The nightmare that drove my husband to kill our daughter

KAREN LAWSON was asleep when her husband, James, woke her at 4am to tell her something so heartbreaking she could not initially comprehend it.

Only when she heard him pick up the phone, ask for the police, and say, "I've just killed my daughter, you'd better come round", did she realise she was not dreaming. She ran into Sarah's room where she found their beautiful, but suicidal, 22-year-old daughter dead.

"I ran downstairs, shouting hysterically 'James, what have you done?'" she recalls. "He was sobbing. I threw my arms around him. He told me he had helped Sarah to die.

"She had taken an overdose for the umpteenth time and laid down next to him, resting her head on his chest, but when the Temazepam pills weren't working, she asked him to go and buy her paracetamol. He did not want her to die alone, so he smothered her with a pillow instead.

"I could not feel any anger or blame for James. Even before the police were banging on the door, taking my husband away in handcuffs, and long before a judge let him walk free with a suspended two-year prison sentence for manslaughter, I knew who the real culprits were: the mental health professionals who had failed our daughter so miserably."

This week, more than four years after her daughter's death in April 2000, Karen Lawson's damning indictment of the mental health services has been upheld. The scathing report by the Surrey and Sussex Strategic Health Authority into the circumstances leading up to Sarah's death, has condemned the mental health services as dysfunctional, fragmented, and woefully inadequate, and said that Sarah was failed at almost every level by the system.

Sarah had a history of self-harm and the report on her comes during a week in which new figures, released by the Government, reveal that Britain is facing a hidden epidemic of this condition. More than 170,000 people a year, mostly teenagers and young adults, seek treatment after deliberately cutting, burning or mutilating themselves, and thousands more are feared to self-harm without telling anyone or seeking help. And yesterday another father, Andrew Wragg, was charged with the murder of his terminally ill son, Jacob, 10.

Mental health campaigners say the Lawson case highlights how many young people who self-harm are treated without compassion or understanding by the system.

At her cottage in West Sussex, Karen, 49, says her daughter's depression, though incurable, was definitely manageable, and that there was no reason why she should not be alive today. Her desperate story - recalling Sarah's life and death and their foiled attempts to get her help - chronicles a catalogue of failures by the NHS almost beyond belief in 21st century Britain.

"Sarah was about 17 when I first started noticing something was dreadfully wrong," recalls Karen.

"As a child, she had been a normal, energetic, fun-loving girl, with lots of friends, who was above-average academically. But as she entered her late teens, I noticed that she was becoming more withdrawn, and always wore long sleeves, even on the hottest days.

"One day, I looked through her room and found a bandage caked in blood together with razor blades. I was shocked and went to see Sarah's GP, but she told me Sarah was an adult, and she was not at liberty to discuss her patients. I protested that as a concerned parent I wanted her to be fully informed. Did she know Sarah was cutting herself? The GP almost kicked me out, practically slamming the door on me. That set the trend for the hostility my husband and I experienced from the health professionals, though, to be fair to that GP, she phoned and apologised after she had asked to see Sarah's arms and gasped, 'Oh my God!'" The GP referred Sarah for treatment to a psychiatric nurse at the local Greenacres mental health clinic.

Karen accompanied her daughter and listened with rising indignation as the nurse flippantly told Sarah the solution was to "take up a hobby", such as "learning guitar". "I thought, good grief, this is ludicrous. Here she is cutting herself to bits - will no one do anything to help?"

By now, Karen, a secretary, and James, a builder, were insistent that Sarah see a psychiatrist-But just before her first appointment, Sarah took an overdose. It would be the first of more than a dozen suicide attempts, though each time she would have second thoughts and tell her parents, who would rush her to AE, and where she would have her stomach pumped, and her arm stitched up.

But in AE, too, the Lawsons say they were treated with contempt. "I

remember a nurse looking at her lacerated arm, which resembled a cut salami, saying: 'Oh, who's been a busy girl tonight, then?' There was no care there.

They would discharge her without referral to the duty psychiatrist."

Perhaps most devastating to Sarah was that when she finally saw a psychiatrist, Dr Fernando, he turned out to be, as the independent report admits, totally "incompetent".

Often he could not remember who Sarah was, or why she was there. It transpired that Dr Fernando, who has since died, was an alcoholic and drug addict. Colleagues had made complaints, but senior figures in the health trust covered this up.

"It was totally devastating to Sarah that no health professionals would help her," says Karen, her mouth taut with pain. "Not only were our lives in turmoil trying to support Sarah, but we had to fight the system as well. My husband and I were being torn apart, and we have a son, Jamie, a year younger than Sarah, who loved his sister and felt totally at sea, too. But never once was a social worker assigned to our family. I was living on a knifeedge, not knowing when I walked in from work whether I would find my daughter dead or alive."

The final, crushing indignity came at the local Homefield Psychiatric Hospital - described by the independent report as a "despised hospital" more likely to damage an inpatient's mental health than help it - on the day that Sarah died. Her GP had referred her there after she had made three suicide attempts that week, but the head nurse decided to eject Sarah without anyone formally assessing her because she was carrying cannabis.

"I tried to plead with the nurse that it would be dangerous to let Sarah out," recalls Karen, angrily.

"But this woman was like nurse Ratched in One Flew Over the Cuckoo's Nest.

Once, when Sarah refused to eat, she told her: 'Oh, go on a drip then, I don't care.'" That night Sarah wrote a heartwrenching suicide note. It said: "To all those I love - you have all done your best by me. I have done this not for me but for you so that you can live your own lives. Words will never express how much I love you all and how sorry I am that it [has] come to this."

When she asked her father to help her die, he faced a horrendous choice.

"Neither James nor I had wanted her to die in some multistorey car park," says Karen. "At least she died in her home with people who loved her."

The fallout from Sarah's death has taken its toll. Karen and James have divorced, and she now suffers severe depression, needing 20 pills to get her through the day. "The past four years have been a nightmare," she says. "I have coped with the death of my daughter, the trial of my husband, my divorce, and the interminable wait for this independent report.

"Sometimes I find myself staring at the carpet in a trance. I have my good days and my bad, though hopefully I am starting to see a glimmer at the end of the tunnel. But life will never be the same. It's as if the mental health service chucked a grenade into the room and blew us Lawsons to the four corners."

She carefully opens a pink box lined with white velvet. Inside she keeps a few of Sarah's possessions - a ring, perfume, but also three gruesome police photographs of Sarah lying dead in her bedroom, her arm cut like a railway line.

She looks long and hard at the photos, then picks up the happy, vivacious one on the mantelpiece.

"You see," she says, "that's the picture that people who self- harm present to the world: smiling, happy.

But what you see is not what's going on. I knew that. You would have thought that the health care professionals would, too."

(c)2004. Associated Newspapers Ltd.. Provided by ProQuest Information and Learning Company. All rights Reserved.