Woman's Hour - A New Series Exploring Teenage Mental Health

Episode Date: June 17, 2019

Over the next couple of weeks we’ll be devoting a lot of time to teenage mental health. If you’re reaching for the off switch you do need to hear this - people on the front line with real experience and insights. We’ll be talking to health professionals, teachers, parents and, finally, young people themselves. We aren’t naming any of them so they can talk freely. Today, two health professionals: a Consultant in Emergency Medicine who leads on Mental Health and, to begin with, a GP, the first point of call for many teenagers and their parents. You’ll hear them talking about CAM-H. – that’s an acronym for Child and Adolescent Mental Health Services.We discuss the latest front cover of French satirical publication Charlie Hebdo. It is an explicit and sexualised image of a football on a woman’s vulva. How have French feminists reacted to it and what is the impact on the Women’s Football World Cup which France is hosting? For more than thirty years, Maud West ran a detective agency in London. What was it like being a female detective in the early 1900s? We hear from Susannah Stapleton on her new book about the life and career of Maud West, one of Britain’s first female detectives.Why are women asked to undergo painful medical procedures without adequate pain relief, how prevalent is this, and what are the consequences? We hear from Paula Briggs, Consultant in Reproductive Health at Southport and Ormskirk Hospital NHS, Katherine Tylko anti-hysteroscopy campaigner and a woman who recently underwent an hysteroscopy.Presenter: Jane Garvey Producer: Kirsty StarkeyInterviewed Guest: Agnes Poirier Reporter: Catherine Carr Interviewed Guest: Susannah Stapleton Interviewed Guest: Paula Briggs Interviewed Guest: Katherine Tylko

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme, peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hi, this is Jane Garvey and this is the Woman's Hour podcast. It is Monday the 17th of June 2019. Today, mental health. There's no doubt that we're all able, we're almost encouraged to discuss mental health like never before. But if you need help or if a child, particularly a teenager, needs help, is it actually available these days? Can you get the right help? How long do you have to wait?

Over the next couple of weeks on Woman's Hour, we're going to be looking very closely at the issue of teenage mental health. And what you'll hear on the programme is the people who are going through it, whether as carers, as patients, or as medical professionals, telling us how it really is. We've kept them anonymous so they can be free to be absolutely honest about their experiences. And we start that series of conversations on the podcast today. You can find out more, although perhaps not everything, about the life of Maude West, who styled herself London's leading lady detective, and she started work in the early part of the 20th century. And we talk about hysteroscopies.

Are women expected to routinely put up with really painful medical procedures that no man would be expected to put up with without really decent high-level pain relief? So that's on the podcast today, all of that. But we started with a conversation about the magazine Charlie Hebdo. No one will have forgotten that 12 people were killed in a terrorist attack at the offices of that French satirical magazine in 2015. You'll recall the hashtag Je Suis Charlie and the marches celebrating and supporting free speech.

So fast forward to the latest edition of the magazine, which has a cover featuring the Women's World Cup, which is taking place, of course, across France right now. And it's a pretty explicit image of female genitalia and a football. And over the top of the image is, we're going to be eating it up for a month. You can probably, yes, form your own ideas about what that's a reference to. I talked this morning to Agnes Poirier, the French journalist, writer and broadcaster, and asked her about reaction to the cover of Charlie Hebdo.

Well, it's always a mixed bag of people finding it very funny and others finding it appalling. It's always like this with French satire, which is quite unique in its style. And Charlie Hebdo. I discovered it like many other people one early morning, and I thought it was quite early to see it. I hadn't had my breakfast yet. And if you'd like, it's always a tale of we have different identities. So as a feminist, I sort of cringed a little.

And of course, it's crass and a bit vulgar and a bit offensive. But the citizen in me thought, you know, smiled and thought, this is Charlie Hebdo. This is, you know, how free they are. And so, you know, and they paid so dearly for being so free. And, you know and they paid so dearly for being so free and you know it's it's a cartoon that doesn't incite hatred that is uh not calling for murder and it's teasing it's actually sexist

but in a teasing way if you if you really look at it just uh you know after you've recovered from the first uh uh just watching it for the first time. You say it's not in a sexist way, but is there... No, no, I said it's teasing. It's sexist in a teasing way. Okay, sexist in a teasing way. I get that absolutely right. That's what you said. Would there be a magazine that would depict male genitalia in that way in France? Well, actually, there was. And they did in the past. They mock everything. So, you know, when some feminists said this is really appalling, and not only

feminists, some people, you know, took to Twitter and said this is appalling, then a lot of people just said, well, this is what they do. And they came up with a lot of covers mocking male football with male genitalia, you know, and going back decades.

And that's specifically, this magazine has done that, has it? Yes. And we tend now to concentrate on Charlie Hebdo whenever we talk about French satire, but there are many others. And at a time, you know, at the same week, we heard that the New York Times, of all publications, was ending their political cartoons, you know, at the same week, we heard that the New York Times, of all publications, was ending their political cartoons. You know, you think, well, you know, good for Charlie. What they do, what French satire do, is to provoke, to shock, to make you think, and perhaps more importantly, rethink, to get you out of your comfort zone.

And it is a very uncomfortable feeling sometimes. You don't need to buy it if you don't like it. But you can't stop seeing it, though, can you? Presumably it's displayed in public across newsagents. Well, it depends. And it depends on the subject, actually. And I was quite happy for my daughter, who's quite young, not to be, not to see it on the kiosks. So perhaps a decision was made for that one. So, but, you know,

the real topic here is, and it's a very optimistic one, it's women football, because there's an incredible momentum at the moment in France. And perhaps we can talk about this because the viewing figures... You're absolutely right. We need to celebrate the good stuff which is that people are flocking to these games and they're being entertained. And you know what? The TV

viewing figures are double what was predicted. And the stadiums are packed and families go there and little boys and little girls and fathers and mothers and grandparents flock to cheer the French team.

And the good thing in this is that a good game is a good game, basically, whoever is on the pitch. And it might attract, I mean, it will necessarily attract far many more sponsors. And what does that mean is that it's going to redress the pay imbalance in women's sport. And that's really something to rejoice. Yeah, certainly. If that happened, that would be something we'd celebrate. Thank you very

much, Agnes. Agnes Poirier, French journalist, writer and broadcaster, about the cover of Charlie Hebdo. Of course, the sport, the football continues, importantly, in France across the week. England and Scotland both have games this week. Coverage, of course, on the BBC. Now, teenage mental health, which I said at the outset, is going to be the focus of Woman's Hour

over the next couple of weeks. And we really obviously want and need your involvement on this subject. You might well have heard already that the Prime Minister is at a school in London today. She's launching a new initiative. This is about teachers being trained to spot early signs of mental health issues in pupils. Well this head we've spoken to and you'll hear more from him later in the next couple of weeks. This head says, frankly, schools have already got too much to do. The expectations society has of schools is getting greater and the pressure on schools to achieve outcomes

in terms of both academic performance, financial performance, the well-being of people has changed and increased and we're in the public eye for everything and anything I think rarely a day goes by without a story on the news where a politician or someone from industry will say and of course what we need is schools to do and that's lovely and we'll try and do whatever we can but we can't do everything. Well that head teacher was speaking frankly to us and we will try and do whatever we can, but we can't do everything. Well, that head teacher was speaking frankly to us, and we've kept every contributor anonymous so they can really speak freely. And you can hear more from him on Thursday of this week. You might well know that last year, referrals to child and adolescent mental health services

across the country were at their highest level ever. There's no doubt we're all becoming so much better at talking about mental health issues but if you need help is it available? This week and next you'll hear from health professionals, from teachers, from parents and from young people themselves. Today the voices of a consultant in emergency medicine with responsibility for mental health issues and first the real life experiences of a GP. People come for a very large variety of reasons which now have all been subsumed under an umbrella sort of idea of mental health and we're more and more are pathologising sort of feelings that people have and we're very disconcerted by

any form of distress so that when particularly young people become distressed they come I think often quite quickly to the doctor or a family member will come to the doctor and it's difficult to know whether they want to be labelled and they want to be sort of diagnosed as having a psychiatric problem or a mental health problem or whether they want not to be. I mean, that's part of a supposed skill of a GP is being able to pick out which of those things is wanted.

But also you do have to sort of balance the fact that you don't want to medicalise everybody who comes through the door. And also even sort of looking for diagnosis is only the first step in actually helping people to feel better. So your role as a GP is in some cases kind of a gatekeeper to other services. You're kind of signposting people on, you could go here, you could try this, this is what I can offer offer you so if a young person comes to you and you think actually yes they do require more attention and it's not for the primary care team to give it to them what do

you have in your arsenal in a sense real real crisis is almost easier because there is some services there available for that you may be able to get the acute psychiatric team and get an early appointment for someone to be seen by a secondary care specialist the sort of middle range are really difficult actually because there isn't so child and adolescent mental health which is called CAMH in most parts of the country has been systematically really totally under-resourced and under-loved. And really tragically, actually, at the exact same time as they increase awareness, they've continued to run down those services. And now we find the waiting list for that were absolutely extraordinary.

Like what? I don't know what it is in our region at the moment. The last place I was, we would be waiting usually three to four months. Months? Yeah. And during that three to four months, yeah and that during that three to four months that child or adolescent has no support other than gp usually family and school but there isn't anything else so how does that feel then if you've got a young person who i don't know

has an eating disorder or is self-harming and would really benefit from those services how do you feel when you think i'm about to tell them there is somewhere to go they're going to have to wait for it i mean it's incredibly it's incredibly difficult i don't i think anyone can see that that's difficult eating disorders are a very specific example they have again they're very very specialist services and they're immense waiting lists which are quite firmly gate kept so that you have to hit a certain BMI to be included in various places. It's incredibly frustrating when it's early days in an illness and you can see where it's going to go, but you haven't got any way of intervening early.

And actually, if you can get in early, you can make a much more significant difference, whereas waiting for it to become entrenched is really, really frustrating, actually. Furthermore, families and children themselves become incredibly upset and frustrated. You're the only point of contact. People will come back to you week after week, more and more upset, more and more frustrated. You're offering them 10 minutes at a time to deal with that. If they're very lucky, you can give them a double. That would be 20 minutes. You know, they want something doing you you've achieved this diagnosis which can sometimes be elusive but now you can't sort of give them the help they need to get going and that that's incredibly frustrating and in the sort of gp

community is it something that you talk about like what do we do about this how can this be better managed how can we help to advocate for better services what's the sort of chat amongst gps these will be the consultations that often do cause distress to the doctor as well because the frustration of not being able to help someone and then not being able to help them again and then again it is really demoralizing and i think it's one of the things that we do tend to talk about a lot informally amongst ourselves is you know what can I do with this specific person is there anything you can think of that we can offer him or her in the interim and and is there any way to manage the risk because actually for a lot of um adolescents you you know you can sort of split hairs over

diagnosis all you like but there are a significant small but significant number of children and young people who will actually seriously harm themselves and whether they did it with a full depression diagnosis or not or they were fully suicidal or not they're they're they've done something terrible that's irrecoverable for everybody concerned and and you always have that in your mind i think in the sense that you're holding the risk on your own and that the poor family and the child are holding the risk at home and and there's there's no other sort of safety net and the outcome could be as bad whether it's an actual mental health crisis or whether it's someone with normal distress trying to express that okay yeah exactly so so i think that what makes them a particularly difficult

group in a sense in a very and a group that should be distinguished from adult mental health is is that you have this impulsivity that is slightly less dominant and in in inverted commas normal adults so adults with severe psychiatric illness often impulsivity will be a feature but otherwise it it it is less so whereas in children or young people you can have impulsivity anyway as part of a growing brain and and that can mean that a child who really perhaps isn't severely depressed and is actually functioning and would not score on any of our systems and perhaps if you sat down and did a proper diagnostic consultation over an hour they wouldn't perhaps come up as markedly

distressed or even or even at significant risk of suicide but who will then have one impulsive evening or one you know accidental moment where even whether it was on purpose intentional whatever their hope of outcome some you know catastrophe can occur is there anything that gives you cause for hope that the government might be talking about or that moves in primary care towards better understanding or funding of mental health? Or do you feel quite despondent? I find young people themselves quite a large source of hope because they are so articulate and they are so keen to help each other, actually.

And usually I actually find the patients themselves more inspiring and promising than anything else. And also the fact that families do care so much and they are, you know, although it can create difficult scenarios, that, you know, it's amazing to see how much people knock themselves out for each other. It really is. In terms of systems, I don't want to speak for everyone else, but I do feel that there's a sort of disingenuousness going on whereby there's a lot of sort of lip service paid to mental health and a lot of we've done a mental health initiative and we've raised awareness and I don't really care to see any more posters or adverts I'd like to see some proper funding put

back into CAMH some recognition that family therapy is important part of it that the allied disciplines are crucial that occupational therapy is important that practice nursing which has been decimated is essential there's hardly any community psychiatric nursing anymore that was incredibly valuable but they've taken out the whole there's some recognition that specialist services need money but they're the they're the last point of the pyramid and they're absolutely funneled down so we have waiting this and there's some awareness that gps can deal with lots of things but very little kind of funding or training available and actually it's not so much training

you need the actual stuff and it it sounds like a boring much raised political point but you can't look after people if you don't have people there to do the looking after. You know, you can raise as much awareness as you like, but if there's one doctor in a room with nowhere to refer to, it doesn't really help me or anyone else to be aware. I'm an emergency medicine consultant in an emergency department, and I'm mental health lead for that department. In my own department we know there's a 25% increase in attendances for under 16s with mental health problems so that's a big hike and we think that's been going on for a long time. That's against a background of adults going up by about 12 to 14% each year. That's significant. Yeah, yeah, yeah. For a long time Royal College

of Psychiatrists and other people have been saying, if you come in crisis as an adult, you should get a response within an hour. So that's, if you're 18, that's what'll happen. If you're 16, you wait a day. Is that just purely funding? Yes. Yes, it is. There's been a bit of an uplift of funding in beds a couple of years ago, and the government's talked about more funding. It's going to take a long time for it to get through,

and I doubt it'll even touch the surface really there's a survey on the royal college of emergency medicine website about camh services for patients coming to the ed and there's some very interesting comments one of which described i'll read it to you it's so appalling that it has reduced our staff to tears under the resignation of a senior ed nurse emergency department is not the place for an acutely disturbed or distressed children young person to be there's no appropriate room to accommodate them they wait hours for assessment have you had any staff who just can't hack it and think actually perhaps understandably for their own mental health i can't do this, there are people in our teams that have moved on, moved on to things that are perhaps a bit more sustainable.

Longer term, you see a bit of compassion fatigue. There's a few people that come regularly in child and adolescent. There's more in adult care where we see them twice a week sometimes. Yeah, it's hard to start again afresh and keep being sympathetic and keep being kind potentially 53 percent of people rated the services for young people in their department as poor 12 said it was awful over that they meant they had safety concerns and so it goes on so what does a typical day look like in terms of your role is there a typical isn't no there's no typical

day so i if i'm doing a clinical shift i will just go and see whatever patient is there a tricky bit i find with seeing particularly a teenager is it takes longer to get them engaged to try and work out what's happened to them and often i get the feeling I don't necessarily get to the bottom of what's happened but I get an idea and then I have to work out whether that patient potentially could go home. The national guideline is that everybody stays in to have an assessment by a CAMH team the next day but that's quite a big thing for a teenager to stay in a paediatric ward overnight the average age of a paediatric mission is probably two or three so little people who are snotty and coughing and short of breath and then you have a some teenagers well not many but one or two at any one

time that's hard and then there's the ones that are really distressed and you think okay you're going to come in you're going to wait to see can h and then if you need to have a be admitted to a adolescent mental health bed they could be five days in an acute hospital the most distressing thing for me is watching people get worse in that time in hospital so they're completely they're distressed anyway because they've done a significant self-harm or they're significantly suicidal, enough that people want them to be admitted. We tend to keep the 16-year-olds in our emergency observation areas where there's people with head injuries and alcohol

and older mental health patients with sort of established patterns of self-harm. You don't really want them to have to be exposed to that. So they get a single room, which is good. It's quiet quiet it's calm it's safe but it's like being in a prison our room has one window that looks out on a brick wall and there's that so nothing's happened yet so no news on the bed no news on the assessment and then coming to keep going back and say this is what we've done this is we phoned you've got nothing to offer that is really frustrating you're trying to manage parents expectations the child usually just becomes quite not child a young

person quite quiet quite withdrawn potentially and that's not good i have a an amazing manager who whenever there's a young person waiting for a bed he just gets on the phone and he will phone everybody until he can agitate to get to bed and he does a good job actually he's worked his way around the system and he feels that's one thing he can do but I watch the frustration with him and how many phone calls that takes emergency department is the default for when everything goes wrong so I've looked after child in a foster care or in an institution when that that breaks down, they end up with us. And then we end up with a young person who has been violent

because their life's not going well for them in a paediatric A&E. And then we have security around trying to keep this person safe because they might be acting out or trying to help self-harm or sometimes being quite aggressive. I mean, that's rare, but that's really distressing, and that's when my nurses really struggle. We then come in and we'll offer some sedation, which doesn't seem like a great option either.

Sometimes it gives someone some time out, but it does feel a bit like, well, we're just kind of medicating you to make you easier to manage, not necessarily to help you. That's hard. Sometimes our only treatment has been, can someone go and buy this child a burger king that will help sometimes thinking outside the box and i worry about the effect it has on staff working in a service that's not sustainable so if i was a mental health clinician only seeing

people with self-harm i'd want there to be quite a few supports and opportunities for training and perhaps doing other things that's not always self-harm but yeah actually they seem to be just right rotas you'll you'll see that many people and you'll you'll work that many weekends and i worry that that's not sustainable for people i wonder as a clinician what your sense of some of the factors behind maybe teenage suicide rates going up or more self-harming or more presenting at A&E and I wonder what they tell you about why they're unhappy. They often feel isolated in their social groups so they may have a few friends. Some will say they have been bullied online. There's a bit more sort of gender dysphoria.

I'm very biased because I don't see the people who have gender identity problems that don't have mental health problems, but I see some that do. And that often seems to be a long-term thing. Academic pressures, I think, in some environments. Everything is measured, isn't it? You have an attainment goal. And I think people are always comparing themselves to other people. People's self-esteem quite often is quite low because they are being measured at school and they're also effectively being measured on social

media by how they feel that they are viewed by others. Sometimes there are kind of groups of young people who manage their mental health problems together, and that has good points and bad points. So there's a community of people who've been in hospital together, and when one of them tries to take their own life, everybody else seems higher risk. Sort of contagious? Yeah, sort of, but I guess they're distressed because someone they've effectively lived with in a mental health hospital has tried to take their own life or has completed suicide,

and then we've actually not had many but when we have had a suicide we've actually put alerts on people that know that person so that we are aware when they come in that they may be at higher risk yeah what does it feel like when somebody who has been under your care or you're aware of on your radar as an A&E department does end up taking their own life as a young person. It's horrific. There's one or two of them I've known really well, actually. And then you've watched them. Sometimes you've watched them for several months and they've continuing self-harm behaviour and assessment and people trying to manage them in the community.

And then the same behaviour then ends up in a completed suicide. And you know about their pets, you know about their family. Yes, it's tough very very powerful testimony from a consultant in emergency medicine who has responsibility for mental health issues and before that the gp and the line i took away from what she had to say you can raise awareness as much as you like she said but there is a bot of course and the bot being you can't always get the help you need when you go out there and are brave enough to ask for it. Catherine Carr was the reporter there, and there'll be more voices on Women's Hour over the next couple of weeks. And on Friday the 28th, that's a week on Friday, a panel of experts will be on the programme talking

about everything raised in that series of conversations. So if you're in this in whatever capacity, as a health professional or as a patient or as a carer, please do feel free to email the programme via our website, bbc.co.uk slash womanshour. Please do take part. You can tweet as well at BBC Women's Hour. And here's one tweet from a listener who says, I recognise the situation being described today

as a massive gap in the system to support children with mental health issues. We were failed despite our GP doing her very best. This is a huge problem. Tomorrow on the programme, the sex therapist Dr Ruth Westheimer is with us. She's 91, she's still full of vim and you can hear her advice on the programme tomorrow. Now, Maud West also had quite a lot of vim and quite can hear her advice on the programme tomorrow. Now Maud West also had quite a lot of vim and quite a lot going for her. She was, well she styled herself London's leading

lady detective and she's the subject of a new book by Susanna Stapleton, The Adventures of Maud West, Lady Detective, Secrets and Lies in the Golden Age of Crime. Susanna, welcome to the programme. Hello. Now, how did you find out about Maud West? Well, it started from my love of golden age crime, actually. I was reading, I think, one of Gladys Mitchell's Mrs Bradley mysteries and just wondered, were there really female detectives working at that time? So I googled, as you do, and came across very, well, nothing really. But then I found a description of Maud, of a photograph of Maud in an online archives catalogue and

fell into this massive rabbit hole from there. So it's a fascinating rabbit hole though and effectively you turned detective to find out about a detective. Yes, yes. She was, well, there's a colloquial term we could apply to Maud. She sold herself very well, didn't she? Yes. Bit of a blagger, old Maud. Yes, yes. I mean, one newspaper called her one of the most vivid characters in London, and she worked very hard to live up to that. She wrote lurid articles about her supposed work in the press and dressed up for disguise photographs as Charlie Chaplin. When did she start though what era was she working in? She started in 1905 and she worked through to 1939. Long career. Yes and a fascinating period of social change as well.

Yes take us into that world then because initially she was very busy solving kleptomaniac issues at effectively Edwardian house parties. Yes yes so weekend house parties around 1910. Big problem with kleptomaniacs of very wealthy women sort of just helping themselves to knickknacks at their hosts' parties. And private detectives were brought in to mingle amongst the guests, disguised as guests or as servants, and just keep an eye and sort of retrieve anything that might have slipped into a pocket by mistake. Yes, oops, I've put that priceless ornament in my handbag.

So there really was a lot of that going on, was there? Yes, yes. I mean, there have been studies about why kleptomania became such an issue in high society at that time. I mean, there is obviously the problem with the lower classes, it would have just been plain old thieving, but if you're a lady, it's kleptomania. I think there was even a suggestion that some very well-connected members of the royal family may have been dipping there yes

yes we don't i mean she's long dead by the way so i think i'm all right so i think it was queen mary okay so um we've established that she might have helped herself to one or two little knickknacks along life's highway um let's talk too about marriage and divorce because this was another lucrative area for the likes of Maude. Yes and it was really where Britain's private detective industry started with the change in divorce laws in 1857 which opened up divorce to the masses or at least those who could afford the fees and the investigation fees and one of the stipulations of divorce at the time, as it was for many, many decades afterwards,

was that you had to prove adultery. And so many ex-police detectives set themselves up as private detectives in order to provide this very service, because it's not something you would necessarily want a friend or a family member having to stand up in court and discuss. There are all sorts of repercussions that can come from that. So detective work in Britain, private detective work, really arose from that need to prove adultery and divorce. There was a slightly farcical element to all this, though, wasn't it? Because in some cases, you'd have to ask a friend to pretend to be going with you to a hotel. Yes, I mean, that is one way that people did it.

But there were prosecutions for collusion and for perjury with things like that. So you had to be very careful. And so private detectives just kept you one step removed from that. And they took all the flak in court, really. And boy, did they take the flak. Yes, okay. And the newspapers really did lap all this stuff up oh they did yes yes and what was the the weekly that maude in fact wrote for you

mentioned um oh yes one of she wrote quite regularly for pearson's weekly which was rather tawdry rather tawdry i'd have got it i know that yes i mean it's an absolute hoot to read what articles about cheese smugglers and things like that. Cheese smugglers. Cheese smugglers. A problem, apparently, at the time. Right. Who knows? It might be in the future, the way things are going. So tell us a bit more.

I don't want to give too much away about Maud, because there are a few little bits of Maud that she didn't want to reveal. Yes. How did she get to be a detective in the first place? And how many women were there doing this sort of work? Well, Maud health gave many different accounts of how she became to be a she came to be a detective um and i'm not sure how many of them i can describe but that none of them quite added up should we say that but um there there is evidence

that um quite a few um actresses actually went into detective work because there was a great crossover of skills between being on the stage and blagging your way through life, getting into places you shouldn't really be. And putting on different disguises. Yes, yes. And she did dress up, but she had a variety of disguises that could take her just about anywhere.

Yes, yes. She certainly wrote about using disguise a lot, variety of disguises that could take her just about anywhere yes yes um she she certainly she wrote about a lot using disguise a lot whether she actually did in her everyday work is debatable but i think she certainly used disguise at some point and and quite often female disguise just simple ones such as a nurse's outfit can get you into all sorts of places um wigs were very popular obviously just changing hair colour. And at one point she said, of course, no one expects a middle-aged woman

to be on their tracks. So that was the biggest disguise of all. So we need to make clear, although there are doubts about some of what Maud said about herself, she was good at her work. Oh, yes. Yes, she was a great detective

and she was a phenomenal businesswoman as well. How did the police regard these lady detectives? They were actually very accommodating to them. big old boys club but they all needed female assistants at least and female detectives to get to go into places where men couldn't go so actually it was quite a friendly sort of access relationship

all around. I thought it was such a slice of life this book I really enjoyed it unexpectedly I enjoyed it actually I should say Susanna thank you very much so if you're a fan of medical information, by the way, there's some cracking medical stuff in here about Maud's husband in particular. But anyway, I'll leave that to you to explore. As you say in the book, he wasn't exactly a catch.

No. No, just read the book. Susanna, thank you very much indeed. Maud West, A Lady Detective is the subject of Susanna Stapleton's new book. Now, I mentioned at the start of the programme that we were talking about medical procedures like hysteroscopy. Now, this is a procedure that involves inserting a very thin telescope with a camera on the end to examine the inside of the womb. And it's something that is relatively routine. However, some women, we should emphasise here, some

women find it extremely painful. And the idea is that perhaps women are being asked to put up with medical procedures no man would ever be expected to endure without pain relief. Here is the experience of one woman who had a hysteroscopy. I was 66 and I started bleeding. So I'd got postmenopausal bleeding, which I knew immediately could be a symptom of cancer. So I went to the GP and was referred for an appointment. And on the day, what happened? Two days before, a letter came with two separate patient information leaflets in this told me it would be uncomfortable

with cramp like pains and like a smear test i wasn't unduly worried by this i'd already had cramp pains i'd had a coil fitted in the past i'd given birth to an eight pound three ounce baby with only a bit of gas and air so yeah so you were no you were no novice also it said to take two paracetamol or ibuprofen before it did mention a local anaesthetic but said that they don't normally use it because of side effects i just needed to know if i had got cancer or not what was it like i was hit with the most intense unimaginable pain. And this was when the device was inserted? Yes. I've never experienced anything like it before. It shot right up my body, up to my neck. It took my breath away. My legs were twitching. My heart was thumping, I was sweating. The pain was just so overwhelming

and it was carrying on so I started to panic. Can I ask, had you taken pain, you'd just taken a couple of tablets had you? I had and I'd eaten. I started to panic a bit, then I started to feel sick and faint and then the next thing that happened was this burning sensation went all over my body. The pain stopped then and the doctor's nurse came round to me and said, it's cramps dear. I managed to nod and eventually got out the word no and the nurse stopped the doctor. I think the people doing this know that it can hurt a lot. I know that in the end you did have the procedure, didn't you,

but with an anaesthetic. Afterwards I went to see the doctor and I told him that that was horrendous. I said if childbirths are 10, that was 15 to 20. What were you eventually diagnosed with physically? Complex hyperplasia. Which means? It's an overgrowth of the lining of your womb and it can eventually lead to cancer. So you did need treatment and you... Yes, I've had a hysterectomy last October. Yeah, and you wouldn't have had that or you wouldn't have been

diagnosed with that without that procedure? Oh no, the test is a really good test. It saves a lot of women's lives and some very fortunate women don't feel much at all. Yeah. And then there are some like me at the other end and a lot of women somewhere in the middle. So it's a good test. We shouldn't put people off going for it. No, well gone. What I feel strongly about is

a general anaesthetic was not mentioned to me up front as an option. Severe pain wasn't mentioned to me before at all. Well, thanks to that woman who was prepared to talk so frankly about her experience. We'll talk in a moment to Paula Griggs, who's a consultant in reproductive health. Catherine Tilko campaigns on this issue.

Catherine, good morning to you. Hello there. I guess you'll have understood that experience only too well. Can we talk about general anaesthetic? How often is it mentioned in relation to hysteroscopies? Well, if Woman's Eye could help us with one thing, it would be to get across the fact that it should always be mentioned. And we're really lucky that we've worked with the Royal College of Obstetricians and Gynaecologists,

and they've produced a really good leaflet. And I'm going to plug it here. It's rcog.org.uk. Actually, I can save you your breath. Thank you. We're going to put a link to that on the Women's Hour website. Thank you. And what we want people to do is to read that leaflet and it tells you your risks of severe pain.

The fact that you actually have the choice of asking for a general anaesthetic on some really enlightened hospitals have IV conscious sedation. Now, when I have a colonoscopy, which I have to have regularly to check for cancer, I always say, yeah, please, I have conscious sedation. Now, when I have a colonoscopy, which I have to have regularly, you know, to check for cancer, I always say, yeah, please, I have the sedation. There's no question about it. Men get sedation for colonoscopies. That's endoscopy of the colon, endoscopy of, you know, so why not women? And we just want people to give fully informed consent, know they've got a choice of pain control, not go through a sort of conveyor belt procedure like the woman who spoke to you went through. We want individualised care and then a really good doctor.

And we know there's some damn good clinics out there. A really good hysteroscopist will interview the person if that person, say, has problems with speculum exams, faints with their period. Then you can do something. So that's what we're looking for, really just information. Of course. Thank you very much, Catherine. Paula, our consultant in reproductive health, why isn't a general anaesthetic always offered to women? Because it's not always needed. I think both the patient and Catherine have made some really good points.

The RCOG have produced best practice in outpatient hysteroscopy which recommends vaginoscopy so that's not putting a speculum in and that reduces discomfort. Actually that guideline does not recommend conscious sedation and I think the most important point that the patient made is that women should have the option of a general anaesthetic. They also should be in control of when the procedure is stopped but there is fluid that's put through the camera to improve the ability to see what's there and therefore even when the equipment is removed for some women there is still cramping discomfort because of the fluid and the patient really was describing I think an element of cervical shock so although the pain was horrendous the dizziness and the nausea that she experienced

were additional factors which made the procedure very uncomfortable. Is there any way of telling which women will find it really painful and which won't? I mean the lady I spoke to had given birth she was absolutely no amateur in the pain stakes she'd been through some stuff in her time and she found it excruciating. Yeah and I think that's another very good point there is no way of predicting who's going to find the procedure very painful. So it's just important that all women are given the information about local anaesthesia, topical anaesthesia being an option, and the ability for the procedure to be abandoned at any point.

I think I've just done two hysteroscopies, and because I knew on here, you know, asking the patients, how was that for you? And neither one of them found it in any way invasive or uncomfortable. And they didn't have anaesthetic? They didn't have any anaesthetic. They had vaginoscopy. We had a clear view of the inside of their uterus and clearly were undertaking these procedures to reduce the risk of missing cancer, which is very treatable if it's picked up in the early stages. Well, I think we're absolutely adamant, and so is our patient. This is important. You need to have these procedures. It could save your life.

But I just wonder, Paula, whether, I mean, the bottom line, I guess, is that all too often it might seem women are expected to put up with stuff that men would never be expected to put up with. Is that still happening? I don't think so. I think we all aspire to provide good patient care to make the patient very much part of that consultation. And when that experience goes wrong for a patient,

I think we feel regret with that. And I don't think any doctor sets out to cause severe discomfort. And it's very, very difficult when you're counselling patients about a procedure to get that balance right about explaining what's going to happen. But for most women, it's a tolerable procedure. But for a very small number, it's painful because what you don't want to do is make the patient incredibly anxious because that then increases the risk of them having a low pulse rate which can cause nausea and dizziness and make them feel worse

and I'm absolutely convinced of that because routinely fitting coils, the more anxious the fitter is, the worse it makes that for the patient. For everybody. Paula Briggs and thanks to her and indeed to Catherine and to the patient we talked to earlier in that conversation. We did get some, well, fascinating emails and tweets on this. Louise obviously had a horrendous time. She says, my hysteroscopy felt how I would imagine a backstreet abortion with a knitting needle would feel, but without the whiskey. Louise, I'm horrified to hear that

that was what it was like for you. We should say, of course, and we cannot emphasise this enough, that not every woman feels anything like that level of pain. Clearly, though, some people do find it excruciating. Liz is a listener who emailed to say, I was sent for a hysteroscopy last year and I found it very painful. The doctor who carried out the procedure explained what would happen. He was caring, as were the entire nursing team. The process lasted for about 15 minutes, but it did feel like torture. The pain was so excruciating that it went into a kind of shock, which means that your blood pressure drops dramatically, your pulse rate slows and as I'm an insulin

dependent diabetic my blood sugar fell rapidly as well. I honestly felt as if I was about to die. As soon as I realised this was happening, which did take a while, I alerted the staff and the procedure was stopped. Apparently, as your doctor said, this reaction occurs in quite a small number of women and there's no way of telling who it will affect it took me about 10 minutes to feel reasonably better and another hour or two before i felt completely all right from nancy i'm not one to cause alarm and i am genuinely generally very stoical but my hysteroscopy was a painful and traumatic experience. As the consultant tried to pass the scope through my cervix, I let out an uncontrollable animal roar and I frankly kicked him with all my might, hitting the consultant in the chest so he flew to the other side of the room.

He was very apologetic and said that my cervix was unusually tight. I haven't had children. I spent two hours in the post care room in tears and shock. Later on, I did have the procedure under general anaesthetic. I think I need to make the point that obviously, if you've had a hysteroscopy and it was all right or bearable or fine, then chances are you're not going to email the programme. So we just need to bear in mind that that, I'm sure, is the most likely experience. Because the last thing we want to do is put women off having these procedures, which, as our patient said in the middle of that conversation, is so important and indeed can be life-saving.

But clearly, this is an issue. And it's something that a lot of people feel very, very strongly about. Now, teenage mental health is something that we're going to be talking about over the next couple of weeks and thanks to everybody who's already emailed us about this. My background is school public health nursing, says this listener. Our service is being decimated, which impacts hugely on the preventative element of work with young people. The problem is the same with all public health preventative work.

If nothing happens, that's no acute drama, the government thinks nothing needs to happen. We work to raise awareness at the most difficult of times, knowing that school and public health nursing isn't a luxury, but a vital frontline NHS service. Why don't mental health hospitals have their own emergency departments for mental health issues, says this listener. Why don't mental health hospitals have their own emergency departments for mental health issues, says this listener. Why go to a general hospital? You wouldn't attend a mental health hospital with a broken leg. Right. Yes. I mean, that's a good point. I mean, we're not really in a position to completely wholesale reinvent the NHS and the way it works. But these are all really important questions that I hope will at least scratch the surface of answering them over the next couple of weeks.

And just a quick heads up again, it's June the 28th, which is a week on Friday, that the entire programme is going to be about teenage mental health and the issues raised during the series of conversations you'll hear on the programme. Now, Susanna Stapleton is still here, the author of the book about Maud West, the lady detective. People are always interested. Our listeners love a detective story, but they also want to know how you got to the truth about Maud West, because you started in our conversation on the show by saying that you Googled and there was nothing there. So where do you go then go then I mean frankly my instinct would be to pack it in pick an easier subject but but you didn't do that well I suppose to start with I am a historical researcher by by trade by profession so so the next thing I did was after I checked all the easily available archive catalogues from

the comfort of my home I then stayed in the comfort of my home and looked at the easily available digitised newspaper collections that were available online. And that's when I first came across the more lurid stories that she had written about her work, but also some clues about her going to events and appearing at events and talking. She met Dorothy Elsayers at an event in London. So I knew that she was real and really a detective.

Her office was actually not far from where we're sitting now, was it? No, no, it's in New Oxford Street. And it's now, it's been destroyed, the building, hasn't it? Yes, yes. But in an amazing coincidence, my literary agent, when I started writing the book, they were based in Drury Lane and I knew that he said, well, we're going to have to move office at some point.

I got an email from him one day saying, oh, I think I'm sitting in Maud's office. And the agency had moved into the building that replaced the location of Maud's office. It the agency had moved into the building that replaced the location of Maud's office. It was like it was all meant to happen. Yes, there were many, many coincidences while I was doing this. As ever with books we talk about on Maud Mazzaro, it's the chunks of social history I found absolutely fascinating.

And cocaine has been in the news a lot over the last couple of weeks for a string of reasons that people will be familiar with. Drugs were not illegal, were they, until 1920? Yes. And they feature quite prominently in your book. Yes, yes. So there was a time when it seems like pretty much everybody could have just been off their heads all the time, really.

Well, they weren't dressing up or being kleptomaniacs. They were off their boxes, yes. Yes, yes. But it became a problem during the First World War for the government and for the military They were off their boxes. And this was alarming the authorities, worrying about the effectiveness of the fighting force and things like that. So there were Defence of the Realm Act regulations came into force during the war to damp down the sale of narcotics to soldiers and around military bases and things like that. And that then became enshrined in law in 1920 under the Dangerous Drugs Act. And that's when drugs started to go underground.

Where they have remained. Where they have remained. And nightclubs and sort of illicit drug dens and everything came to the fore in the sort of roaring 20s then. We've been very careful. I've been very careful for once, not to say too much about who Maud really was. Yes.

Would you describe her as deceitful, deceptive? She wasn't a nasty person. No, no. And those aren't words that I have generally ascribed to her in my mind. I think she's outrageous and a real PR queen and probably quite a bit of a drama queen. She'd have fitted rather well into the 21st century. She would. I mean, I can't imagine what she would have done with social media

and it's probably best that we can't see it. She'd have had a field day. And I'm unsurprised to hear that this is going to be a TV show. Yes, it's being developed a script is being written by an amazingly talented team and it's sort of bouncing around getting edited at the moment so who knows if it will actually make it onto our screens these things can take time

but in your dream world who will play Maud? in my dream world absolutely Rebecca Front I was watching one of her episodes of Psycho Bitches which is a fabulous programme and she just gave one look and I thought oh my god that is mortal that is absolutely mortal

so well Rebecca if you're listening give your agent a tinkle your agent a tinkle and see if you can get this meeting with Susanna set up and her people. Yes, definitely. Okay, thank you very much. Thank you. Really interesting to talk to you.

And Susanna's book is about Maud West. It is called, the official title, got it here, The Adventures of Maud West, Lady Detective. And the subtitle, Remarkable True Story. Well, some of what Maud said was true, certainly, but not all of it. Yes. Thank you very much. And tomorrow on the programme, I know I keep going on about this, but Dr Ruth is with us with loads and loads of powerful advice about how to keep relationships going.

But also I wanted to mention the BBC Two series Mum, which I know a lot of people have really enjoyed. Lesley Manville is the star. She plays a widow, Cathy, who falls for Peter Mullen's character, Michael. And it's fair to say that her son isn't all that glad about Mum's new relationship. So what was it like for you if you wanted to introduce a new partner or a prospective partner to the rest of your family?

Did that person get a warm welcome? How did people behave around the new person? Let us know via email bbc.co.uk slash womanshour. We all live in a digital world. How we work, how we play, the way we live, navigate the world, morals, laws, memories, even how we generate a thought and we share it with someone. These are all filtered, stored and sorted by the technology in our devices, in the cloud, and even in the pavement beneath our feet. So we have to ask, how is the technological world shaping us as people? I'm Alex Kratosky, and I want to introduce you to The Digital Human, the podcast that tells the stories of being human in the digital age.

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