Woman's Hour - Inquiry launched into NHS maternity 'systemic racism'

Episode Date: February 12, 2021

An urgent inquiry to investigate how alleged systemic racism in the NHS manifests itself in maternity care was launched this week. Anita is joined by Sandra Igwe, co-chair of the inquiry and who set up The Motherhood Group to support Black mothers after her experiences of giving birth, and Dr Karen Joash, Consultant Obstetrician and Gynaecologist at Imperial College and spokesperson for race equality at the Royal College of Obstetricians and Gynaecologists.Girls sit at home waiting for 'Mr Right, a nostalgic fantasy invented by their parents. There has to be a better way." The words of Mary Oliver who with her friend Heather Jenner set up the UK's first ever Marriage Bureau in 1939. The book she wrote nearly 80 years ago has just been republished and the story has caught the imagination of Hollywood producers. So who was Mary Oliver and how relevant is her advice today? Film director Richard Kurti who rediscovered Mary Oliver and dating expert Charly Lester discuss.As many as one in six young people now experience mental health problems ranging from depression to self harm and anorexia. The situation’s got worse over the last year of lockdowns and school closures leading some doctors to warn that the problems we’re seeing now are just the “tip of the iceberg”. Yesterday Emma spoke to the Children’s Minister Vicky Ford about young people facing mental health issues and where they can go for help. We were inundated with emails from concerned parents who have not been able to access the help they need. One mother, Lucy, shares her story with us.You may be familiar with the novels of Thomas Hardy- he’s known for his realist novels, often with tragic characters struggling against their passions, fate or the circumstances in which they find themselves. Although many feature strong female characters written with real sympathy – Hardy writes them from the point of view of an omniscient, all-seeing narrator. But over the coming year, Radio 4 is dramatizing some of the novels purely through the eyes of the prominent female characters. Hardy’s Tess of the D’Urbervilles will be first – this Sunday at 2pm. Later titles include Jude the Obscure, The Woodlanders, The Hand of Ethelberta and Two on a Tower. Katie Hims dramatized Tess of the D’Urbervilles and she joins Anita Rani to talk about writing the story from a female perspective.Presenter: Anita Rani Producer: Kirsty StarkeyInterviewed Guest: Sandra Igwe Interviewed Guest: Dr Karen Joash Interviewed Guest: Richard Kurti Interviewed Guest: Charley Lester Interviewed Guest: Katie Hims

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 everybody, Anita here, welcoming you to today's Woman's Hour podcast. Good morning, we have made it to another Friday, so how have you all coped with the weather? I was out filming yesterday, I can just about feel my toes again. But thankfully, the Woman's Hour studio is warm and inviting, and it is lovely to be here with all of you. So much to talk about today. Not least, your responses to hearing what Children's Minister Vicky Ford had to say about mental health services for young people on the show yesterday. Thank you to anyone who shared your story. I'll be reading a few of your emails later in the programme.

Now, many of us have pondered this question on a lonely, lovelorn evening. How do you meet a partner? A lot of single people wondering this now more than ever, I'm sure. Well, we're turning to the past, to 1939, to see how it was done then, when the UK's first ever marriage bureau was opened by Mary Oliver. And she very handily wrote a book all about the experience. So we're chatting romance today, or maybe lack of romance. And I'm curious and a bit nosy. I'd love to hear from you. How did you meet the love of your life?

Were you set up? Maybe it was a chance encounter at a bus stop, in a club or at a tea dance, or the thoroughly modern way via an app. Maybe you met through a marriage bureau. Well, I want to hear your tales of romance. Why not? The more unusual, the better. And we've had some tweets in already. Stephanie says, I was in

the school play in the sixth form in 1969. He came with his mate whose girlfriend was in the same play. We all met up outside the head's office then on to the pub. My first 17-year-old visit to the pub. Oh, this is the clincher. He took the top of the beer bottle off with his teeth.

I was smitten. 52 years ago, still married, 47 years. You can text on 84844 with your tales. Text charge at the standard message rate. Please do check with your network provider for extra costs. You can also contact us via social media at BBC Woman's Hour or email via the website. I'll also be filling you in on a

brand new adaptation of Tessa the Dervils for Radio 4 and this one is written from the perspective of Tess rather than her creator Thomas Hardy. We'll be hearing from the writer but first. An inquiry into to investigate how alleged systemic racism in the NHS manifests itself in maternity care was launched this week. I'm joined by Sandra Igwe, co-chair of the inquiry who set up the motherhood group to support black mothers after her experiences of giving birth and Dr Karen Joash, consultant, obstetrician and gynaecologist at Imperial College and spokesperson for race and equality at the Royal College of Obstetricians and Gynaecologists.

Morning to you both. Welcome to Woman's Hour. Sandra, why has this inquiry into racial injustice in maternity care been set up? Hi, everyone. So glad to be here. Black women are not listened to as a whole. We don't believe like our basic human rights have actually been met. We don't feel like our words and our concerns are taken seriously in this country. And I do believe that we are not a priority here. And it's time for our voices to finally be heard, amplified and for change and action to now come. And there's some very worrying statistics that have come out, haven't they? Absolutely. Yep. So black mothers um four times more likely to die and have complications in pregnancy um a 2013 study also found that black and asians were less likely

to receive pain relief than our white counterparts and we're also less likely to um you know have a choice of where we actually give birth and we're less likely to feel like we're treated with kindness. And that resonates so much with me, because that's exactly how I felt when it came to my pregnancy and birthing experiences as well. And what are you hoping to do with the inquiry? How long is it going to go on for? Well, it will go on for one year. So this time next year, we would hopefully complete the inquiry. And we're hoping that the, you know, we find actions and concrete recommendations to bring, essentially bring the death rates down for Black and Brown women and hopefully for us to have our dignity and our respect intact when we

are pregnant and giving birth and also we want to actually hold decision makers accountable so that they understand what racism actually looks like. And also to finally, finally listen to Black women like myself, Asians as well, and to take our words seriously, to stop stereotyping us in our birthing experiences. And also for us to know our rights. I had no idea of my rights when I was pregnant, when I gave birth. And I'm hoping that more Black women and brown women like me know our rights during our pregnancy so that we have more authority. I'm going to bring Karen in.

Karen, these figures are shocking, disturbing and totally unacceptable. Black women four times more likely to die in pregnancy or childbirth than white women. Asian women twice as likely. Why is this happening? Do you believe there is systemic racism within the NHS? Thank you very much for giving us the opportunity to discuss this. It's such an important issue. So I'll first of all go back to in terms of what you discussed

about the statistics and really ponder why nothing has been done today. I do think there had been a little bit of a narrative amongst us as a medical profession and I had also bought into the narrative that a lot of these excess statistics were due to women coming from abroad or women being poor and those were the issues that led to their healthcare outcomes. Some of the analysis that was being done in the last two years actually revealed that that was not the case. It's not because of a social economic difference. And I really want to lay that on the table. So I myself, if I go into hospital with my best friend who's

white, I'm more likely to die. And actually, although we're talking about this in the context of maternity, this transcends all specialties. It transcends into medicines. It transcends into neonatal outcome. So the RCOG has picked up on this and has been brilliant in setting up a task force which was commenced in 2020. And essentially looking at three different areas, looking at what you described, looking at the system in which we deliver care,

looking at us, the caregivers, and looking at the women as well. We very much know that there will be some elements of structural racism, which will be some elements of structural racism which will be unavoidable because the NHS was created for a white British population but unfortunately as it stands it doesn't necessarily meet the needs of those that it intends to give health to and that's if we look at the different systems we're looking at differential attainment, I'll mention a publication Snowy White Peaks which looks at the people who commission services.

So, for example, even I as a woman, if all my services for women's health are commissioned by a man and they're the people who sit on the board, we will not get it right. So we need to get the right diversity in everybody from all backgrounds, all together, working out the best health care system that meets the needs of everyone. So do we need more research into this? It sounds like what we need is action. We do need some research, but we need action as well. Totally agree. So rather than just simply sitting and saying that these statistics are bad, that's what the race task force is about,

is really to start to take action. So we're looking at ways in which we can arm women with education to know their rights to know about different conditions that affect them on the rcog website ready have a lot of stuff about patient information but i'm very much a believer that education is power and education is power in all elements of life so if you understand your health you can optimize your health really really it's all well and good educating the women who need to access the services but what about the people they're meeting at the other end when they walk into the hospital and the doctors and nurses in it very well said fantastic for raising that so again we need to think about a term a bus term called cultural competency what is it about i mean i had bad experiences my son unfortunately

nearly died from pneumonia and we went to A&E three times. And on reflection at the time, when I sat back and I felt, why did they not listen to me? Why did they not believe that I was lying on the bed with my son in the middle of the night, hoping he wasn't going to die when I could see him having rigors? Because they couldn't see the blue in his lips. So it's really looking back to our textbooks and how we train ourselves. You are absolutely correct to recognise those signs and symptoms. Why is it that more black and brown babies die in the neonatal period? Is it because we're not very good at picking up jaundice because we don't see it on the colour of the skin because it's not in the textbooks, it's not well taught and there's so many elements of that that we need

to really get right and work on and that's what we're doing. And Sandra, your experience of giving birth to your daughters led you to set up the motherhood group why was that yeah so when i um in my birthing experience um it was extremely um traumatic for me both on both occasions i do have two daughters and um i was sent back five times um when i was you know in in labor and i was told you know that i was fine when I asked for pain relief. With my second daughter, after begging and after screaming for hours on end, I still was refused pain relief.

And with my first daughter, I did beg. And after 37 hours, I was given epidural, which failed. And it really, really confused me at the time as to why they weren't believing me, why they kept saying, I'll be fine. I don't need it. I don't need it. I was so confused and angry at the time as to why they weren't believing me why they kept saying I'll be fine I don't need it I don't need it I was so confused and angry at the same time that I was being treated I felt differently because of the color of my skin um and also I told them that I felt my baby's head

starting to crown they didn't believe me I felt her head and once they could see that her head was actually there then they you know brought some more staff into the room and quickly um you know got her out which she passed meconium stool on the way out to show how stressed she and i both um both were and um immediately i i knew that something wasn't right and that you know black women as a whole i don't feel like our words are taken really seriously and i do believe there's an element of you know the angry black woman stereotype that a lot of healthcare professionals do have in that vulnerable period and I was told that I was being rude and having an attitude when

I was just in excruciating pain and that was that's what essentially led me to start my organization the motherhood group and what and what are the rest of the women in the group saying to you? In what ways are they being discriminated against? Yeah, so right up until even the postnatal period. So I went on to have undiagnosed postnatal depression and that's because I didn't feel like I could trust the healthcare services and share my feelings and how I was feeling because I felt like,

what's the point if they don't really listen to me what's the point of sharing it with them and so I've heard quite a number of other black women share similar situations to mine where they just felt like they also were being judged and not taken seriously based on the colour of their skin. Karen, Sandra just said something really interesting there about she didn't feel she could trust the services. Do you think this is not just about maternity? This is about the NHS general and how people from black and Asian communities access health care services and how they feel about that. Yeah, thank you so much for raising that, because that is absolutely key. Because always sit back and look that when we're looking at mortality, we are looking at the tip of the iceberg because you will

look at mortalities at the top but what about all those near misses all the people that don't get the correct health care that they are supposed to get but they somehow survive they therefore are scarred by that psychologically they themselves their families they don't trust the health care system or the services what about those people we don't even have the analysis of those people at the present we don't have the the analysis of those people at present. We don't have the research into the new misses. And that is a really vital key part of information that will help us to make our services better and safer. When we now look at that, we then look at the fallout of all of that. Is it affecting you? Is it affecting me? It is. It affects all of us

because we then come back to the situation where we are with COVID-19 in the pandemic and we look at the increasing number of people from black and brown that have been affected and ultimately it's affected all of us. So what needs to be done? What change needs to be implemented? So for us we're asking the government to commit to reducing this statistic by 50% within the next five years and And really, we want to really work with the government to ensure that targets are set rather than people just, you know, keep talking about it. Let's do something about it. Let's really work together and really tackle this problem, which I know that we can do. There are solutions there and we can work together to sort it out. And Sandra, what do you want to see happen as a consequence of this inquiry?

No, of course, just similar to what Karen said, we want to see happen as a consequence of this inquiry? No, of course, just similar to what Karen said, we want to see action. We want to, you know, as I mentioned before, we want to drive action by making sure that those who are decision makers, policymakers now are held accountable and put deadlines in place for these stats to be lowered. We want to see healthcare professionals and other experts working directly with decision makers and policymakers to know what exactly needs to change and how we can have access to safe, respectful and also dignified care. What would have made your experience better? How would you would rather have been treated I mean like I was vulnerable call me by my first name look in my eyes if I say I'm feeling a pain in a particular area checking it immediately not ignoring me not taking my words taking it lightly checking if I'm okay just just being

treated like a human being it's not it's so simple to me but it's still not done surprisingly so yeah Karen and I and I would definitely say to the healthcare professionals that are out there just ask and ask again when you see somebody look beyond the skin just recognize that person may be a bit afraid of you they may not want to open up to you if you are from a slightly different background and all it does is just takes a little bit of time get rid of that doctor cloak the professor cloak the professional cloak and just say i'm here to care for you tell me what you need thank you both karen joash and sandra igway if you'd like to share your experience um please do email us you

can head to our website to get the email address now girls sit at home waiting for mr right a nostalgic fantasy invented by their parents there There has to be a better way. Not my words, although they could be. They're the words of Mary Oliver, who with her friend Heather Jenner set up the UK's first ever marriage bureau in 1939. The book she wrote nearly 80 years ago, The Marriage Bureau, about the success and failures of her matchmaking business has just been republished and is so good. So who was Mary Oliver and how relevant is her story in advice today? Well, I'm joined by dating expert Charlie Lester and film director Richard Curti, who rediscovered Mary Oliver.

But before we start, let's get a taste of Mary herself. Here's a short extract from the book read by Helen Quigley. They always come in together. And the elder one, Miss Mannering, read by Helen Quigley. for Miss Knox, and how much better it would be if she were introduced to him. According to her, every man she meets is fascinated with her. Actually, they usually invite her out to lunch, and she takes them back to tea at her flat, which is full of taffeta cushions and smells faintly of Harris tweed scent. She always wears expensive tweeds and diamonds. After that, she rings them up incessantly for days and frightens them away. Meanwhile, she becomes more and more determined to pin one down,

chiefly because she wants to be relieved of the worries of a dwindling alimony. One of the reasons, one of the many reasons why the book is so much fun. She's so straight-talking, isn't she, Richard? Richard and Charlie, welcome to Ormond's Hour. What a find, Richard. Tell us about Mary Oliver. How did you discover her? Well, she literally was a footnote in history. I was working on a script for Fox Searchlight about a royal chef, and I was doing some research about social history between the wars. And in a footnote on the chapter on relationships was this little line that said, in April 1939,

two 25-year-old women set up the very first marriage bureau in the country. And I was fascinated because I thought in April 1939, it was so obvious that Europe was sliding into a cataclysmic war. Why would anyone think about setting up a marriage bureau? And I started Googling and I found this battered old book that was published just once in 1942, written by Mary Oliver and a really talented journalist, Mary Benedetta. So I bought it and I sat down expecting it to be old fashioned and stiff and very brief encounter. But what leapt off the page to me was this incredible voice of Mary, young, rebellious, outspoken, not afraid of offending everyone prickly. But underneath it all, she had dedicated her life to helping people find happiness and the Bureau

was an amazing success within a month they had hundreds of people a week writing to them and it lasted for decades it was matching people for decades and who was she what kind of family did she come from she was the maverick she was the misfit she came from a middle-class farming family just outside Cambridge but she was the daughter that everyone in the family always worried about. They kept trying to palm her off with people. They sent her out to India to arrange a marriage. She hated the man. He just kept writing lists for her about what she should do after they're married. So she cancelled the wedding, sold the wedding presents and used the money from that to get her passage back. And it was on the ship back from India that she had this idea there's got to be a better way of men and women finding each other, something that empowers women.

And you're right, she's, and the book is so much fun to read. She's this thoroughly modern woman, empowered woman in 1939, isn't she? And she does empower her clients as well. Completely. It's all about, she is, the book is like the Haynes manual of love and marriage. You know, she lifts the bonnet and she says, this is how it all works. If you want to succeed at this game, this is what you have to do. And she's aware that a lot of people have got themselves into ruts and they need help to get out of it. And she is that help. And it could be everything from going and buying them new clothes, buying them laundry, teaching them how to behave, teaching them about what each other wants. There was a great example, Mr. Dulap, who I really responded

to, who was 57. And he had this, his only assets were like a little wayside garage with no electric light and no sanitation. But he had 20 acres of land, a pony and somebody else's cows. And Mary said to him, install a flush toilet I said but why the views are beautiful she said install a flush toilet and I really related to that because when I was in my 20s I was living in London and I thought I was in a good relationship and one day the girlfriend said to me she said go and buy a washing machine and I said why the laundrette's fine she said buy a washing machine Richard and I said but it's a rented flat she said when you move you can take it with you and I said no no it's fine two She said, buy a washing machine, Richard. And I said, but it's a rented flat. She said, when you move, you can take it with you. And I said, no, no, it's fine. Two weeks later,

she finished it. And I was like, why did she finish me over a washing machine? But I read Mr. Dulap and I thought, I get it now. I get it. It's like, I failed the audition about, do they have domestic ambition? And she went into that space and she just explains it to everyone. Let me bring Charlie, our dating expert into this. You're still having to explain to people that they have to have domestic ambition, Charlie. Not quite. I do have to explain about photos on dating apps a lot. I don't know if that's the new equivalent. Could you explain what the dating landscape is now?

We've come so far since 1939, haven't we? I mean, this was the first ever marriage bureau set up in the UK. Do we still have marriage bureaus? Do we still have matchmaking services? What's the distinction between apps and dating and matchmaking? I mean I would say there's quite still quite a large distinction between the online technology and real life matchmaking so that does still happen and the main distinction really is the cost so you can go and use the dating app for free um if you want the service of a matchmaker these days you're looking at anything i would say probably between two and thirty thousand pounds to have to your because you're essentially um getting outsourcing your

your love life to someone else right someone else is going to find that person for you um so yeah these agencies do definitely still exist exist. And the reason that the costs vary so much is, I guess, partly in the service that they're offering and also in the clientele that they deal with. I mean, there must be a huge difference between what you get for £2 and what you get for £30,000. Yes, I know. I mean, this is the interesting thing. I know, you know, I've worked in this industry a long time. I know a lot of the matchmakers and um and to be completely honest in the UK most of the paying members are women and it's the men that the agencies have to find and I know a lot of the agencies will actually look for the men on the dating apps so I kind of think if you've got the time you may as well start by not paying anything and doing the search yourself at least initially. Mary writes about wanting to make people realise that they're not doing anything mad or extraordinary by coming to the marriage bureau and she also says that people very rarely

told people how they met. Is that still true today do you think? Do you think there's still a stigma? Well there's definitely a parallel so there was I would say 10 years ago there was a huge stigma that surrounded online dating. You would get people who would get right at their wedding in the speeches would still be you know explaining a lie as to how they met each other they wouldn't they wouldn't admit that they met on a dating website and I think that that stigma has lifted probably in the last six or seven years I think um you know actually the more casual apps like tinder that have just become so every day have actually and they really gamify dating right they turn dating into a game that you could play, that you could play for your friends. So a lot of people who aren't single have played, played in inverted commas on Tinder on their

friends' phones and tried to find matches for their friends. And that has really brought it into the everyday vernacular and really lifted that stigma. So, but one thing I will say is that I do think there is still an element where some people feel like if you're having to go out and find love, you have somehow failed. And I think that that is a parallel that we can draw with Mary's time really. And that this idea that if you just haven't been at the right, in the, you know, in the right place at the right time, then I think people see it as a reflection, are they not attractive enough in some way? Whereas actually, you know know these ideas

are these meet-cutes that were served all the time in romantic films of you know your hands touching over the cereal box how often does that really happen you know you might not have met on a dating app but if you've met in a pub or in a nightclub is that any more romantic than going online and deciding right I want to find a partner I said we've had some lots of people getting in touch with their very romantic um meet-. Lots of meet-cutes happen with people listening to Woman's Hour. Margaret says, I met my husband on the back of a lorry,

a carnival float. We talked to one another all the way to Hinkley. He was dressed like John Wayne and I was a southern belle. How romantic. Keep your, how you met your partners, the stories coming in.

She also was more than just someone trying to matchmake, wasn't she, Richard? She was really, she was actually teaching people how to make themselves more attractive to the opposite sex. Tell us about this wonderful character, Somerset. Yes, so she says, she realised that people did not have the tools to help themselves. So Somerset was a woman, a young woman,

who had ended up in this little village looking after an invalid aunt. And hopeless, she just could see the rest of her life extending in front of her with no escape. And one day she was wrapping up the flowers in a bit of newspaper and she saw a little clipping about Marriage Bureau and she thought, this is my one chance for freedom. And she went up to the Bureau and she almost ran away because she was so nervous and Mary took her in hand and she realized that this woman was a beautiful young woman but had

made herself plain and dowdy and attractive and she set about releasing the passionate young woman that was inside her she took her shopping she burned all her clothes she got her in lingerie she got her a haircut she got her a nice suit and the woman was unleashed she said it was incredible to see this woman be reborn and she successfully I mean she actually went from one extreme to the other and is that something you have to do yourself Charlie kind of right really kind of give people pep talks well not quite quite to that degree but I do think that actually probably the area that people need help with these days is marketing themselves, because I think particularly us Brits days is that they end up going too far. And so using their best ever photo that looks nothing like them or a picture that's 15 years too old. And then you want to meet this person in real life and you don't want your first impression to be one of disappointment.

And that's the thing I find myself explaining time and time again to people. It's been so fun talking to you both. We could really talk about this book all day. Richard, is it going to be turned? Are we going to see her on our screen soon? You are. Yes, you are. Two fantastic young women producers in LA have picked up on it because they love the whole rebellion thing and they are developing it as we speak. So watch the space. We will do. Richard and Charlie, thank you so much. It really is a brilliant book. Marriage Bureau. She does remind me of that marvellous Miss Maisel. If anyone's seen that, that's a thoroughly modern woman trapped in another era.

Now, on yesterday's programme, we heard that as many as one in six young people are now experiencing mental health problems, ranging from depression to self-harm and anorexia. Worryingly, situations have got worse over the last year during the pandemic, leading some doctors to warn that this is just the tip of the iceberg with a time bomb on the horizon. So many of you listened to that discussion and got in touch that we wanted to revisit it today

and share some of your experiences. First, to remind you of some of the background. Now, since 2003, the Department of Health has distributed child and adolescent mental health services, or CAMHS, funding via local authorities. One of the main criticisms now is that the money gets diverted as it's no longer ring-fenced. The local government association website states demand has gone up, funding has stagnated, and waiting times for treatment have increased. On average, clinical commissioning groups spend only 1% of their budget on children's mental health, which is 14 times less than adult mental health. The amount varies from £202 per child in Islington to just £25 per child in Crawley. In 2019 to 2020, a total of over half a million children in England were referred to CAMHS for help, which is up 35% on the year before. In November, the Chancellor announced an extra £500 million that was going to mental health

services overall. And in May, the government also put £5 million into mental health care via Public Health England. Some of this money has been pledged to young people's services. The amount isn't specified and these figures offer mental health support across all ages and the BBC has also just launched a new platform on its website called Headroom to help with people's mental health during this time of the pandemic. There's a link to it on our website. Now yesterday the Children's Minister Vicky Ford spoke to Emma Barnett about the issues and how children's and mental health services around the UK are coping. There are parents listening to this trying to get help right now for their children who won't recognise what you're saying.

So actually what I've encouraged people to do is to come forward and get that help. There's a significant amount of help out there, much improved from when I was young, much improved actually from even the past couple of years. I think they're trying. With respect, I think they're trying. And if they go, for example, last week was Children's Mental Health Week. We've produced a huge list of advice for parents of different places they can go to to get help and support. If your child is extremely unwell, then the first point of call, of course, must be to be your GP who can refer them on.

Children's mental health services have continued during the pandemic. And a lot of those therapies and discussions have happened digitally, which for many young people have helped them. But the referrals, as we know, there needed to be extra investment into mental health services, and that has come in the past few years and an extra 500 million coming this year.

There is urgent help right now. Sorry, if you've sought help, if you've done exactly what you've said and you haven't still been able to get it. One of the other things we've done during the pandemic is we've set up a 24-7 crisis helpline for mental health. That's there on the 111 NHS 111 service. It's in every single trust across the country. And we've made sure that that is there for adults as well as for children, for children as well as for adults. There's a message from Paula saying, my daughter waited nearly two years from an autistic spectrum diagnosis.

Over two years that we first asked for help, she's still waiting to see a psychiatrist. She's self-harming. We're desperate. We really want help. The minister isn't providing it. So, Paula, what I would say, if your child is self-harming and serious problems, do call that mental health crisis line. And we're also in the process of going through a major review of the special educational needs and disability system, the SEND review, which is an absolute top priority,

and I will be reporting on that later on this spring. Well, following that interview, we were inundated with emails from concerned parents who've not been able to access the help they need. Lucy has shared her story with us. I just felt compelled to call after listening to the minister on Women's Hour. As a mother to a 16 year old who lives with autism and ADHD. For the last few years he's also been accessing child and adolescent mental health

services and it was difficult to listen to the minister because what she's saying doesn't necessarily match up with lived experience. My son was diagnosed age six after a two-year process of referral and waiting and it was also suggested at that age he needed a special school which he didn't ultimately get until age 14 which meant an eight-year wait. During that time he attended two mainstream secondary schools and had a really difficult time at one point this included being placed in isolation and not being allowed to go to the toilet and having an accident because of that he was continuously misunderstood and and therefore not supported appropriately that then started to have an impact on his mental health and like many people we waited two years for

assessment and intervention and then when COVID started quite understandably the intervention was paused one day at school he he took himself up onto the roof having left the the classroom and you know that was his way of letting us know that he was really struggling and he really needed some help the intervention started again after that and it almost felt like it took a crisis before you know support can be accessed which has been our experience at every step of the process with my son the initial request for support and intervention has usually been turned down and you have to ask again and again and lean on systems to get the help that you need. He has now been discharged from the Child and Adolescent Mental Health Service because he is now stable and he's stable

because he's been getting the help and one wonders how long it will be before we have to ask for that help again. I think until there's a more proactive way of supporting young people and less emphasis on responding to a crisis, we're likely to continue to have these difficulties. I'm sympathetic to there being a finite amount of resource and a finite amount of available trained professionals. But I think we need to think imaginatively about how we get past those problems. And I think that's the conversation that we need to be having. You know, as a mum, you know, you want the best for your child. You we need to be having you know as a mum you know you want the best for your child you want there to be support for your child and that isn't there at the moment in the way that it should be. And that was a listener Lucy you heard from there but

we've had another email in saying I cannot believe the interview with Vicky Ford she seems to be blaming parents for not seeking help for their children I'm literally shouting at the radio CAMHS is chronically underfunded. My autistic and depressed teenage daughter was given 50 minutes a fortnight because of short funding. She tried to commit suicide three times before more support was given. She's now following excellent care with a DBT program. We have to reach crisis point to get the help we need. I begged CAMHS to give more support as she was talking about taking an

overdose, which she eventually did. I was told none was available. As a teacher, we cannot be expected to deliver mental health provision to our students. It's not our job. CAMHS needs to be properly funded. So what is the reality of your experience in your family? Have you been able to access the services you need? We're going to be looking at this in more detail, so we'd love to hear from you. Do get in touch at BBC Woman's Hour, or you can email us through our website. Now, you may be familiar with the novels of Thomas Hardy. He's known for his realistic novels, often with tragic characters struggling against their passions, fate, or the circumstances in which they find themselves. Although many feature strong female characters written with real sympathy,

Hardy writes them from the point of view of the all-seeing, omniscient narrator himself. But over the coming years, Radio 4 is dramatising some of the novels purely through the eyes of the prominent female characters. Imagine that. Hardy's Tess of the d'Urbervilles will be the first, this Sunday at 2pm,

and later they will be treated to Jude the Obscure, The Woodlanders, The Hand of Ethelberta and Two on a Tower. And Katie Hymns dramatised Tess and she joins me now. Welcome, Katie. For anyone who isn't familiar with the story of Tess, we don't want to spoil it for them, but describe her situation for us. So her name is Tess Derbyfield she's beautiful uh she's 16 years old she's the eldest daughter of a large family that live very

precariously uh they're financially really vulnerable their father the head of the family is a is a pretty feckless soul uh he. He has the responsibility of taking the bees to market at 2 a.m. And because he's been out drinking, Tess instead is sent to take the bees to market at 2 a.m. And she falls asleep while she's driving this car and the horse is killed in a collision in an accident. And she feels completely responsible for this, the death of the horse, which is a huge source of income for them. They can't replace the horse. And without it, they can't work so she feels this obligation to go and claim kinship with the wealthy d'urberville family because the uh the the local parson has just uh informed the uh feckless dad the night before that they are the um the um descendants of the noble d'urberville family so tess is sent to

claim kinship with the wealthy d'Urbervilles who live some miles away. And actually they aren't real d'Urbervilles, the wealthy lot. And on her first visit to Mrs. d'Urberville, she meets Alec d'Urberville, the son, and he's a very predatory character and he's the kind of agent of much of her downfall. Yeah, and he takes advantage of her, doesn't he?

So we can hear a clip of that right now. OK. I don't know how long I slept before Alec returned. Tess? Already at that hour, most likely some men were stirring and striking lights in not very distant cottages. Where are you? Men with good, sincere hearts.

Ah. I found you. And none of them could help me because they didn't know. They didn't know the danger I was in. But then I didn't know myself. What the danger was. Until it was too late. Tess.

Dearest Tess. I'm back, Tess. I'm back, Tess. I'm back. What are you doing? Kissing you. Don't. You let me kiss you before. No, I didn't.

Yes. Yes. No. Tess. That was the moment. That was it. The thing that led to everything else. Most of all, it led to this.

This place. These four walls and that window with the bars. Oh, I'm engrossed, I'm hooked. And then shock horror, she falls pregnant, which is a typical trope of a Victorian fallen woman. What was radical about Hardy's telling of the story? I think he's completely on her side. He's asking his readers to show compassion and understanding for this woman and this journey

that she makes this kind of tragic disastrous journey of her life and and how it goes horribly wrong so he's um he's he's pointing up the double standards of um you know um for women who you know cannot possibly be seen to have had sex before marriage. And when Tess's husband confesses that he has had sex before marriage, she feels maybe she's free to also tell her about, tell him about her past and he rejects her. So Hardy is talking about the sexual double standard. He's talking about the hypocrisy of religion as well. When Tess isn't allowed to bury the baby in consecrated ground because the baby wasn't baptised. So she she actually baptises this baby herself.

And it's a really moving, I find it incredibly moving when she gets all her siblings around her to baptise this baby. And it's a moment where Tess does have some agency, actually. So it's quite an important moment in the book for me. And it's really moving and it's really surreal as well. She wakes up all her brothers and sisters in the middle of the night to try and save this baby by baptising him there and then. And she asks the person, will it count? Will it count? And it's very moving. So what did you find you having to do? Because obviously, what we're going to be seeing for the first time or hearing is it from her perspective rather than through

Hardy's gaze. So what did you really have to change? I think what was interesting is that we're no longer watching her. We're not watching her with Hardy. We're inside her head. So we don't, Hardy cannot stop talking about her mouth and her arms. We don't hear about her mouth and her arms. And it's quite a relief to me because that was one of the things I was struggling with. And so we're inside her head. We're not observing her all the time. And she has hardy sensibility. She has some of his pessimism. She talks very early on in the book before anything's even gone wrong about how they live on a blighted star. So she has his soul and his intellect. And consequently, without constantly being reminded of how beautiful she is, it gives her more substance I think but I think one

of the things I struggled with is that he doesn't represent Angel Clare the kind of semi-hero of the book as particularly desirable there's no descriptions of how he looks really apart from the fact that he has a straw-colored beard so when I was trying to write about Tess's desire for him I only had a straw colored beard to go on and I could have done with more to work with there I felt did you want to add anything else to her obviously because you're a 21st century woman did you find yourself going oh if only I could just make her do this or if yeah I got really obsessed one night before I'd finished the adaptation with saving her because she of course it's a tragedy so she has a tragic end and

I I rang the producer I was like can we just change the ending and the producer was kind of like oh I don't think so and of course you can't it's like putting the wrong head on on on the right body you know this is a tragedy everything in the book is set up to to end in a certain way and it's Hardy's story it's not my story I kind of hit my limits there I did want to save her very much and it's Hardy's story, it's not my story. I kind of hit my limits there. I did want to save her very much. And it's a bit like when you watch Romeo and Juliet and you think, oh, maybe they won't die this time. I was like, maybe I could, you know,

maybe she doesn't have to die. Anyway, that's it. It wouldn't be the same. Why are these stories so enduring? Well, I think it's incredibly beautifully written. It was a very important story to tell then. I think it is a feminist written it was a very important story to tell then I think it is a feminist story in so many ways you know it's not perfect but how could it be perfect and it's

it's it's beautiful and also I think the way that Tess is it's an ordinary life made extraordinary in the writing and she's she works you know she works really hard and relentlessly and and he presents that as a story worth telling about this woman who has an ordinary life and becomes extraordinary. OK. Yeah. Yeah, Katie, thank you. We're looking forward to it. The first episode of Tess of the d'Urbervilles is on BBC Radio 4 at 2pm on Sunday, the 14th of February.

That's all for today's Woman's Hour. Join us again next time. Hi, I'm Zahnd Van Tullican. And I'm Kimberley Wilson. of February. That's all for today's Woman's Hour. Join us again next time. to take a tour of the human body. Each week we hone in on a specific body part, from the eyes and lungs to the appendix or the vagus nerve, and we ask how we can understand it better, ourselves more, and combine the body and mind to produce positive change. So subscribe to Made of Stronger Stuff on BBC Sounds. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started, like, warning everybody.

Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby.

It's a long story. Settle in. Available now.