Panorama 2020 E05
Category
🦄
CreativityTranscript
00:00Now, you know why I'm making a video? Because I like making videos.
00:08This is Callie Lewis. She ended her own life in 2018, when she was just 24.
00:16Callie was very, very passionate about whatever it was she would turn her mind to. She was
00:25really passionate about animals and animal rights, so she would always say that she much
00:28preferred animals to people. Callie sometimes struggled with mental illness.
00:36I don't get humans at all. They're really weird. People, if they try to talk to me,
00:40it must be like trying to talk to Spock or something like that.
00:45We've spent the last 16 months with Callie's family, trying to find out what went wrong.
00:53Just weeks before her death, Callie became a member of an online suicide forum.
00:59Without those forums, I think my daughter would have really struggled to find the information
01:04that she was looking for about how to die. Suicide rates among young people have been
01:11rising and for young women are at record levels. When Callie needed help, it wasn't there.
01:19I'd be disregret. It's asking for help, to be honest. I'd be disregret. It's asking for
01:25help because if I'd just not handed her over, I think there's a much higher chance she'd
01:32still be alive today.
01:49That one's nice. Is that you? Yeah. Wow, you look so young. I was young. How old were you?
01:5516 when I had her. Wow. Callie's mum, Sarah, always knew her daughter was unique.
02:01As she grew older, if you got into a conversation with her, it wouldn't just be a normal conversation.
02:07You couldn't just make small talk. It would be an intense conversation that she would,
02:14you know, turn into this sort of like inquisition, basically.
02:20At 11, Callie was diagnosed with Asperger's syndrome, a mild form of autism.
02:28It made relationships outside the family hard, but she was close to her grandfather, Graham.
02:35She had some very odd obsessive behaviours, which were not things you could control.
02:41She would sort of just do them.
02:46We just accepted her as one of us, a little bit more eccentric than most.
02:54As a teenager, Callie sometimes felt she didn't fit in.
02:58I'm like a cyborg with this human skin on. It's quite funny. I kind of like it, though. It makes me laugh.
03:07She was diagnosed with chronic depression and sometimes talked about suicide,
03:12but could also be extremely joyful and was a loyal friend.
03:17Nine years ago, she met Jan, and despite their age difference, they developed a rapport.
03:23When I met her, I spotted straight away she was autistic, and I think she spotted I was as well.
03:30She was also aware that I seemed to be coping a lot better,
03:35and then she was aware that I was coping a lot better.
03:40She was also aware that I seemed to be coping a lot better,
03:45and then she was doing, and she couldn't understand why.
03:49And the only answer I could give her was that because I've lived with it longer, so I've kind of adapted.
04:00When Callie was 23, she left her South London home to move in with a boyfriend.
04:06Life had been going really well for her.
04:09She'd been happiest for a consistent period of time. I'd known her for a very long time.
04:16But by the summer of 2018, Callie and her boyfriend had split.
04:21Her mental health had taken a turn for the worse.
04:24She cut off all contact with her mother and moved to Kent.
04:28I suspected she was staying with her friends, but I couldn't be sure.
04:34You know, when I tried to call her on WhatsApp, nothing.
04:38Callie had begun to think seriously about ending her own life.
04:46Callie spent hours searching the internet, and eventually she came across a website
04:51where she felt she might be able to get some help.
04:53We're not going to name the site because it contains extremely harmful content,
04:57but it was a chat forum where she would post anonymously.
05:00And in one of the first posts that she left, she said,
05:03I'm glad I found this site as it feels near impossible to discuss suicide openly.
05:11Callie had been staying in her friend Jan's spare room.
05:14When she'd had suicidal thoughts in the past, she used to talk them over with him.
05:19But not anymore.
05:21It was at that point where she totally just engrossed herself with the suicide websites
05:29who were encouraging her how to do it.
05:33So she felt if she communicated with me, she wouldn't be able to do it.
05:38But if she cut me off and communicated with them, they will make sure she did it.
05:43When we found out about the websites, the suicide websites,
05:47she'd been on that, that really set off an alarm bell
05:51because it began to feel like an obsession.
05:55She could have a depressive mood and a suicidal thought,
05:59and that was manageable because you could help her through that.
06:03But her obsessions, you just couldn't do anything about them.
06:17On August 10th, Callie posted to the suicide website,
06:22revealing she'd recently made several attempts to hang herself.
06:26An actor is reading out her messages.
06:31Please to God, help me.
06:33I have now freaked out and failed four times in the last month.
06:37Is there any way to make it easier?
06:41Despite her obvious distress,
06:44no-one on the forum tried to persuade Callie not to kill herself.
06:51A few days later, her friend Jan found out about the suicide attempt.
06:57In a way, it shouldn't have been a shock, but it really was.
07:01And I just...
07:04As soon as I saw her, I just...
07:08Well, I started crying, she started crying,
07:12and she explained everything.
07:17Jan was so worried about Callie that he broke her confidence
07:21and telephoned her mum, Sarah.
07:24I think there's two things that made me think this is really serious.
07:29I think, first of all, was the fact she'd cut off all contact with me.
07:38And then, you know, Jan calling me,
07:42for him to be worried, you know,
07:44because Callie would sometimes talk about suicide.
07:47So that didn't shock us, but for Jan to say she has detailed plans,
07:51she's going to do it, I know my daughter,
07:53if she's going to do something, she'll do it.
07:57Sarah called 999.
08:00The police found Callie at another friend's flat.
08:03They saw she had bruise marks on her neck and a noose.
08:07After they left, Callie posted to the suicide forum.
08:12Hey, guys, just to update you, the police left in the condition
08:16I visit the mental health team, which I agreed to,
08:19although I still intend to leave Friday morning
08:21and just try to remain undetected until then
08:24and be vague with the mental health team.
08:29Callie discovered that her mother had called the police
08:32and that Jan had been the one to tip her off.
08:35I realised it was a bad idea to be so open,
08:38but since I'm autistic, I find it extremely hard to be dishonest.
08:43I feel extremely betrayed by my friend.
08:47Furious, Callie moved out of Jan's flat.
08:52My decision was she either lives or dies,
08:55and so it was easy that she had to live.
08:58The consequences of it, you know,
09:02was very hard.
09:07But I would have done it again if I had the chance,
09:12only hoping that this time it would have worked.
09:33Callie had an appointment with the mental health crisis team
09:36the following day.
09:38Before that, she visited one of her favourite places,
09:42an animal sanctuary near Canterbury,
09:44where she'd often spend time watching the wolf pack.
09:53All the while, she was still on the suicide forum.
09:58Any advice for the crisis team?
10:00I'm seeing them in two hours.
10:04You'll need to play along and pretend that it was just a passing cloud
10:07and that you're getting better.
10:11Callie took the advice to heart.
10:14She told the crisis team she no longer intended to hang herself.
10:19What she didn't tell them was that she'd found a new method
10:22on the suicide forum
10:24and had already bought what she needed to carry it out.
10:31Callie was released, and when her family heard,
10:34they set out to find her.
10:40So my dad and I had gone down planning to bring her back.
10:44The most worrying thing was discovering
10:47that she'd bought a suicide kit.
10:50She lived on nothing, and to spend good money on a suicide kit
10:55just wasn't Callie at all.
10:58We both said the same thing. We said we can't help her.
11:01It's too serious, because if we bring her back,
11:04we'll have to lock her up in the house, stay here with her,
11:09switch off the internet, switch off all data.
11:12You know, we'll just have to get her off those forums
11:15and break it, basically.
11:18Desperate to get her daughter help, Sarah again called 999.
11:23She told police that Callie was on her way to Dover Priory Station.
11:29Callie's family was so concerned about her mental health
11:32that they came here with the police so she could be sectioned.
11:35They finally found her here at the train station,
11:38and this is the last place that her mum ever saw her alive.
11:43The police officers stood by the fence,
11:45we stood by the ticket barriers,
11:47and she came out and we grabbed hold of her,
11:50and she just started screaming and yelling,
11:54and that was when the police were able to intervene.
12:02I told her I loved her.
12:04I didn't get anything back, but I just thought, you know,
12:08just in case I never see her again, which turned out to be the case,
12:11I thought at least I've said it to her.
12:15The police brought Callie here,
12:17whilst her mum and grandad waited by the train station for news.
12:23And we were standing there and it was well gone 11,
12:27and eventually a police officer came up to us and said,
12:31we're sectioning her.
12:33And I just collapsed.
12:37I just thought, thank goodness,
12:39they're actually going to keep her safe.
12:41Police detained Callie for her own safety,
12:44but with no mental health bed available for her,
12:47she had to wait with officers in a police car all night.
12:58At 8.30 the next morning,
13:00Callie began a further mental health assessment
13:02at St Martin's Hospital, just outside Canterbury.
13:07Callie again denied any immediate intention to kill herself,
13:11and again the assessors took her denials at face value.
13:15Callie was released.
13:19When they asked if I had immediate plans to harm myself,
13:22if they released me, I said no and laughed off the idea as ludicrous,
13:26saying I just wanted to go and get something to eat.
13:32Callie also told the crisis team
13:34she didn't want her mother being given any information about her treatment.
13:38The next thing I knew was about lunchtime when I heard a phone call.
13:41I said, she's on the suicide website, she's autistic,
13:44she's got all her equipment.
13:48And I said, and she will definitely kill herself using this method
13:51if you let her go.
13:53And they just said, thank you very much,
13:56you know, we'll make note of that information.
13:59I now know that phone call happened
14:01after her assessment had already finished.
14:08The next day, the community mental health team took over Callie's care
14:12and things began to go disastrously wrong.
14:18A duty care coordinator called Callie three times.
14:22When there was no answer,
14:24Callie should have been visited at home on the same day.
14:28That didn't happen.
14:30She was never seen by the community mental health services.
14:34They were supposed to have contact with her all the time
14:37and they were supposed to isolate things and that didn't happen.
14:43The person who made the phone calls
14:45was then assigned as Callie's full-time caseworker.
14:48But they went on sick leave and no-one was assigned to take over.
14:54Callie became lost in the system.
14:59If you look at any unforeseen death,
15:05usually it's not one thing that kills them.
15:09And in Callie's case, you can see that.
15:12You suspect that at any point something could have gone right
15:16and she would still be with us today.
15:29Seven days later, there'd still been no further attempts to contact Callie.
15:34By now, she was over 350 miles away in Cumbria.
15:39Any chance to help her was rapidly slipping away.
15:46Current plans, head to an undisclosed location,
15:49stay in a hostel for a couple of days,
15:52then move to a nearby campsite.
15:59So Callie came up here to Windermere in the Lake District
16:02and she was still speaking to people on the suicide website
16:05for the few days that she was up here.
16:07And she was asking them how to go through with it
16:10and how best to stop her friends and family from finding her
16:14and from stopping her.
16:19Wish me luck. It's been great getting to know you all.
16:24Good luck. We all wish you a swift travel.
16:28May you find peace, my friend.
16:34Dying now, guys.
16:36I'm going to try and listen to music and drift off to sleep.
16:40Goodnight.
16:50To us, she was so clearly very, very ill.
16:56More ill than we'd ever known her to be.
16:59And during those sort of two weeks where we just didn't know anything,
17:04we just kept on telling ourselves,
17:07they'll keep us safe, they'll definitely keep us safe,
17:10because we couldn't believe that wouldn't happen.
17:14It took 13 days before Kent and Medway NHS Trust
17:18even realised that Callie had gone missing.
17:22In the two years before Callie's death,
17:25it had been warned twice by the Care Quality Commission
17:28about the danger of some patients falling through the cracks.
17:33What I would like to know is what happened
17:37without any sort of covering over.
17:42I just want to know the truth.
17:44And the truth is actually quite easy to bear.
17:48The truth is not something that hurts.
17:51The truth actually just gives life to things.
17:59Sarah hopes to get answers in a phone call with the local NHS,
18:03which has promised a report on what went wrong.
18:07Well, someone saw the lessons learnt.
18:09She was determined to die in a very logical, calm way.
18:12The only way you get to that stage is to be brave.
18:15The only way you get to that stage
18:17is to be very, very, very seriously mentally ill.
18:23I kept her safe all her life, and then the moment I asked for help,
18:28she stops being safe, and that's just...
18:31..very hard really to come to terms with.
18:34I feel I made the wrong decision.
18:37It's the thought of her just wandering around, myself, lost,
18:41and nobody able to help her.
18:45That really... That really upsets me.
18:49I just need to know there's somebody somewhere I was caring for
18:52and nobody was, and I wasn't able to.
18:56That's the...
19:08In its report, the Trust acknowledges a series of failures in Callie's care,
19:13in part caused by unfilled posts and staff off sick.
19:19Callie's caseworker said that she was handling 40 cases
19:22at the time of Callie's death,
19:24and she would consider 20 to be a reasonable amount.
19:28What do you make of that?
19:30I think that what we currently have is a service that's on its knees.
19:35So we have staff who are exhausted
19:38and who are regularly carrying far greater
19:41than would be an acceptable or manageable caseload
19:44to still be able to give good quality mental health care to people.
19:47They then might go off sick, for example.
19:50Other people then need to step in,
19:52so the consistency of care is potentially lost.
19:55And ultimately, the most important factor it impacts on
19:58is people being able to be safe and supported
20:01by the community mental health team.
20:12The Care Quality Commission inspects and rates
20:15all mental health care providers in England.
20:18It also surveys people over the age of 18
20:21who use England's community mental health services.
20:25Every year for the last five years,
20:27satisfaction with the service has gone down,
20:30with patients saying they are unable to see NHS staff often enough.
20:35We need a wholesale investment in community mental health services.
20:40We still have pockets of care
20:43where there are gaps in service provision.
20:46We need good quality 24-hour crisis care available in the entire country.
20:52We need to have a real investment in community mental health teams
20:57so that those community mental health nurses can do their role
21:01that they want to do and that they strive to do
21:04in terms of building those really strong relationships
21:07with people who are struggling.
21:17Although the number of community mental health nurses
21:20has increased by 15% over the last five years,
21:23across all mental health services,
21:26there are around 10,000 unfilled posts.
21:30NHS England told Panorama that in the next four years
21:34it will create a further 10,000 new posts
21:37for community mental health teams
21:39and is increasing funding by almost £1 billion a year.
21:46It also says that in October 2019,
21:49the Care Quality Commission reported a general improvement
21:52in the quality of community mental health services.
21:56After Callie died,
21:58her family also began to look into the influence
22:01of the suicide forum she'd been part of.
22:04What we found was a huge amount of very, very, very vulnerable people
22:11sort of trying to support each other,
22:14trying to help each other,
22:16trying to help each other,
22:18trying to help each other,
22:20trying to help each other.
22:23Sort of trying to support each other,
22:25but they were in no...
22:28You know, so many of them were not in any fit state to support each other
22:32because the sort of support that was being offered was,
22:36here's how to pull together a suicide kit.
22:42The website has over 10,000 registered members
22:46and in the six weeks before her death,
22:48Callie posted almost 200 messages to the site.
22:53We've tried tracking down the owners of this website,
22:56but they've gone to extraordinary lengths
22:58to keep their identities a secret.
23:00They hide behind these online aliases
23:02and there's no physical address or way of contacting them
23:05except by sending a message through the website itself.
23:11We wanted to challenge them about the harmful content on their site,
23:15so we sent a message requesting a filmed interview.
23:18They wouldn't appear on camera
23:20and would only send text message answers to our questions.
23:27In our conversation, they told us,
23:29we offer a space to discuss the topic of suicide without censorship.
23:33Our community and website does not encourage suicide.
23:36That is strictly against the rules.
23:38When I asked them if it was harmful
23:40to provide vulnerable people with detailed suicide methods,
23:43they said, information is power,
23:45what you do with it is your responsibility.
23:51I think they're kidding themselves
23:53if they think that actually these are helpful forums,
23:58because I think without those forums,
24:01I think my daughter would have really struggled
24:04to find the information that she was looking for about how to die.
24:13Suicide is preventable. There is always another option.
24:17One of the things we hear from families often
24:20is that there are so many missed opportunities to save their loved ones.
24:24And what we'd say to anyone who's struggling to cope
24:27is suicidal feelings are temporary.
24:30They may not feel it at the time, but they will pass
24:34and there is support available.
24:36There is always another way.
24:40More than a year after she died,
24:42an inquest into Callie's death is held.
24:45It's highly critical of the Kent and Medway NHS Trust.
24:50The inquest finds that a lack of training in relation to autism
24:53probably contributed to Callie's death.
24:56But the harshest criticisms were for the system that failed her.
25:02They found that her death was contributed to by neglect
25:05and that insufficient efforts were made to contact her.
25:11So really grateful that they listened
25:15and acknowledged that her death could have been avoidable.
25:21Kent and Medway NHS Trust told Panorama...
25:35We apologise unreservedly for this.
25:39Following Callie's death, we put in place a number of actions
25:43to help improve safety and have since embedded
25:47an improved set of standard operating procedures
25:50within our community mental health teams.
25:57The inquest also raised concerns that the suicide website
26:01that Callie had accessed could contribute to further deaths.
26:06The Samaritans are part of a government initiative
26:09looking at ways to protect vulnerable people
26:12from such harmful content.
26:16We think there may always be individuals
26:19who are posting harmful content.
26:21We don't want that popping up on the first pages of searches.
26:24So if we can't get rid of it, let's try and bury it,
26:27let's make it difficult to find for people
26:29so that when they are looking for information,
26:31what they're coming across is the helpful, supportive information
26:34first and foremost.
26:49Welcome to this beautiful place
26:51where we gather to celebrate the life of Callie.
26:56What brings us here is a united love for her.
27:03I think we all know that Callie was unique.
27:06She wasn't much like me,
27:08and she wasn't much like many of us that are here today,
27:11and I think that's why we're here.
27:13She did sometimes talk of ending her life,
27:15but until those final few weeks,
27:17I never thought she'd actually do it.
27:20I used to imagine her still alive at 90,
27:23surrounded by cats and cups of tea,
27:26probably still saying she wanted to die.
27:34I really do believe that her mind is one that would have changed the world
27:37if only the world was one that was more accepting
27:40of people who are a little different.
27:43So she never fitted in any normal mould,
27:46but we did love her unconditionally.
27:48She was my firstborn.
27:49She was the first grandchild who had grandparents,
27:51and she will always be the oldest of three sisters.
27:53Always my oldest daughter.
27:55I love you, Callie.
28:08Callie was a whole person.
28:10She wasn't just her illness.
28:12She was somebody who, you know, lived a really full life
28:17and had some amazing experiences
28:20and, yeah, I just want to remember her like that.
28:34If you are feeling emotionally distressed
28:36and would like details of organisations which offer advice and support,
28:40go online to bbc.co.uk actionline
28:44or you can call free of charge at any time
28:47to hear recorded information on 0800 066 066.