Families are complex.

Young people frequently present to us in the context of the breakdown if their parents' relationship.

It can be a very sad time and have an enduring emotional impact on a young person for many years.

In the UK 2 million teenagers may be living with one or both parents who drinks too much alcohol. Other teenagers live in the contexts of parental mental and physical illness, domestic violence and the abuse and neglect that follows. Some children live in households with some or all of these factors in play in addition to parental criminality, drug misuse/addiction, parental unemployment and poverty.

Consequently some teenagers in this situation will be very unhappy and go on to be depressed and traumatised. Other children will find a way to be more resilient and get through these many factors about their social context and about their parents that just do not appear to change for the better.

Young people in these contexts often present with the symptoms of depression, overdoses, cutting, drug and alcohol misuse and criminal behaviour.

In a therapeutic context we are likely to be treating the symptoms of depression, anxiety disorders, complex trauma and psychotic episodes with psychiatric drugs and psychological therapy.

In complex cases the medications may be of dubious value and the therapeutic process may be prolonged. If the young person cannot trust the doctors or psychologist or therapists, then acting out of crises by way of suicide attempts can follow which activates emergency procedures to contain the situation and maintain safety, to the extent of prolonged and unhelpful hospital admissions to an overburdened inpatient network during the Coronavirus pandemic of 2020.

The complexity of processes within a mental health services for young people may mirror the complexity and tragedy of a young person's background as mentioned above.

Sometimes the doctor or psychologist or therapist becomes recruited into caring parental role, which cannot be fulfilled in the way a young person may want. Furthermore this relationship comes to an end when the young person becomes an adult at 18 years of age. Usually better outcomes are achieved if a young person has other adults in their life who are positive role models, such as more distant relatives or sport's coaches.

Health professionals in these situations are invited by the young person to show sincerity, compassion, kindness and strong commitment, which can be hard for us to honour in the context of work pressures. This vital request from a young person also highlights the qualities of being they need in their parents and carers which they are not receiving. Young people may need their parents to step up for them and when this dies not happen it may be too painful.

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