Teenager starves to death alone in emergency accommodation

RNZ News

a day ago

Photo:
123rf.com
Warning: This story discusses eating disorders and disordered eating, and contains disturbing content.
The parents of a teenager who starved to death alone in emergency accommodation believe that multiple agencies failed in their care.
Their only child was able to keep them at a distance on the grounds they did not accept the teen was transgender - an identity the parents say the teen later abandoned.
However, the couple allege that while attentive to their child's gender identity, various care professionals failed to adequately respond to the threat from a long-standing eating disorder.
The 13-year-old girl in the photo, whom RNZ is calling "Vanessa" at the parents' request, is dark-eyed and dark-haired like the teen's mother.
Vanessa looks shy about having the photo taken.
It's the kind of photo any proud mum might have on her phone ... the next photo is not.
It's of naked, skeleton-like remains, shrouded in the black nylon of a police body-bag.
That photo was taken on the day in January 2023 that the teenager was found dead in a locked motel room, about an hour from the parents' South Island home.
Vanessa had just turned 17.
The last time Vanessa''s parents had heard from the teen was two days previously: a message at 7pm to the mother, Catherine*.
"She texted me 'Mama, I love you'.
"She didn't want to see us because she didn't want us to know how bad it was, the anorexia," Catherine says softly.
"But you can see she suffered."
Catherine and her husband are still waiting for a date for the coroner's inquiry into their only child's death.
There is no doubt of the immediate cause of death: cachexia (extreme wasting), due to anorexia nervosa, according to the post-mortem report.
The teenager weighed 30kg, which was 17kg less than she weighed as an 11-year-old.
However, the parents believe it was the lack of adequate oversight by multiple professionals in health, education and social welfare in the last few months of Vanessa's life, which allowed that death.
All the government and community agencies involved - Health NZ, Oranga Tamariki, the Ministry for Social Development, the Education Ministry, Presbyterian Support and the Salvation Army - have expressed their sympathy for the family, but said they were unable to comment as the case was still before the coroner.
Vanessa was an extremely bright, sensitive, cheerful pre-schooler with a lively curiosity about the world.
An only child, born to her parents late in life, Vanessa was "dearly hoped for, least expected", Catherine said.
However, the family's happy, ordinary life was shattered when Vanessa was sexually molested at the age of five by an older child at school.
The Rape Crisis counsellor who helped the family through the ghastly aftermath warned her parents that puberty was often a trigger point for children who had suffered trauma.
"And that's exactly what happened to Vanessa. She was nearly 12, just at the start of puberty, when anorexia hit."
Over the next five years, Vanessa would be hospitalised 10 times.
Catherine said Vanessa would starve herself to the point where it threatened to damage the teen's heart.
"She was overwhelmingly fixated with exact measurements, calories calculated, over-exercising, drawing disturbing and macabre images, hiding food in her room."
Vanessa sought out pro-anorexia websites, connected with like-minded people via the Discord app and tried to hide the weight loss.
"She used to drink litres and litres of water before a check-up when she knew she would be weighed. We turned the water off, but then she would go drink from the neighbour's hose."
Vanessa became increasingly argumentative, and even violent towards them, Catherine said.
Several times they were forced to barricade themselves in a room and call the police.
"When you are very hungry, you are angry all the time. When she had these explosions, we wondered where she got the energy from."
A psychiatrist from the local Child, Adolescent Mental Health Service (CAMHS), in a report dated December 2017, noted Vanessa "resists the idea that she has an Eating Disorder".
"She has various rationalisations for her eating patterns and weight loss. She would like to contest the ridiculous nature of having to gain weight and eat in prescribed ways with anyone who would enter that debate with her."
Vanessa continued to insist the obsession with weight and diet was "normal" and "all teenage girls were similar".
The teen also suffered from obsessive compulsive disorder (OCD) and was diagnosed with autism at 15.
The parents believe the "black and white thinking" that is characteristic of autism intensified her anorexic ideation.
Vanessa exercised obsessively - running on the spot in her bedroom or the bathroom, according to one medical note.
"During admission in hospital, mother said that despite being hooked up to an IV line with her mother lying on the bed beside her, Vanessa was doing sit-ups."
While continuing to deny she had an eating disorder, Vanessa would become "oppositional and defensive" when her behaviour was challenged, the clinician wrote.
In January 2019, when she was 13, a Family Court judge put Vanessa under a compulsory treatment order, at the recommendation of her doctors.
"This was a huge relief to us," Catherine said.
"This court order was the only barrier between her and her death. The only thing stronger than her obsession [with not eating] was her fear of going back to hospital. She hated it so much."
In a letter to the judge, her father described his fears for her life, which (as he now notes) "seem sadly prescient":
"Before you, you see my beautiful, vibrant, inquisitive daughter, with an intelligence well beyond her tender years. What you cannot see is the year or more of anguish, hopelessness and tears that began when our warm and wonderfully ordinary family life was turned upside down by the arrogant, manipulative and destructive mental illness called Anorexia Nervosa."
Since its onset, Vanessa had "practically never eaten of her own volition", he wrote.
"That her death may well be a painful and premature one is the bitterest and most crushing possibility. What parent could ever envisage such a hell?"
Some things were going well for Vanessa.
School work was easy, Catherine said, and she was years ahead of her peers in maths, sciences, computer programming and other subjects.
She met a boy.
At high school, she was also introduced to the concept of gender diversity and at some point in 2021 became non-binary.
Vanessa adopted a gender neutral name ("V") and pronouns, which were used by staff and students.
However, Catherine said immediately after a messy break-up with the boyfriend, Vanessa started identifying as a boy.
At home, the arguments were now about gender identity as well as food, with Vanessa/V accusing the parents of being transphobic.
"She tried to 'educate' us by sharing influencer videos. She said she must be right because all the health professionals and online articles agreed with her."
Some clinicians quickly affirmed V's boy identity.
However, Catherine said the teen's long-term psychiatrist was sceptical.
"The psychiatrist advised us that Vanessa was using the transgender identity as a mask for her continuing anorexia - that Vanessa was saying the reason she didn't want a curvy, female body was not because she was suffering from anorexia, but because she was really a boy.
"The psychiatrist recommended not affirming Vanessa's transgender identity."
The school clashed with the parents over their refusal to buy the teen a boy's uniform.
"The Dean rang, said we were being ridiculous, and gave Vanessa special permission to wear her own trousers at school, thus undermining both us and the psychiatrist who had known Vanessa for five years."
In year 10, Vanessa enrolled with Te Kura, the Correspondence School, as V.
Because all their child's schoolwork and social life were now online, it became difficult for Catherine and her husband to limit computer use.
"Vanessa didn't have a phone yet. There were rules about handing in the computer at a certain time each night but it was a battle every day."
Vanessa/V left home in March 2022.
In an email to the psychiatrist, the father described an escalation in "ritualistic" behaviour and highly-restricted eating, abusive language and paranoia in the lead up.
On 8 March, he had asked to check the computer.
"It rapidly escalated into a battle over the device ... very quickly we both realised she had something to hide (hence the screaming and determination to hold the computer).
"Although we retreated downstairs to a locked room, she kept screaming and violently kicking the door."
They called 111.
While they waited for police to arrive, their neighbour watched over Vanessa from a safe distance.
"She reported that Vanessa was screaming, kicking and head-butting the wall before running inside."
The police found a hammer stashed in a bedroom and the teenager hiding in the roof cavity.
A check of the computer later revealed Vanessa/V had been using the Discord app and viewing (with other users) disturbing material.
On 13 March, the teenager moved in with the family of an ex-classmate.
Vanessa/V was referred to Oranga Tamariki and a caseworker arranged for the host family to receive an Unsupported Child Benefit.
The parents were asked to write a letter to Work and Income confirming they could no longer have Vanessa living at home.
"Vanessa seems receptive to this idea, probably not least because she now has practically unlimited use of a computer," her father noted drily to the psychiatrist.
Then on 7 April, the court lifted the compulsory treatment order at the request of the CAMHS.
"Her psychiatrist said to me, 'Let's give her an opportunity'," Catherine said.
"And I was like, 'To do what? To die?'. Because we knew that she would just stop eating.
"My daughter wrote in her diary the only reason she kept eating was because she didn't want to go back to hospital."
That month Vanessa/V was also discharged from CAMHS, which had been treating the anorexia and other mental problems.
The reason given to the parents was that Vanessa was "not engaging", Catherine said.
"Of course she wasn't engaging. She was a teenager with a serious eating disorder."
Vanessa texted her parents that if they would not accept her as a boy, it was better they did not see each other at all.
"We were devastated. We didn't know where to turn or what to do. I couldn't sleep or eat.
"Her father became introverted and silent."
They had no contact until August, when Vanessa caught Covid and texted her mother.
Catherine dropped off some supplies and after that they kept in touch everyday by text.
"We were so relieved that Vanessa was now talking to us again that we didn't press to see her. Slowly we began to rebuild our relationship."
At the same time, Vanessa's relationship with the host family broke down.
Family Works, a service run by Presbyterian Support, found the teenager emergency accommodation.
Catherine said Vanessa continued to keep them at a distance, but allowed them to supply various items, by dropping them off at an agreed location.
Catherine said it was not only the 16-year-old who excluded them from her life, but also the small army of professionals in health, education and welfare agencies, who had assumed responsibility for their child's care.
"Vanessa, and everyone who was supposed to help her, accepted the belief that we her parents, in not agreeing that she had become a boy, were uncaring bigots who deserved to be cut off."
Some of the caseworkers involved did not even know about the history of anorexia, Catherine said.
She did manage to see Vanessa in November 2022, at the motel where she was living.
"She had a self-contained apartment with her own bathroom and kitchenette.
"She was pleased and surprised to see me but was very emaciated."
The motel manager told RNZ that she and V became very close in the three months they lived there - but she was not aware the teen's health was deteriorating.
"V was very anorexic when they came and continued to be so."
But because the teen always wore a puffer jacket and baggy clothes, it was hard to tell whether things were better or worse, she said.
"My concern was for that sad child.
"My main concerns were 'Can I help this person become more resilient? Can I help them find happiness? Can I help them get hold of life somehow and enjoy it?'."
The teenager repeatedly assured her they were "eating OK", and social workers from Housing First (run by the Salvation Army) regularly visited clients at the motel.
"To be honest I knew very little about anorexia, but I now know that people with anorexia are very good at covering what they are doing or not doing."
V frequently went food shopping and discussed food, there was "always food in the fridge".
"We only discovered afterwards that lot of food was returned to the shops and money refunded."
At Christmas, she gave V dinner and "treats".
"As far as I know, no-one else visited. We were the only ones who gave V any presents for Christmas or their birthday."
She described the teenager as "absolutely delightful".
"They couldn't make eye contact but weren't averse to physical contact.
"V would frequently ask me if it was alright to have a hug.
"The only time they got upset with me was when I suggested that at some point, they had to learn how to do some things for themselves because they would be living independently in the future, and they didn't want that.
"That scared them, they wanted to stay here.
"V told me this was the safest they had felt for years, here with us."
The last conversation she had with V was two days before they died, when she tried to get V to make their own bed.
"I refused to do it because I was trying to encourage them to do more things for themselves.
"V said to me 'L, do you hate me?'. And I said 'No, I love you, that's why I'm asking you to make your own bed'."
She found out later that V had persuaded another guest to make it for them.
"That guest is pleased the last thing they did for V was something kind."
V's death was a tragedy, she said.
"They were a lovely person - we laughed and chatted, it was a pleasure to know them and I'm just really happy that - at least for the time they were here - they enjoyed themselves, they felt safe, they were comfortable."
Vanessa's parents both saw her for the last time on 1 January, 2023 - but only at a distance.
"She was wearing a puffer jacket in the middle of summer. She wouldn't let us near to see how thin she was, using the excuse 'You don't accept I'm a man'."
However, her parents said subsequently, Vanessa phoned her father and then her mother to say she was "seriously questioning the 'gender identity thing'" and wanted them to know she was indeed their daughter.
They were hopeful their child could be returning to them, but that was not to be.
In an email to V's GP, the Family Works team leader said the teenager had dropped "a significant amount of weight" since she had last seen him in early December.
"His weight loss alerted several staff members in the office. I spoke with V about his health and encouraged him to make an appointment with his GP to ensure he is getting the appropriate support."
The teenager reported feeling tired from exercising and "overwhelmed" due to autism.
"He fell to the ground at one point saying his legs were so tired, when I dropped him at home, he lifted his legs to get out of the car. He stated he has enough food and is eating well, as well as sleeping okay, however this is not obvious in his physical appearance."
The worker said she was "breaching his confidence" because she was so concerned for him and wanted to alert the doctor.
A GP appointment was booked for the next week - by then, however, the teenager would already be dead.
"I do not understand why no-one called an ambulance that day," Catherine said.
"How can it be that a child collapses in front of all these people [at the Family Works premises] and no-one calls an ambulance?"
It was the height of summer and temperatures were sweltering.
Catherine later heard the teenager had asked the motel manager for a walking stick and a hose to drink water from the tap without getting out of bed.
"The manager said she thought it was weird but did nothing about it. I asked her as calmly as I could 'A minor asks you for a walking stick and a hose to drink water from the tap - are you not going to anything about it?'.
"She got angry with me and said 'We are a motel, not social services'."
The motel manager told RNZ she did not recall any mention of a walking stick, but the comment about the hose pipe had been taken "out of context".
"V often made odd requests. With hindsight it possibly meant more than it sounded like, but it wasn't uncommon for certain requests that were unusual."
Catherine said Vanessa last left her motel room on a Thursday.
Saturday was her parents' wedding anniversary, and they decided to go for a drive in the country and were out of cellphone reception for a few hours.
After that final text on Saturday night, Vanessa could not be contacted.
"She would always text back because she knew I got worried. So we were worried."
On Monday, Catherine rang the motel, but the manager said if it was not a "professional call", she could not put it through.
So Catherine rang Vanessa's GP, who organised "a welfare check".
When Catherine rang the motel again, the phone was handed straight to a police officer.
"I knew immediately that Vanessa had died."
When they arrived at the motel, there was a stench.
Vanessa was lying in bed with her laptop propped up on her lap, dead two days.
"At the scene, the Police corrected us when we used Vanessa's name and insisted on using a male name and pronouns," remembers Catherine.
"I was so distressed by this."
Vanessa's parents believe the teenager's death was the result of the removal of the protections of the Compulsory Treatment Order nine months previously.
Catherine said it appeared there was "wilful blindness" on the part of those professionals, who were so focused on affirming Vanessa's gender identity, but did not pay the same attention to the eating disorder which would kill her.
Their crushing grief is made worse by the knowledge that so many chances were missed.
"Acknowledging and reporting her deterioration would have been a simple matter. Had they done so, our treasured daughter would still be alive."
*Names have been changed for privacy reasons.
Health New Zealand
National director mental health and addictions service enhancement Phil Grady: "On behalf of Health New Zealand, I would like to extend our sincere condolences to this family for their loss, which we recognise has had, and continues to have, a profound and long-lasting impact.
"As the matter is still before the Coroner, it is not appropriate for us to comment further at this time."
Oranga Tamariki
Deputy chief executive tamariki and whānau services Rachel Leota: "The death of any child is devastating for their family and community, and I would like to acknowledge the grief this young person's family will feel.
"As this matter is still active before the coroner, we are unable to comment further at this time."
Ministry of Social Development
Group general manager client service delivery Jayne Russell: "Because your questions involve matters before the Coroner, we are unable to comment."
Ministry of Education
Spokesperson: "First and foremost, I want to express my deepest sympathies to you, Catherine, and your family for your loss. I cannot begin to imagine the pain of losing Vanessa.
"Because this is an active case before the Coroner, we are unable to comment. I understand how difficult it must be for you and please know that our thoughts are with you, and we appreciate your understanding."
Presbyterian Support
Tumu Whakarae Tauiwi (Co-CEO) Barry Helem: "I am not able to provide any comments regarding an individual client. Presbyterian Support contractually cannot provide personal information as all client case notes are held by the Ministry of Social Development Youth Service Support Unit.
"It would also not be appropriate to comment while this tragedy is under active review by the Coroners Court.
"Our service is contracted to the Ministry of Social Development to assist young people to access the Youth Payment benefit. Part of a young person's obligations in receiving the benefit is to engage in education where clients have a choice of which area of study they wish to pursue. Our Youth Coach roles are not social worker positions; however, staff often advocate for clients and refer to other agencies/organisations if clients require other supports such as; a client's GP, transitional housing providers etc."
The Salvation Army
Regional housing manager: "In regard to your query relating to Vanessa, The Salvation Army has supported countless New Zealanders over the years in their housing situations, and we always complete regular assessments as well as care and support procedures for tenants, often in collaboration with referrals from other organisations we work alongside.
"We are bound by strict guidelines under privacy legislation and professional social work ethics to protect the dignity and confidentiality of those we support, regardless of whether they are named publicly or not. Even with assurances that a person will not be identified, questions that pertain to individual cases risk breaching those standards. For this reason, we are unable to comment on specific individuals or their circumstances."
If it is an emergency and you feel like you or someone else is at risk, call 111.
Sign up for Ngā Pitopito Kōrero
,
a daily newsletter curated by our editors and delivered straight to your inbox every weekday.