to school. Occasionally she is not that keen to go to school. Give me a teenager who has not sometimes felt they would rather go back under the duvet.... But in Julie's case I have to do a bit more than just the routine check that they have a pulse before I push her out of the door. This is week 4 of the big experiment which is Julie attending mainstream school at all. For most of last year, dropping out of school was the norm not the exception, and her high attendance so far this term has been little short of miraculous. The stakes are high, however: if she starts dropping out of mainstream school again, nobody is really sure how she will get an education, and she will have failed at the goal she set for herself. On the other hand, if she pushes herself too hard and goes to school when she is not able to cope, there is a real risk of becoming seriously ill again. Even the immediate consequences of going in on a bad day, as we found out a couple of weeks ago, can be serious (she ended up back in accident and emergency yet again), and the long-term risks of not getting out of the hospital may be worse.
So at a point in the morning rush when I would usually be running around nagging her brother about his rugby kit, or trying to grab my laptop, I am sitting on my bed next to Julie doing my risk assessment checklist. It starts something like:
1. Is she paying attention? Losing focus, not able to hold a conversation is a sign of trouble.
2. Is she obsessing about things, having odd ideas or having difficulty making decisions?
3. What risks are we talking about? Have they increased?
4. Is there any obvious step we should take immediately to reduce a high risk?
Today we compromised: we warned the school she would come in late, skipping the first couple of lessons. This gave her the breathing space she needed, but still kept roughly to the original plan for the day. I always do try to get her involved in assessing the risks herself, but the process can be quite fraught - the sort of conversation you have to have is not the sort of conversation you expect to be having with your children. What does she think is the risk that she will self-harm if she goes into school? What does she think might be the risks if she does not go into school? It's hard for a fifteen year old to think like this, but essential: I can't always be with her. She has to be able to decide for herself when it is better to step back from danger. At the same time, we can't reduce the risk to zero - she also has to decide when she should take a risk.
Over the year, I've got better at estimating risk, and I've got better at living with it. I dropped her off at the school gate later on in the morning and drove off with hardly a backward glance, knowing that it was not going to make any difference whether or not I worried about what was about to happen. You have to trust the child, and you have to trust the other people around her, to manage. She did cope, though it was just as well it was one of the days when one of the counselling team was on-site because they spotted her walking round the playing field looking distressed, brought her in, talked her down, and persuaded her back into classes. I guess our risk estimate was a bit too low today, but she survived.
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