The rise of non-surgical beauty: ‘My mum said my lip looked like a rubber dinghy’

Claudia Wright has filler injected into her lips every two months to plump them out, and is having them done again in two weeks. “I want them to look big,” she says. She likes them best the day after the procedure, when they are still swollen. When they settle – lip enhancements are supposed to last up to 18 months – it makes her want to book another appointment.

Wright, who is 24, is open about the procedure on her beauty blog and Instagram account. “I like the fake look,” she says. “I’ve got bleached blond hair, I have long eyelashes. I like that look, I’m not trying to look natural. I’m so open about everything I’ve had done, I don’t think it’s an issue.”

She started having lip enhancements when she was 21. Her mum, she says, recently told her that her top lip looked like a rubber dinghy “and that if I carry on getting it done no one will take me seriously. She’s really against them.” But women her own age have told her they love them and ask where she gets them done. “If anything, I’m getting a little bit more each time I go now because I want them to look more full. I did want just a full top lip but now I want both of them looking really full.”

The British Association of Aesthetic Plastic Surgeons (Baaps) recently released its annual figures showing a 40% drop in the number of cosmetic surgery procedures performed by its members, the lowest for nearly a decade. After years of steady rises, it came as a bit of a surprise. The economy and job insecurity was blamed – cosmetic surgery is expensive, after all.

The truth – says former president Rajiv Grover, who compiles the annual audit– is a bit more nuanced. Baaps only represents about 40% of cosmetic surgeons and he suspects that, with the wealth of information online (including many dedicated cosmetic surgery forums), people are researching experts and choosing a specialist, rather than a general cosmetic surgeon. They are going to a breast surgeon for breast augmentation or an ear, nose and throat surgeon for a nose job – surgeons who practise a bit of cosmetic surgery on the side, but aren’t members of Baaps, and so don’t get included in the figures.

But he accepts there may be a drop in surgery overall (if not by 40%). Surgeons are reporting a reduction in the number of procedures a patient has at one time. Before, he says, someone might come “to have some liposuction of saddlebags, as well as having some skin removed from their lower tummy and maybe some breast surgery, [but] now they’re just having one of those things done. That’s where I think uncertainty in the economy will have come into it.” Crucially, though, he says, “there is a rise in what you can have done without surgery. If people don’t have the time to spend two weeks off work recovering from a facelift and want a little bit of improvement, they can have whatever is on offer without downtime.”

The sheer number of non-surgical procedures is dizzying, and ever-growing. Botox is now so well established that it celebrates its 15th anniversary as an FDA-approved cosmetic treatment this month, but you can also have your face lasered and peels applied to improve skin texture, and ultrasound therapies to tighten. You can have tiny threads, that gradually absorb into the body, put in your face during your lunch break to hoick it up, and filler put into your cheeks. Soon, people will be able to have fat-melting injections for their double chins. At-home treatments are also increasing – you can get home laser hair removal and microneedling devices (rollers with tiny spikes that prick the skin and are supposed to encourage collagen production). One DIY trend that emerged last year was dermaplaning – using a scalpel to shave a layer of skin cells and hair, from the face for a supersmooth, airbrushed effect.

“A significant proportion [of patients] say they’ve come to me because they don’t want surgery yet or they want to try to prevent it from happening at all,” says Dr Frances Prenna Jones, whose clinic in Mayfair offers a wide range of treatments. “Twenty years ago your only option was surgery – now there are machines, injectables and so much more you can do. A lot of the time, it is replacing the need to have surgery done.”

Machines using lasers or LEDs “work deeper down within the muscle to make new collagen and elastin to give that nice infrastructure, and tightening effect”. Previously, loose skin was cut away and tightened. Now it is plumped up with injectable filler. Volume replacement is what has really changed in the last few years, says Prenna Jones. “Even three years ago, people would say, ‘I am not having filler, there’s no way.’ Now that people understand what it really means – that you don’t have to have puffed-up lips or puffed-up cheekbones. When I look at the amount of filler I was doing three years ago and the amount I’m doing now, that’s definitely on the rise.”

The cost of the treatments hasn’t come down spectacularly, so she doesn’t think that is driving popularity; it’s more the fact it is becoming normalised. “Now I think women accept that it is part of their monthly budget, the same as doing their hair.”

The use of more intense beauty treatments – such as teeth whitening and HD brows, where eyebrows are dyed, waxed and shaped – has accelerated in the past few years. “It is becoming increasingly normalised to have more done [to meet] what we think of as quite basic beauty standards,” says Heather Widdows, professor of global ethics at the University of Birmingham and author of the forthcoming book Perfect Me. “It doesn’t feel like a big hurdle to go from getting your hair done to Shellac-ing your nails to Botoxing.” There is less stigma, she says. “I think Botox, to use one example, is now being seen as routine maintenance, and that’s a very different scenario from 10 years ago.”

Kylie Jenner is famous for her lips, which have been filled. Photograph: Steve Granitz/WireImage

What is driving the change can’t be attributed to one thing, she says. “We live in a more virtual and visual culture. We look at images differently, we have HD and computer technology that means we see flaws in skin we didn’t see before. And more people we know have had non-surgical procedures.”

Surveys about body image, she says, routinely show an epidemic of unhappiness about appearance. The rise of more “normal” women (ie, not supermodels) who become YouTube and Instagram stars should, in theory, mean wider and more democratic standards for beauty, but in reality it is their “normalness” that has changed the idea of what normal is, particularly when it is accompanied by heavy makeup and invasive procedures. “It puts pressure on all women to feel they have to look like that,” says Widdows.

What is striking, says the Guardian’s beauty writer Sali Hughes, is the number of much younger women seeking to alter their face. Contouring makeup, where different shades “shape” the face, is “predominantly a young woman’s trend and it’s fuelled by celebrities, but the celebrities who fuel it as a trend also have surgery and non-surgical procedures, so it’s a triple-pronged attack. It just so happens that young women can only afford the contouring part. It really exists to look good in pictures.” But the more disturbing thing, she says, is how many young people want, or are having, non-surgical procedures. She recently met an 18-year-old at an event who told her all her friends want fillers and lips like Kylie Jenner (the youngest of the Kardashians, who had lip-filler injections) for their birthdays. “They want their parents to pay for fillers for them.”

The aim, she says, is not to look natural. “They’re mimicking a surgical look or at least a heavily injected look that celebrities wear. I think young people are much less interested in pretending that this is what nature gave them than we perhaps assume. Where you would once hear actors in their 40s and 50s completely denying non-surgical procedures, and I quite understand why, even though I don’t think they should, young people don’t have that anxiety about non-surgical.”

Dr Tijion Esho, founder of the Esho clinics in London and Newcastle, says there has been a culture change. “One big thing now is people start earlier,” he says. Before, people would not consider these treatments until they were in their mid-40s. “Now women in their mid-20s are very aware of the ageing process and are already doing things to halt it early. The non-surgical treatments are improving more and more. It doesn’t mean non-surgical will ever replace the knife – there is a limitation to what non-surgical can do – but, in many areas, people can get improvements that are satisfactory.”

Fillers have changed everything, Esho says. He can use fillers to improve the shape of someone’s nose – a cheaper, less permanent version of a nose job without the need for general anaesthetic – for instance. In February one patient, Holly Hagan, the 24-year-old star of the reality series Geordie Shore, posted pictures on Instagram of some filler she had to change the shape of her nose and chin.

Dr Tijon Esho also shaped Holly Hagan’s nose with just fillers. Photograph: Instagram

‘When we’re doing fillers in young people we have to be very careful, from an ethical standpoint,” he says. “Legally, it does concern me because there is no law to say what age someone has to be to undergo fillers. Someone could treat a 16-year-old, but ethically that is wrong.” The non-surgical industry is unregulated and anyone can set themselves up as a practitioner with no training. Botox is prescription-only and people should be seen by a prescriber – a doctor, dentist, nurse or pharmacist – but that doesn’t always happen, which is why beauty therapists can offer it cheaply in salons.

Has the look that young patients are after changed? There is a growing minority, Esho says, “where there is an evolution in what we perceive as beauty”. Some bring in Instagram pictures where they have been heavily filtered, and skin and faces are flawless, and say they want to look like that. “It has almost gone full circle. Initially, when surgery and non-surgical aesthetics were available, it was the treatment of the rich. It was a statement to have it done so people wanted to let you know. Then there was a transition where people didn’t want others to know, it became more natural, understated. Now, it has gone back, but because now the services are more accessible, it’s more obvious. And social media has made it more noticeable.” His most popular treatment is providing lip filler, which accounts for about 70% of his work.

On YouTube, you can find numerous videos of vloggers who have posted about their lip fillers. Gabriella Lindley, a beauty vlogger, has had more than 360,000 views of hers; another video she put up, entitled “My Lip Filler NIGHTMARE” in which she talks about how her lips went lumpy, has had more than 314,000 views.

Vlogger Gabriella Lindley’s My Lip Filler NIGHTMARE! Photograph: YouTube

Jessica Balkay, 22, researched lip fillers on YouTube before getting her lips done for the first time. “I wanted to get it done as I just didn’t like the shape of the sides of my lips and wanted a fuller top lip.” She said it has made her “really happy. I love makeup and taking selfies and having my lips looking fuller just made me feel happier with my appearance.”

She is planning to have a few more injections to build up the size and shape, then plans to go every six months for top-ups. “I think in my generation it is becoming a lot more normalised to have non-surgical procedures,” she says. “I don’t see the issue with that as long as people research reputable places and are doing it for themselves, not to please others. I don’t want to look like anyone else but myself, but I want to be a prettier version of myself.”

Where will it end? Widdows sighs. She thinks the use of non-surgical, but still invasive, procedures are likely to become commonplace. “Doing nothing gets harder and we have to wait and see whether Botox becomes ‘required’, like [people consider] visible body-hair removal or hair dyeing. That’s the way it’s moving.”

Hughes is a bit more optimistic, particularly where much younger women are concerned. “The only glimmer of light in the whole sorry picture is that at least non-surgical procedures are not lasting, so one hopes that young people outgrow them in the same way that I outgrew lightning bolts drawn down my face.”

The rise of non-surgical beauty: ‘My mum said my lip looked like a rubber dinghy’

The girl who said no to FGM – video

Jaha Dukureh, a survivor of FGM and forced child marriage, became a lightning-rod for change in the Gambia, her activism contributing to the eventual government ban on FGM and child marriage. She was named by Time magazine as one of the 100 most influential people in the world. Here she confronts her past, her family, her culture, her religion, her country and its leaders

• WARNING: Contains images that some viewers might find disturbing
  

• This is an edit from the Guardian and Accidental Pictures’ feature documentary Jaha’s Promise

The girl who said no to FGM – video

Trump once said women should be punished for abortion. Now, he"s making it happen | Lucia Graves

In the mass of protesters thronging the National Mall in Washington DC on Saturday, one sign stood out to me. It was a wire close hanger mounted on cardboard, held by a young woman of color in pigtails. “Never again,” it read.

As it turns out, for poor women overseas, never was only as far away as Monday.

Donald Trump used his first full day as president to reinstate a Reagan-era executive order that will have a devastating impact on those with the fewest resources: women and girls in impoverished parts of the word. The order, best known as the “global gag rule,” will strip funding from any international NGO that provides abortions services, or even discusses abortion with patients seeking educational materials or referrals.

Study upon study has shown eliminating access to abortion services doesn’t eliminate abortions, it just forces women underground into dangerous situations.

What is the ‘global gag rule’, and why does Trump support it?

For a guy who has been billed as a populist, it’s perhaps surprising that having roughly half a million people – three times the number that attended his inauguration – flood the streets of Washington has done nothing to alter his policy.

It did, however, do something else: it hurt the president’s feelings.

Trump’s defining qualities as a child, according to multiple biographers I spoke with, is that of a schoolyard bully. And it’s the rare thing about him that hasn’t changed. That’s why the fact that he dedicated one of his first acts in office to undermining the rights of women seems to me like something close to tit for tat.

Because Trump has been outspoken with regard to the other executive orders he signed off on Monday – instituting a federal hiring freeze, and withdrawing from the Trans-Pacific Partnership. But he hasn’t made a point of talking about abortion access unless asked. While it’s true executive’s implementation of the “global gag rule” has historically been reversed as soon as the opposite party takes over the White House, previous proponents – Ronald Reagan and George W Bush – ran on platforms of social conservatism. Trump was less easy to pin down. As he told Howard Stern of his stance on abortion in 2013: “it’s never been my big issue.”

Trump seemed to have outsourced the question to his running mate Mike Pence, a staunch anti-abortion advocate whose selection by Trump was widely seen as a peace offering to evangelical voters alienated by Trump’s lifestyle. The peace offering worked and Trump won evangelicals in a landslide.

But illusions Trump would, as he put it in a fleeting election night gesture, “be the president of everybody,” just went out the window. “The president, it’s no secret, has made it very clear he’s a pro-life president,” his spokesman Sean Spicer said in the first White House press briefing. “He wants to stand up for all Americans including the unborn.”

It’s quite the way to describe the gutting of a policy that’s spared an estimated 289,000 women from pregnancy- or childbirth-related deaths, according to the World Health Organization.

And it’s not just about abortion. Service providers denied funding under the gag rule could be stripped of the ability to carry out even the most basic women’s healthcare, as global family planning group Population Action International (PAI) has previously reported, resulting in the collapse of entire healthcare networks. WHO estimates 21 million unsafe abortions are performed globally each year, resulting in nearly 13% of all maternal deaths globally. And Marie Stopes International, a major global family planning advocacy group, estimates the loss of its services alone could mean 6.5 million unintended pregnancies, 2.1 million unsafe abortions, and 21,700 maternal deaths in Trump’s first term alone.

PAI puts it even starker terms: “The only goal the policy will achieve is to punish women in already challenging circumstances by blocking access to essential care.”

If Trump’s desire to “punish” women sounds familiar, that’s because, well, it should. In March of last year he said those seeking abortions should endure “some form of punishment” for doing so. And while yes, he walked back his tone-deaf statement in the explosive political aftermath, his actions Monday spoke louder than words.

Trump once said women should be punished for abortion. Now, he"s making it happen | Lucia Graves

AA Gill said NHS could not give him new cancer treatment

AA Gill, the revered critic who died on Saturday aged 62, described in his final article how the NHS could not give him a cutting-edge, potentially life-extending cancer treatment but triumphed on a human level where private healthcare does not.

Described as “a giant among journalists”, the Sunday Times columnist died three weeks after revealing he had the “full English” of cancers.

In a final piece published in the Sunday Times, Gill said he had been denied an expensive therapy – costing up to 100,000 a year – that may have helped him live “considerably” longer and was the weapon of choice for “every oncologist in the first world”.

The former smoker was diagnosed with lung cancer that had spread to his neck and pancreas, with tumours that were inoperable and unsuitable for radiotherapy, after noticing his health was failing in the autumn.

AA Gill on the front of Sunday Times magazine. Photograph: Sunday Times

He described how he was told by a consultant oncologist that a pioneering new treatment for cancer, immunotherapy, would give him his best chance at fighting the disease, but it was not available on the NHS.

“The National Institute for Health and Care Excellence (Nice), the quango that acts as the quartermaster for the health service, won’t pay,” he wrote.

The consultant told Gill the treatment would be “particularly successful” with his kind of cancer, but told his wife Nicola Formby: “If he had insurance, I’d put him on immunotherapy – specifically, nivolumab. As would every oncologist in the first world. But I can’t do it on the National Health.”

Gill said that the prohibitive cost of nivolumab was £60,000 to £100,000 a year for a lung cancer patient, about four times the cost of chemotherapy.

However, he said that “old men who think they’re going to die anyway aren’t very effective activists” and do not see the “public or press pressure that young mothers’ cancers and kids’ diseases get”.

He added: “As yet, immunotherapy isn’t a cure, it’s a stretch more life, a considerable bit of life. More life with your kids, more life with your friends, more life holding hands, more life shared, more life spent on earth – but only if you can pay.”

Gill, who previously said he wanted to have his treatment on the NHS due to a sense of “human connection”, drew attention to the health service’s performance in international oncology rankings.
He wrote: “It was the first question I asked my oncologist, Dr Conrad Lewanski. ‘Why is this such a bad place to get cancer, when we have lots of hospitals, when we teach doctors from all over the world, when we’ve won more Nobel prizes than the French?’. ‘It’s the nature of the health service,’ he says.”

AA Gill, journalist and restaurant critic, dies aged 62

Gill eventually underwent a course of platinum chemotherapy at the Charing Cross hospital in London.

He told how, in the weeks before he died, he was rushed to hospital in pain “by miles and miles the worst thing I have ever lived through”. After doctors discovered his pancreatic tumour had grown to the size of a fist they offered more chemotherapy.

Gill finished the article, which was printed before he died and published in the Sunday Times, with a conversation he had with a cancer nurse. “(She said) ‘You’re supposed to be with me down in chemotherapy. I saw your name. Why are you up here?’,” he wrote. “’Well, it turns out the chemo isn’t working’. Her shoulders sag and her hand goes to her head. ‘F***, f***, that’s dreadful.’ I think she might be crying. “I look away, so might I. You don’t get that with private healthcare.”

AA Gill said NHS could not give him new cancer treatment

Shamefully, the autumn statement said nothing about social care | Jennifer Dixon and Anita Charlesworth

The chancellor’s autumn statement was met with incredulity and dismay by many in health and social care. Incredulity because the unusually extensive analysis and briefing on the state of the NHS and social services was so brazenly ignored, and this when the NHS is top of the list of issues the public holds dear. Dismay because of the likely consequences for the very groups in society that, ironically, the PM has pledged to help. Why did this happen?

Politicians of all stripes, patient and community groups, thinktanks, local authority leaders and many more express disbelief at the outcome. Does “project fact” no longer work? Are we in a “post-truth” world? Or is this short-termism by the government writ large?

Let’s look again at a few facts. Social care is at a tipping point. So says the Care Quality Commission, which should know, given it inspects all 17,000 social care providers in England.

Spending by local authorities on older people’s care has fallen by almost 10% in the first half of this decade. The number of older people receiving care has fallen by more than 400,000 – one in four fewer people getting help with basic needs. Family, neighbours and friends pick up the pieces and some older people pay privately. But increasing numbers of the poorest have no one to turn to. This growing gap has a human cost, but it’s also affecting the NHS.

Anyone using or working in the NHS can see that hospitals are full, operating at unsustainable capacity levels. There is a growing number of older people in hospital, medically fit to leave but unable to because of a lack of care in the community. The number of patients waiting in hospital for care packages to be put in place has risen by more than 40% in the past year alone. Other older people are in hospital when their condition could have been prevented by better support.

If the NHS was awash with money, this might be inefficient but manageable, but it isn’t. The NHS is receiving almost no increase in funding for 2018/19 and 19/20, despite growing demand and widespread deficits in hospitals. Increasing waiting times for care are the predictable result.

Meanwhile, the government continues to claim that the NHS is receiving an extra £10bn between 2014/15 and 2020/21, despite a direct challenge from the chair of the health select committee and a warning from the UK Statistics Authority. It makes this inflated claim based on a definition of “NHS” different to that used by all previous governments.

Extra funds were promised for social care from last year’s spending review, but too little and too late. Many working in social care are on the lowest wages. The national living wage will rise to £7.50 from April 2017 – welcome for the workforce, but a further cost pressure. This, coupled with rising demand from an ageing population, means social services across England face a £2.4bn funding gap next year.

Local authorities are running out of options – they have cut providers’ margins to the bone and many are walking away from contracts. Almost everyone currently receiving local authority-funded social care has been assessed as high need, so withdrawing services will bite especially hard. Who will hurt most? The poorest. The “just about managing” will “just not manage”.

With lower growth forecasts, extent of debt and the disruptive uncertainty of the vote for Brexit, room for extra public sector funding is limited. One option is to look again at the triple lock that ensures that state pensions increase by inflation, average earnings or a minimum of 2.5% a year. The triple lock has helped reduce pensioner poverty. Since 2008, the average income of those over retirement age has risen by 11% and the number of pensioners in poverty has fallen. But money alone doesn’t guarantee a dignified old age. For the most vulnerable old people, cuts to social care have left them without help with basic needs. There is scope for the chancellor to reform the triple lock before the 2017 budget to redistribute funds by boosting social care.

The referendum has shown that the active ingredient to prompting the political class to address a thorny issue is less about forensic analysis – “project fact” – than the mobilisation of public rage. It is worth pondering why this hasn’t yet materialised for the old and vulnerable.

So much for “a country that works for everyone”. This looks more like short-termist business as usual.

Dr Jennifer Dixon is chief executive, the Health Foundation. Anita Charlesworth is director of research and economics, the Health Foundation

Shamefully, the autumn statement said nothing about social care | Jennifer Dixon and Anita Charlesworth

"They said my son intended to assassinate Donald Trump. And my world just stopped"

On 21 May this year, Lynne Sandford contacted the Foreign Office and the police. She was worried about her 20-year-old son’s safety: Michael was a vulnerable adult, alone in America. He had been there for over a year, and his behaviour – in Skype calls home – had become increasingly erratic. Michael called every other day; after not hearing from him in a week, Lynne reported him as a missing person.

On 18 June, she was woken by a phone call at 11.30pm from the Foreign Office. She remembers every detail. They had found Michael. “I was like, ‘Brilliant – where did you find him?’ And that was the first shock. They said Las Vegas. I thought he was in New York. I said, ‘How did you find him?’ And they said he’d been arrested for trying to take a police officer’s gun in a casino. I said, ‘What was he doing in a casino?’ And they said he was at a Donald Trump rally. They said, when questioned, he had said he intended to assassinate Donald Trump. And my world just stopped.”

Michael Sandford arrested at Trump rally in Las Vegas

On 30 June, Michael Sandford was charged with disrupting an official function, and two firearm offences. He told police he had been planning to kill Trump for a year; the previous day he had been to a gun range to learn how to shoot. He was living out of his car and was in the US illegally, having outstayed his visa. A month on, he faces up to 30 years in jail and his mother is still in shock.

***

Michael was two when Lynne realised there was something different about him. His speech was delayed and his coordination was poor; he was referred to speech and physical therapists. He had a tremor in both hands – ironic, Lynne says, in light of the charges. She imitates his shaking hands. “Trying to grab a policeman’s gun? He wouldn’t have stood a chance.”

Lynne Sandford (mother of Michael), centre, with her mother, Christine, left and Lynne’s daughter, Jessica. Photograph: Mimi Mollica for the Guardian

We are in the sitting room of Lynne’s flat in Dorking, Surrey. Her mother, Christine, brings tea and biscuits. The room is small and stuffed with the paraphernalia of family life. Lynne also has a four-year-old daughter, Jessica, whose favourite colour is clearly pink: there’s a pink scooter, a pink doll’s house. Michael moved out four years ago, but his toy racing cars are still on the mantelpiece. In the family photos, he looks slight and sweet and a little otherworldly. Mother and son were always close. When he was five, Michael’s father left home; Lynne raised him largely as a single parent, with a huge amount of help from Christine. Michael, Mum and Nan: they were a team.

After his wobbly start, Michael made rapid progress at primary school, outperforming most of his classmates. He was unusually knowledgable: they used to say he was like an old man in a boy’s body. And yet in other ways he was very young: he had friends – Alex and Jack were the closest, Lynne says – but he didn’t like going to their houses. His gross motor skills (running, jumping, playing sport) were poor, but his fine motor skills were exceptional. He was great at Lego, for instance, and won a number of competitions. On the mantelpiece there is a cutting from the Dorking Advertiser with a picture of a young Michael holding a matchbox. “Creative Beaver Scout Michael Sandford is celebrating a winning strike after stuffing 210 items into a matchbox,” it reads.

He liked to make fellow pupils laugh, but there were other things Lynne struggled to explain. He took everything literally, and was punishingly honest. “He’d always say, ‘Well, I don’t mean to be rude – I’m just saying it as it is.’ He had a lack of empathy.” Lynne remembers a child in his class whose father died when he was nine. She had lost her own father at a young age, and explained to Michael how the boy might be feeling. “But he shrugged and said, ‘Well, he’ll get used to it.’”

Michael went on to a comprehensive with more than 1,000 pupils, where he was lost. There were detentions for not doing his tie tightly enough, and not having his shirt tucked in. It was only later, when Michael was diagnosed with hypersensitivity, that Lynne made any sense of it: the shirt and tie had been uncomfortable. “A lot of clothing made him itchy. Bedding, too. Sometimes he’d stay up all night. I remember one time going to Gatwick Tesco, a 40-minute drive away, just to buy him cotton bedding at 3am so he’d go to sleep.”

Michael refused to sign a home-school agreement promising to do his homework and wear uniform. “He was the only person in the history of the school who refused,” Lynne says. “I thought he was being a little bugger. But he just looked at me and said, ‘Well, quite honestly, Mum, I don’t know whether I can agree to these things. So I can’t put my name to it.”

Michael Sandford with his mother Lynne. Photograph: Mimi Mollica

He was still showing huge promise academically, particularly at maths. His teachers encouraged him to sit a mock GCSE at the age of 12, which he passed with an A. “This is the tragedy of it,” Lynne says. “He left school with no qualifications, and he has such potential.” Michael was bullied but didn’t like to talk about it. He started to truant. One day Lynne took him back to school three times. She would see him wandering around town on a winter’s day, his hands raw with the cold. She’d bring him home; if he was going to play truant, she’d rather he was somewhere safe and warm.

Michael became anorexic and developed paralysing OCD after starting secondary school. Every other weekend, his mother or grandmother would drive him to Portsmouth to stay with his father, but he became claustrophobic and unable to cope with the car, so that stopped. He became obsessed with hygiene – either not washing or brushing his teeth for weeks, or scrubbing himself until he bled.

At the age of 13, he was diagnosed with Asperger’s syndrome, a form of autism. The specialist said it was the most severe case she had seen in 30 years: his behaviour was so ingrained it would be almost impossible to change. The diagnosis explained a lot, but it didn’t help Lynne cope. Michael stopped going to school. “He said, ‘Why would I want to learn what everybody else is learning? Because everybody is going to know it. I want to learn what interests me.’ We fought tooth and nail about it. He was offered every opportunity: home school, online tuition, private tuition, a special school.” In the end, Lynne says, he sat at home watching documentaries. “I said you’re not going to have any qualifications, and he just said well, qualifications aren’t everything. I’d explain that if you want a job, they are crucial. But he couldn’t see that.”

At 14, Michael became anorexic and was sectioned. He hired a lawyer and brought a case that he should be allowed home

I ask Christine if she thinks her daughter was too soft on him. “I’m afraid I did, at times.” Michael would stay with his grandmother two nights a week, to give Lynne a break. But even she couldn’t get him to eat. “One evening he said, ‘Sorry, Nan, I can’t eat that. Don’t cook for me any more.’ He was bloody-minded.” The two women struggled to cope. “We were trying to learn about his condition, but no one was advising us.” Lynne tried the stick approach, taking away his teenage privileges; it made no difference.

At 14, Michael won a three-day scholarship to join a police training programme. “He had always said he wanted to be in the police force, and that was the last normal thing he was able to do. After that things went downhill. He did the three days, and I think that used up the last ounce of energy he had.” Michael was put on the child protection register – not because he was at risk from an adult, but because he was a risk to himself.

He became so weak from not eating that he could barely get out of bed. Later that year Lynne reluctantly agreed to have him sectioned at the Maudsley psychiatric hospital in London. How much weight had he lost? “He refused to let the doctor weigh him,” Lynne says. But she told them he wouldn’t live much longer without treatment.

“He was like a skeleton, wasn’t he?” Christine says. “Broke my heart, seeing him like that.”

A day after being sectioned, Michael escaped. Police discovered him trying to board a train home without a ticket and took him back. Lynne shows me a letter he wrote back at the Maudsley: “Dear Mum, I’m not bad or evil or naughty and I never intend to be. I try to be polite and non-rude. At the moment I have no death wishes or wanting to self-harm. My first escape attempt was meant to be peaceful and not to harm people or damage property or break the law. Any further attempts will be the same. I do not want or intend to be violent. Unless I feel I am in danger I will be peaceful and polite. I love you very very much and I am sorry that I upset you. Lots of love, Michael.”

The next day she called to see how he was. “They said, ‘Oh, he’s fine. He’s in bed reading legal papers and he’s acquired himself a lawyer!’” Even in his darkest moments, she says, he could make her laugh. Sure enough, Michael brought a legal case that he should be allowed to return home. He lost, but made progress at the Maudsley. While he did not attend the hospital school, Michael agreed to one-to-one sessions with a teacher. The report he received on leaving said: “Michael is a very polite and articulate young man who is confident and pleasant to talk with.” After four months, now 15, he was released.

That year, Lynne was surprised to find herself pregnant with Jessica. She says Michael was fantastically mature about it. “The pregnancy was the result of a brief relationship. I didn’t think I could keep her – I didn’t think it would be fair to Michael. Then he said, ‘Mum, you have to have that baby, and I’ll do everything I can to help you.’”

But life was not easy. Michael had become abusive. “He was never violent, but he would be very verbally aggressive. He’d shout and swear at me, and then he’d be so apologetic. He’d just unleash. I spent most of my time in my bedroom. It wasn’t sustainable.”

At 16, he found himself a one-bed flat to rent a few minutes away. “It was perfect. Clean, modern, a nice outlook over the hills.” How could he afford to live independently? “He was on disability living allowance, employment and support allowance and housing benefit. He didn’t do anything, go anywhere, so he had few other expenses.”

Michael was more content than he had been in a long time. He would visit his mother every day, have something to eat and play with his baby sister, whom he adored. “But after two or three hours, you could see his anxiety levels rise and he’d need to get back.” Lynne shows me a photo album: Michael holding Jessica when she was an hour old, reading to her, helping her on the trampoline, the two of them having a picnic.

In the early days, he let Lynne and Christine come to the flat. It didn’t last; he continued his daily visits home, but barred them from visiting and withdrew into himself. Like many people with Asperger’s, Lynne says, he was a whiz with computers. She worried that he would befriend the wrong sort of people. Another passion was the TV series Robot Wars. Michael once paid £1,000 for a robot and his mother drove him, Jessica and the 16 stone robot to roadshows across the country so it could do battle.

Michael Sandford with Steel Avenger used for Robot Wars.

As Lynne talks, I notice a tattoo on her upper arm, with Michael’s name and date of birth attached. What is the design? She lifts her sleeve and laughs, embarrassed. It’s a playful devil with a pitchfork. “I had it done when he was born. It was just tongue in cheek, because all parents say ‘He’s a right little …’ She trails off. “In hindsight, perhaps I shouldn’t have.”

When he was 17, Michael decided he would learn to drive. His mother was delighted and offered to book him lessons. No need, he said: he had signed up for an intensive two-week course.

“We were terrified, weren’t we?” Christine says.

“Horrified,” Lynne says. Michael had a lesson every day for a fortnight, took his test and passed. He bought a car on eBay for £500, “which is every parent’s worst nightmare. I got the RAC to check it out and they said, ‘Well, it’s not bad,’ and he said, ‘OK, I’m off out.’” Thirty seconds later, he had over-accelerated into another car and written his off.

On New Year’s Eve 2014, Michael told his mother he had news – and she wasn’t going to like it. He was going to New York. “I just collapsed on to the sofa. I said, ‘This is insane – what the hell are you on about?’” Lynne asked her GP and local mental health services how she could stop him. “They said, ‘He’s 18; there’s no way short of having him declared mentally incompetent,’ which clearly he was not.” She tried to see it from his point of view. “His old school friends were at university or having gap years, and we thought he felt left behind. It was his way of being normal – do a bit of sightseeing.”

On 18 January 2015, he left. The next day, she received a call. “All I heard was, ‘Are you Michael Sandford’s mother? This is an American hospital emergency room,’ and again everything in me just stopped. I started yelling, ‘Oh my God! Is he dead? Is he dead?’”

Michael was not hurt, but he had been found by the road in a state of extreme distress. He was forcibly given a drugs test, because the police thought he was high. In fact, he was having a meltdown, and was sectioned overnight. But the hospital discharged him the next day, and he continued his two-week trip in a rental car.

By the time Michael returned home, he was a wreck. “He just broke down and came out with this…” Lynne shudders to a stop. “I can’t say ‘tale’ or ‘story’; I’ll say ‘version of events’.”

“He was terribly, terribly distressed,” Christine says. “He said that, unbeknownst to us, between the ages of 16 and 18, he’d had a girlfriend, and got her pregnant. He said they’d had a scan and it was a boy. And the day after Michael’s 18th birthday, this girl was killed in a car crash. He said that after this he’d attempted to commit suicide twice.”

Michael told them he had a new girlfriend, who had recently moved back to America; but when he got there, a friend had texted to say she was in prison on a drugs charge.

A card from Michael Sandford to his family (including the cat). Photograph: Mimi Mollica for the Guardian

Lynne didn’t know what to think. She still doesn’t know what to think: she has been unable to corroborate the story of the girlfriend and the fatal accident. She has no idea if any of it is true, but says Michael had no history of lying to her, and no history of psychosis. She pauses, and says there was one incident when he was eight and convinced aliens were coming to get him. “He was shaking and cowering, and we took him to hospital. It was like he was possessed.” But nothing since.

Michael told Lynne and Christine he wanted to be there for his girlfriend, Lauren, when she came out of jail. He said he would move in with Christine and save to get back to America. But he couldn’t save quickly enough; he asked his grandmother to mortgage her house.

“He plagued us for money.” Lynne’s voice is quivering. “He said, ‘I’m going to have to either commit suicide or turn to illegal measures.’ We said, ‘We love you, but we can’t do this. I’m a single mum on the minimum wage, and Nan can’t mortgage her house.’”

Lynne looks at her mother, just about holding her tears back. “If you’re OK with me saying this? Quite by chance my mum came into an inheritance. Her sister had left a reasonable sum of money, which Mum was going to split four ways: her, me, Michael and Jessica.” Christine and Lynne agreed to forfeit their shares and pay for a year’s rent for Michael in New York. It was a last resort.

They made Michael sign an unofficial document stating that the money was a one-off to help him turn his life around; that over the year he would come home regularly (he needed to sign on every 90 days for his benefits, for one thing); he would live in the flat; he would not break the law; and he would not attempt to kill himself. It was agreed that his first visit home would be in five weeks’ time, for Jessica’s third birthday.

But Michael never came. He told his mother there was a warrant out for his arrest in the UK (he had left a few utilities bills unpaid). Lynne contacted the police, who assured her there was not, but Michael said he believed his source rather than her. He lost his benefits. Lynne pleaded with him to come home for Christmas, but Michael said it wasn’t an option. He told them Lauren’s friends were now his friends. She began to worry that he had come under the influence of a cult; she also feared that he was simply ill and delusional.

Michael’s Skype calls were becoming less frequent. When he rang, his face was always blurry and against the same white background. Lynne asked him to show her around the flat, but he refused. Just before Christmas 2015, he rang home and said he’d moved into a cheaper flat. It didn’t make sense; the rent had already been paid. But he told them he’d got a refund on the outstanding time, and preferred the new flat.

On 17 April, he told them he’d been kicked out of the new flat, and needed money for a hostel. His father had been sending him £60 a month, and Lynne and Christine sent what they could. They begged him to come home. “He said, ‘I can’t – I’ve been very ill and run up lots of medical bills.’” A month later, Lynne reported him missing.

A letter Sandford’s mother sent to his old flat in New Jersey.

The night after Lynne was told of her son’s arrest, a friend rang. “She said, ‘I think you’d better turn the telly on.’ It was midnight and I saw pictures of him being arrested. Headlines going across the screen. I couldn’t believe it. My son, headline news for something so awful, and something just so not him. It broke my heart because it was the most I’d seen of him in a year. I just wanted to wrap my arms round him and never let him go .”

A few weeks ago, a tabloid newspaper offered to take Lynne and her ex-husband, Paul Davey, to Las Vegas, where Michael is in custody, in exchange for an interview. But Jessica did not have a passport and Lynne did not want to leave her, so Paul went alone. The newspaper promised to take Lynne as soon as Jessica’s passport came through, but then decided not to. Subsequent reports suggested Michael had a thing for guns. Lynne says this is misleading: there was a brief period when he was into airsofting (a game similar to paintball, in which participants shoot at each other with non-metallic pellets). Yes, at one point he had camouflaged his bedroom and hung replica guns on the wall, with help from his father; but three months later the room had returned to its motor-racing theme.

Paul tells me that the first time he talked to his son, via video link, at the detention centre he was unrecognisable. “Michael said, ‘Someone had to stand up for America,’ and was going on about how dangerous Trump’s policies were – building the wall, banning Muslims. He didn’t seem to know what the consequences were, what he had been charged with. He thought it would blow over and he’d be home soon. I saw him again a few days later and he was calmer, much more like his old self. We were talking about what we used to get up to. He never mentioned Trump once.” Paul has not been in touch with him since that second conversation.

Had Michael ever talked to Lynne about politics? “Not once,” she says. “Not to Mum, not to me, his father, his friends. He never had any interest.”

She and Christine talk about his despair in the weeks leading up to the Trump rally. I ask them if they think his attempt to grab the gun might have been a bid to die, while still keeping his promise that he would not commit suicide. “No,” Lynne says instantly. “I think this was his way of getting help. He was always a bit of baby on the physical side of things, so I wouldn’t think he’d choose to be shot. I also think he would have sent me a goodbye letter.”

Why Trump? Did Michael ever talk politics? ‘Not once. To Mum, me, his father, his friends. He never had any interest’

His grandmother seems less sure. “He did tell the police that he thought he’d be dead.” She mentions the most recent messages he had sent her. “One night, just before we got in touch with the police, I said, ‘Look after yourself,’ and he said, ‘I can’t.’ Then he sent me another message saying, ‘I can’t live like this much longer.’”

Did they ever suspect he might do something like this? No, she says. Apart from the verbal outbursts, he has never been violent. “I asked his friend Alex,” Lynne says, “‘You know him in a different way to me; did he ever give you any indication he could do something like he has done?’ And he said no, never. His other friend Jack went on Facebook and said, ‘I want to tell the world Michael isn’t like that.’”

For the past three weeks, Lynne has received calls every night from the detention centre in Las Vegas. All she hears is a crackling and beeping like a fax machine. She knows it is Michael. The detention centre has told her there is a technical issue with international calls.

“Then on Friday night, something incredible happened.” Her face lights up. “Eleven pm, an unknown number rang, and I just heard, ‘Hi, Mum.’ He’d been allowed to call from an office as a one-off. I spoke to him for five minutes. I asked him how he was and he said, ‘Well, not good, obviously. It’s prison.’” Did she ask him what happened? No, she says – she knew time was short. “I said, ‘Your nan loves you, your dad loves you, I love you.’”

She has been told he is on three medications: for anxiety; to help him sleep; and for hallucinations. “He’s hearing voices. He said in that call, ‘I just want to come home and get psychiatric help.’ Obviously I can’t condone what he attempted to do, but he was not in control of his mind. Yes, a sentence by all means, but a sentence over here where his family can visit him and where he can get the help he needs.” Lynne has been warned that US courts are not sympathetic to mental health problems; it is unlikely to affect his sentencing.

Lynne knows she is running on empty. Since she heard the news, she has been unable to sleep and eat properly. Fighting for her son is the only thing keeping her going; she has launched a CrowdJustice page to help with legal fees.

The trial is due to start on 22 August, though Lynne has heard that the case is more likely to be settled before that with a plea bargain. “I assume he will be asked to admit his guilt, and in return be offered a lesser sentence.” In a way, she says, she hopes it does go to trial – so a jury can see how helpless he is. But the danger is that they throw the book at him anyway.

Last week the Foreign Office told Lynne that Michael had been put on suicide watch. Does she think he is at risk of killing himself? “One hundred per cent. If he gets a lengthy sentence and he stays out there, he will commit suicide. He won’t see the point.”

On Friday, a day before this article was published, Michael managed to phone home successfully for the first time. “He was extremely distressed, and begged me to get him home,” Lynne says. “He said, ‘I can’t cope. I can’t last out much longer.’”

• This article was updated on 30 July 2016.

"They said my son intended to assassinate Donald Trump. And my world just stopped"

Individuals should "get control" of their dementia by locating an individual to enjoy them, a Government adviser has said

Dr Charles Alessi, the foremost advisor for preventable dementia Public Wellness England, said medical professionals, dentists and pharmacists should stop practicing “medication by entire body portion” and warned present day medicine tends to make sufferers “conditions rather than folks.”

41 per cent of people aged in excess of 65 stated their Television or pet is their major type of companion.

Speaking at Age UK’s For Later Existence conference, Dr Alessi stated: “We want to give handle back to people and we give handle back to men and women by increasingly their resilience.

“Resilience is actually critical because it offers you control over your situation. Really it really is terribly effortless to get manage more than your issue, and it really is terribly important that we all try to get control over our problem whatever our age is

“The methods to do that are remarkably basic – be lively, connect with individuals. Somebody loves you someplace, you should belong somewhere, appear around you, connect with individuals about you.

“Try to learn something each day consider to support somebody else around you. That’s all you want to do. That activates you. So you are in a position then in which you can search about and get manage of no matter what condition you have.”

He added: “Our challenge is to attempt and get the professions – the pharmacy, the general practice, dentistry, all of them, as well as the care practitioners to not only comprehend this but to really work to provide this to populations.”

Individuals should "get control" of their dementia by locating an individual to enjoy them, a Government adviser has said

MPs should measure themselves to check if they are obese a Lord and major surgeon has said

He stated that there had been rather too a lot of portly bellies observed all around the halls of Westminster and that measuring thier waistline and towards their height was a basic way to check no matter whether they were a healthier dimension.

“At the end of the day you are not able to be obese unless of course you are consuming too significantly – and it seems to be negative if MPs are telling men and women what to do and are obese themselves.

“It is an essential issue and we notice fairly a bit of weight problems in the ranks and, they are eating too a lot of the gross nationwide merchandise. .

“It is killing hundreds of thousands of people, its costing billions and the price is cost-free – consume less and consume more healthily. I hereby empower folks – all they have to do is place significantly less meals in their mouths.”

This week the Nationwide Weight problems Forum warned that Britain’s obesity crisis could be worse that feared with a report suggesting that predictions that half the British population will be obese by 2050 ”underestimate” the scale of the crisis.

In the same debate Lord Tebbit blamed people’s “personal stupid actions” in eating “rubbish” food items for the rise in weight problems. The former Conservative Cabinet minister lashed out at those who “stuff themselves silly” at question time in the Lords.

He advised peers: “Individuals ought to know that if they stuff themselves silly with high calorie rubbish foods they will get body fat.”

“It is their accountability and all the forums and other nonsenses are just making an attempt to divorce men and women from the consequences of their very own stupid actions.”

MPs should measure themselves to check if they are obese a Lord and major surgeon has said