'Please tell your kids it's OK not to be OK' - says mum whose sister died due to anxiety

A brave mum has written a series of books encouraging children to talk about their feelings following the death of her sister due to suicide. Esther Marshall's beloved sister Rebecca was training to be a doctor in the run-up to the Covid pandemic and the pressure simply 'became too much'.

Devastated by her loss, Esther wrote a children's book called Sophie Says It's Okay Not To Be Okay to try to help prevent other families having to endure such heartbreak. The idea is to help teach three to six year-olds the importance of caring for their mental health, and the mental health of others, as well as encouraging open discussions about wellbeing between parents, teachers and children.

"Our lives had literally changed forever in that moment," said Esther. "I wanted to do something and I didn't know what else there was. It was grief, what came out, if only we could have told her these messages, maybe she would have been OK?"

Read more: The Birmingham school with its own mental health clinician and therapy dog

Get: Our free weekly Brummie Mummies newsletter and podcast to keep updated on family news in Birmingham

Demands in Birmingham for urgent mental health care have grown following the pandemic, according to a Health and Adult Care Overview and Scrutiny Committee report, which was published in January 2024. Key issues identified through the inquiry include a gap in support for young people with low to medium mental health needs together with a lack of appropriate and local inpatient mental health beds for young people in mental health crisis. It also highlighted the need to align NHS, children’s social care and education strategy and policy and share data to improve outcomes for children and young people.

Esther has shared her story on the Brummie Mummies Podcast where she also offers tips on how to help children share their feelings. Listen here:

The sisters had been working together on Esther's first book - Sophie Says I Can, I Will - before Rebecca became ill. She was glad her sister was able to read it to her nephew (Esther's son) before she died.

"I wanted my son to understand that women can do just as much as men and that he'll meet people who don't look like him so my sister Rebecca said 'why not write the book that you want to read to your son?'" said Esther, who used to work in diversity and inclusion for Unilever and is now a mum of three taking her books and educational programmes into schools.

"She offered to illustrate the book but, with all the pressures junior doctors are under, she started to suffer from a lot of anxiety and depression and was admitted to hospital and we went down a whole spiral of unravelling with mental health issues.

"Tragically a few months later, we came home to a note from her and she'd taken her life. It was just too much I think. It was just before lockdown came in and I think the pressures that were on NHS doctors - she was still young and they were left by themselves to look after a whole ward of people dying left, right and centre - and I think everything had just got too much, even though we'd been trying for years to get her better."

A Guardian investigation found that the number of children being referred to NHS mental health services in England for anxiety has hit the highest level ever recorded. In 2023-24, across the UK, there were 204,526 referrals of children made to mental health services with a primary cause of anxiety - compared to just 3,879 referrals in 2016-17

In a Birmingham report, Forward Thinking Birmingham, a partnership of mental health organisations for young people in the city, said that anxiety, depression, neurodevelopmental conditions and self-harm behaviours were the greatest number of referrals over the past four years. Birmingham Women's and Children's NHS Foundation Trust is investing £2.7 million from the Service Development Fund into a range of different mental health schemes for children and young people.

Esther has sold more than 25,000 copies of the books since launching in 2021. She has added a rainbow into each of her books in memory of her sister and has now written a third book called Sophie Says Be Proud of Who You Are.

"All I want to do now is tell my son, and every child in the world, these messages to help them be OK," said Esther, who lives in London. "I feel these are the most important lessons I want everyone to learn. This is what we should be putting in books, it's what children should be learning from a young age. Of course, maths and English is important but this is what I want to be reading to my child at night.

"There's also a school programme to help children understand how to talk about their feelings, together with their parents and teachers too, to try to change the narrative a little bit and hope and pray that the same thing doesn't happen to anyone else's family."

Esther has also a range of Feelings and Affirmations Cards that can help work as conversation starters. Find out more about her books and cards via her Sophie Says website, which also features an education hub with sheets you can download and print to do with your kids for free.

Signs your child may be struggling with anxiety

Esther isn't a mental health expert but, from experience, says that sometimes the signs can be very small and that it is often a combination of the following factors coming together that may mean it is worth talking to your GP:

• Eating habits - if they're eating less, or more, than usual

• Not getting excited about activities they used to get excited about

• Curling up, complaining about pain - usually stomach ache or headache

• Sleeping - more or less than usual, or constantly tired

• Behavioural changes - more angry, anxious or very quiet

• Talking themselves down - saying I can't or won't do this, or I don't like myself

If you are concerned your child is struggling with anxiety, look at the NHS website and speak to your GP.