Key quotations illustrating subthemes within understanding factors underlying premature mortality in MCN
| Theme | Quotes |
| Burden of mental ill health and substance misuse issues | “Most of the people I know that’s died, their mental health has just been shot to bits, it’s all about the drugs. They’re taking the drugs because of mental health, is that bad? I’d say more the mental health killed them…the drugs just done that job.” —Individual with lived experience of MCN |
| “These [new psychoactive substances] are completely changing the conversation to what they were 10, 15 years ago because these drugs, how they work, how quickly they hit, how quickly they can be produced, how quickly for many of them you’re on cloud 9, you’re away from it, 15 minutes later you’re back as a normal person. Within those 15 minutes what damage you could have done to yourself, to your life, to other people, to other people’s lives.” —Individual with lived experience of MCN | |
| “And there’s a reason why people are taking spice, because oblivion is better than reality. That’s the truth of it. It’s a much better option facing up to what society is.” —Individual with lived experience of MCN | |
| “I just find that people who have got mental-health issues and also have addiction problems fall through the gaps, time and time again.” —Front-line staff | |
| “The waiting list for CAMHS [child and adolescent mental health services] is ridiculous. You’ve got to be well up there on the scale to get referred. Someone with a little bit of anxiety is not going to get put through to CAMHS, whereas that anxiety will then just carry on getting worse and worse and worse, and then you end up with someone with real mental-health issues.” —Front-line staff | |
| Lack of hope, stigma and health-seeking behaviour | “You don’t see another way…it’s just doom and gloom and like you say this one’s dead, this one’s in prison, there’s nothing ever…it’s like being in the sort of devil’s dungeon, to be honest.” —Individual with lived experience of MCN |
| “This is my life, so it’s not a care in the world if it is death. Death has got to be better. So to be honest living that life, to some I think death would just be a much easier answer.” —Individual with lived experience of MCN | |
| “It’s a remembrance wall. So all the people in the service that have passed away and every time you go in it’s just getting more, you have to squeeze the names in of the people that have been lost and I know them all, I’m going, ‘Oh so and so has died.’” —Individual with lived experience of MCN | |
| “’Oh you’re an addict,’ the look on their face that it changes visibly, they treat you completely differently, ‘Oh he knows.’” —Individual with lived experience of MCN | |
| “I think that word as well, like, junky really boils my blood, heroin addict is much better. Just picking up the junky, junky, junky, that’s all we get.” —Individual with lived experience of MCN | |
| “…this doctor at the time of [the] appointment isn’t going to be able to comprehend even a tiny touch of what your life is.” —Individual with lived experience of MCN | |
| “We talked to the young people who have got mental health issues and they’re kind of like, ‘Oh no, I don't want to talk to anyone, I don’t want to tell them I’ve got a problem. I’d rather just smoke some weed or take some grass and I’ll be okay.’” —Manager/Commissioner | |
| Poor navigation and limited services | “My staff are supposed to spend their time navigating and signposting and supporting people into other services, probably about 60% of their time is now spent doing benefits stuff, just so that people have got enough money in their pockets.” —Manager/Commissioner |
| “I’m facing this maze full of doors and every time I open a door, there’s another door, sets of doors. There’s no coherent structure within the system that says, Here’s a person who is asking for help, who’s engaging with everything that we’re giving, can we please pull this together so we can actually provide the help that this person needs.” —Individual with lived experience of MCN | |
| “There are no youth services left…there’s nothing left, and that was a huge safety net. It was a learning experience, it was preventive, and it was a place of safety for youth, and it’s not there anymore.” —Manager/Commissioner | |
| “It’s often such a desperate situation that we’re having ridiculous conversations that we want someone to be sectioned or we want someone to go to prison just so they’re in some kind of contained environment where we feel we can try and manage some of the risks.” —Manager/Commissioner |
CAMHS, child and adolescent mental health services; MCN, multiple complex needs.