Can I, as a FC block them giving my LAC anti-d's?

(46 Posts)
Gymbob Mon 12-May-14 16:37:20

My 14 year old LAC, has been told by CAMHS she has 'a low mood'. She hasn't being diagnosed with depression. CAMHS are likely to prescribe my fd anti-d's this week. I have asked if we can try other avenues first, like CBT, or even a placebo if they must prescribe. I do not believe she is depressed, and I'm not on my own, school doesn't think so either. Trouble is, CAMHS have asked her if she would like to start on them, and she is delighted and looking forward to it.

I am not totally against the idea for the right reasons, but I don't feel that they should prescribe anti-d's without exploring elsewhere first.

As a fc, what powers do I have, does anyone know. I mean, do I have the power to prevent them doing this or will I just be overruled?

thanks in advance for any advice or opinions

DameDiazepamTheDramaQueen Mon 12-May-14 16:48:39

FC foster carer? LAC?

Gymbob Mon 12-May-14 17:01:26

sorry FC foster carer. LAC looked after child x

DameDiazepamTheDramaQueen Mon 12-May-14 18:25:24

Oh rightsmile

Have they actually said they will prescribe anti d's?

Low mood over a period of time is usually depression, isn't it?confused

Why would you want to stop something that would help her? Or do you want to explore all options first?

I imagine as she's only 14 they think she's pretty seriously depressed.

Georgethesecond Mon 12-May-14 18:30:45

Don't the LA have PR, but you don't, so they get to decide?

Gymbob Mon 12-May-14 18:52:27

Drama Queen CAMHS have said it's likely that the psychologist will prescribe them this week.

I'm not an expert, but I wouldn't agree that low mood over a period of time is depression - it's low mood. I don't think she's depressed.

Of course I wouldn't want to stop something that would help her - I said that in my original post, but nothing, I mean nothing else has been offered, no counselling, no placebo, no therapy of any kind. Surely that can't be right? If I didn't care, wouldn't I just let them put her on the anti d's, at least I might get some respite from the moodiness! What about the potential side effects, and besides there is evidence that talking therapy can be just as effective in some cases as medication.

George I think you might be right actually thinking about it sad

Gymbob Mon 12-May-14 18:53:18

George - or don't the LA and me have joint PR?

Georgethesecond Mon 12-May-14 18:56:23

I'm pretty sure you don't. Wasn't it covered in training or an info pack?

No you don't have PR. So you can't decide for her.

And unless you're a mental health professional it's best to let them prescribe them for her, they will very likely not do any harm. The waiting list for Cahms appts for therapy is ridiculous - can you access other services? Nspcc? School counsellor? Pay privately out of fostering allowance?

I'm also a fc who doesn't think anti-d's are the obvious answer but if they're not offering anything else it is something. And they're very unlikely to do harm.

Coulsonlives Mon 12-May-14 18:58:40

PR is with the LA and parents on a care order. LA can trump parents if needed.

DameDiazepamTheDramaQueen Mon 12-May-14 18:59:19

OP, what do you think depression is?

Gymbob Mon 12-May-14 19:09:05

Drama this is straight from the dictionary:

'severe, typically prolonged, feelings of despondency and dejection.'

She does not have those symptoms. Why are you being so condescending?

Laurie I have accessed other help for her, and she thinks it's helping, but she's hanging out for the anti d's.

DameDiazepamTheDramaQueen Mon 12-May-14 19:11:07

I'm notconfused I asked you what you thought depression is.

Bowing out, good luck with everything.

Ok, she wants them then she should have them - that's simple.

I'm struggling to understand - are you really anti them?

If she wants them then they are likely to have an even greater effect as she will believe in them.

mrssmith79 Mon 12-May-14 19:13:36

YABU. ADs and talking therapies are very rarely 'stand-alone' treatments. The most therapeutic results are most often achieved with a combination of both. As well as this, results from ADs are never instantaneous - nor are therapy appointments. Starting on an AD may mean that your LAC (how impersonal, I hate acronyms and labels) is much more receptive to therapy once it becomes available - CYPS services are stretched to the limit more or less nationwide.
With all due respect, it's not your place to over-ride experienced professionals, not to mention the wishes of a fourteen year old who, I assume, has capacity and Gillick competence.

ShoeWhore Mon 12-May-14 19:14:14

OP I don't know anything about your position as FC but the charity Mind has a very helpful website and helpline - I wonder if that might be useful?

Here's what they have to say about depression

Roshbegosh Mon 12-May-14 19:23:05

I am a carer and I don't know why you would want to deny her the help the professionals say she would benefit from. They don't just go to a dictionary like you have, they do a proper assessment and treat as indicated (where resources permit). The LA would not view interference from you on that level at all positively. Any other help you can get for her would be more effective alongside the medication they recommend. I do not intend to be rude but the fact is you are not the expert here, if this child were your own you could stop them, but not as a foster carer.

Kundry Mon 12-May-14 19:23:22

You can't give people a placebo in the UK. It's effectively lying to your patients. How could she have any trust in her treating team if she found out they gave her fake tablets?

The definition of depression as a mental illness is not that found in the dictionary, it's medically defined and low mood over a prolonged period of time would easily qualify.

CAMHS would not recommend an anti-depressant to a teenager lightly and presumably are offering other support as well (or know she is getting it elsewhere). Is she seeing a psychiatrist or psychologist or both? You mention a psychologist prescribing which would be unusual as if she is seeing a psychologist they would be offering talking therapies.

Is there a reason you are so against anti-depressants? Proposing she is lied to with fake tablets instead is very concerning.

Fathertedfan Mon 12-May-14 19:41:13

What does the child's social worker think about the proposed medication? I'd be calling a meeting with both my social worker and the child's social worker if I had doubts about any medical treatment that I was uncomfortable with. Historically with all of the foster children who have been in my care, I've acted strictly as part of a team with the other professionals, and my views have always been taken into account with the other professionals in the team. This certainly isn't a time to strike out on a limb in my opinion.

MarathonFan Mon 12-May-14 19:44:23

Gymbob I understand exactly what you're thinking.

I would resist my DCs having Anti-D's too and want to explore other options properly. I don't claim to be any kind of expert but I have had prolonged periods of low mood in my life and there has always been a reason for it - something that could and should be resolved to make me feel better. Drugs may well have helped lift my mood but they woudln't have resolved the issues. If one of my Dc was feeling like that I would want to know we had done absolutely everything to get to the bottom of any problem before resorting to medication.

I know that in some cases depression doesn't have a "cause" as such but I do thing that in most there has at least been a trigger. I imagine a teenager in FC has more reason than most to be suffering from low mood.

I would also like the idea of a placebo and don't understand the outrage, It's a prove scientific fact and can help with all sorts of things. The treatment would be very real.

MrsJoeDolan Mon 12-May-14 19:50:32

Psychologists don't (ordinarily) prescribe anti-ds, usually the psychiatrist as they have a medical degree.

NanaNina Mon 12-May-14 20:45:26

I think the OP is getting a hard time unnecessarily on this thread, as she is merely showing concern for the girl in her care. Can I just say PR is with the LA on a Care Order, though they are meant to keep parents informed and take into account the wishes and feeling of the child or young person.

I can't understand why CAMHS are talking of ADs as only a GP can prescribe or a psychiatrist, but in a case like this a GP would not normally refer the patient t a psychiatrist. I think the way forward is for the GP to make an assessment of whether in fact ADs are an option, and if so, then they should be talking with the LA who hold the PR on the girl.

FatherTed and *MarathanFan - completely agree with you both.

Kundry Mon 12-May-14 21:00:02

CAMHS would involve a multi-disciplinary team including a psychiatrist.

I don't know any GPs who would prescribe anti-depressants to a 14 year old as it is a specialist area which is why she is seeing CAMHS.

Gymbob Mon 12-May-14 22:25:23

Laurie I do not believe that if she wants them she should have them. In fact I think that is outrageous to even suggest it. My fd is a complicated case, and I don't believe that at 14 she is mature or wise enough to make these kind of decisions - much as she thinks she is. She has already mentioned to people on Facebook that she is going to be getting them, and she will no doubt announce that she has been prescribed them.

I have already said I am not anti AD, but I am horrified that CAMHS appear to be going to prescribe them because she wants them. They haven't even done a proper assessment. And even if they had I still think that resorting to medication - particularly for a vulnerable 14 year old - should be a last resort after all other avenues have been exhausted.

Kundry Placebo's are regularly used in the UK, they are not illegal, although the GMC do state it is against GMC guidance. I would hope that she would not find out if she had been given a placebo. I did take her to the GP at her request, as she didn't believe me when I told her that the GP couldn't prescribe AD's.

Fatherted I won't be striking out on a limb, don't worry, but I have made, and will continue to make my displeasure known. Unfortunately, we are between social workers atm, which is really bad timing.

MarathonFan Your support is greatly appreciated here. thank you smile

JoeDolan She is seeing a psychiatrist not a psychologist, the latter can't prescribe.

NanaNina Thank you for your support smile

Roshbegosh I don't want to deny my fd help - why would I. I am wanting the very best for her actually, which is why I am putting so much time and effort into this. I want to be satisfied that if she does get AD's, it the best option for her, and at the moment I'm not.

Shoewhore thanks for the link, it's very interesting.

Mrssmith I understand what you are saying about treatments, it makes sense to me, but I disagree that I should have to allow a 14 year old AD's just because she wants them. Yes, she has capacity but that still shouldn't mean she can have them because she wants them.

Drama apologies for being short [embarrassed]

Kundry Mon 12-May-14 22:53:00

Am trying to think of a time in 20 years of medical practice I've seen someone intentionally prescribe a placebo - it's never.

GMC guidance isn't something doctors muck about with, it's not guidelines that you can follow if you like but you don't have to, you HAVE to follow it.

And I doubt the psychiatrist's assessment was 'you can have them if you want them'.

Nowhere have you said in your post that she is not competent to make that decision though confused

Just because you don't think she is mature and wise enough to make that decision has nothing to do with it unless she's actually determined as not competent.

I have a fc that age who is competent to make decisions I personally don't agree with - multiple piercings, horrible hair dyes and make up - if she wanted to take anti d (and I've already told you I wouldn't be keen my job would still be to support her)

I think you're having trouble seeing what's your decision and what's hers (in concert with her medical professionals)

I've already been supportive of you on this thread and said I agree with you - but me agreeing with what you want is irrelevant. You don't get to make those decisions for her, you don't have PR and if she's able to make medical decisions then she gets to decide whether to take the anti depressants.

I'm very, very surprised you think what I said is outrageous

Feel free to come back and say actually she has extensive learning difficulties and isn't competent to make medical decisions smile

Because I would like to be able to support your position

NanaNina Mon 12-May-14 23:15:31

Oh dear that's touched a nerve! Look OP I think discussing the matter on here isn't such a good idea, as you are getting a hard time and that can't be any help when you are distressed about your girl. Some posters seem to have very fixed opinions and I know this is usual and what MN is all about really, but I'm concerned that you are going to get more frustrated/distressed than is necessary.

Can you arrange a meeting between the social workers, CAMHS and yourself to discuss the whole matter and hopefully come to a sensible decision. I still think CAMHS would need to refer your girl to her GP as I am almost certain there is no one medically qualified as part of the CAHMS team. I can't imagine a GP being happy to prescribe ADs to a 14 year old - not at all, but then that's just my opinion.

Do hope this matter gets sorted out soon.

NanaNina Mon 12-May-14 23:21:54

Kundry I beg to differ about your assertion that it is illegal to prescribe placebos in the UK. I know that in trials to test all sorts of drugs, one group is given a pharmaceutical drug and the other group are given placebos and no-one knows which they are taking. I know that as far as depression is concerned the trials have found that mild depression is as likely to respond to a placebo as to an AD and so it is not usual to prescribe an AD for mild depression, whereas they have been found to be effective for moderate to severe depression.

Given your 20 years of medical practice you must know far more about these trials than I do.

It's illegal to prescribe placebos unless people know they might be prescribed them and they give their consent like in medical trials smile

Rhinosaurus Mon 12-May-14 23:27:58

Nice guidelines for depression in under 18s
www.nice.org.uk/nicemedia/live/10970/29858/29858.pdf

eightyearsonhere Mon 12-May-14 23:57:04

nananina i am afraid you dont know what you are talking about.
firstly all CAMHS teams are headed by- a consultant psychiatrist- a medical doctor who graduates then trains initially in general adult psychiatry then specializes in child and adolescent psychiatry. you are simply wrong to state she would be referred back to her gp. her gp will in fact defer to the psychiatrists.
secondly- using a placebo in trials is with the explicit consent of all who take part. placebo is simply never ever used in clinical practice. it would be illegal and immoral and unethical.
honestly your advice is so wrong.. you really should not concern yourself with these topics. stick to what you know. and you dont know about psychiatry.

NanaNina Tue 13-May-14 00:32:49

Oh dear - well that's told me.....I do actually know quite a lot about CAMHS as I was a social worker and middle manager for a LA Children's Services, and obviously came into contact with CAMHS - indeed the social workers attached to CAMHS shared the same open plan office. I also remember that CAHMS took over from the old "Child Guidance" organisation. My social work career spanned some 30 years. I am now retired.

I am also aware what a consultant psychiatrist is, so don't need your explanation, but the CAMHS in the area in which I worked was certainly not headed by a such a professional, and so there must be differences related to different areas. Of course I also know that a GP will defer to a psychiatrist. Indeed the CAMHS in the geographical area in which I worked did not have a particularly good reputation, but fortunately we had the services of an excellent clinical psychologist who was prepared to take on referrals that CAMHS had declined.

You see I am actually a service user of psychiatric services and am in secondary care, which of course you (with your comprehensive knowledge of such matters) will know that this entails oversight by a consultant psychiatrist and a CPN who I see on a regular basis. I have also been fortunate enough to see a therapist on the NHS as I was an IP in 2010 for 3 months, and had the dubious pleasure of having a weekly review "chaired" by a consultant psychiatrist, who had little idea of how to chair a meeting and so my reviews were a Q and A session between the conslt psych and myself. However I digress..........

I am also a member of the EforE panel (I expect you know that means Experts by Experience) and work with others to improve mental health services in the local MH Trust. Recently I was asked by the CQC to assist them in their inspection of the MH services in the Trust and I facilitated a patient's forum and took responsibility for obtaining feedback from patient's who did not feel able to do so themselves. All of this relates to "Older People" (of which I am one...) The CQC have been very appreciative of my input and have asked if I would be prepared to carry out the same function in other MH Trusts.

My comment about placebos was specifically related to trials and of course I am aware that they are not used in clinical practice and did not make this assertion. Contrary to what you believe I am not a "half wit" so I think you should come down from your high horse, and maybe strive not to be so rude in your posts.

Gymbob Tue 13-May-14 09:59:56

Kundry, I keep trying to tell you she has not yet been assessed by a psychiatrist! Not at all!

Re the placebo, I strongly disagree with you. My mother was given a placebo several years ago by her gp. It was discussed with me and my father, and we agreed that it was the best course of action at the time. I have to say though that at no time did the gp say the word placebo. he said he was going to give her some sugar pills. my mother still doesn't know she didn't have the real deal.

I am obviously of the old school where medication was not given out like smarties just because a child says ' I want this and I want it now'. I am prepared to work with my fd and get the best outcome possible for her.

nana, I am sorry that you have been subjected to such rudeness on a thread that I started, I think it's time to leave it now.

If giving your mum sugar pills was discussed with you and your father does that mean that your mum wasn't competent and/or suffering from a mental health condition that meant you and your dad were best placed to make medical decisions?

I agree you should push for a psychiatrist or a GP to do a proper assessment about whether she needs pills.

Gymbob Tue 13-May-14 10:10:48

it is not illegal! but it is against gmc guidance.

my mum does have mh issues although she does have capacity and she wanted real meds.

If it's against the guidance I'm guessing they will be even more careful seeing as she's in care.

If you're not happy when and if they get round to assessing her properly you might get a chance to talk to the psychiatrist alone, I managed to get a few minutes with her alone once before a fc saw her.

Brittapieandchips Tue 13-May-14 10:25:44

I have a life long mental illness (bipolar disorder) - it is severe enough that I will never be off medication. On top of the mental illness itself I have to deal with the bad memories and consequences of the fact that I very clearly started to be ill in my early teens (with signs before even that), and my mum, with the best will and love in the world, refused to let me have medication and built it up as a terrible thing to me. I was left with cbt which was never going to work anyway but was made harder by the fact I had a chemical I balance in my brain and wasn't taking the medication to relieve the symptoms.

It took me being hospitalised for anyone to listen to me enough to give me medicine for the illness that was ruling my life. And I come from a fairly stable background, with mental health experts in my family who refused to accept that I was very ill.

I don't know this girls life, but I am guessing that she has had a lot to deal with. If the experts recommend it, why would you stop her getting respite from her brain chemical problem so she can deal with it. Most people are only on anti depressants short term and it could make a world of difference to her life.

claraschu Tue 13-May-14 10:26:36

CAMHS is very seriously under funded. Everyone I know who has dealt with them has felt that they have not been given the best possible support.

I know adults who have been prescribed ADs by GPs after two short appointments (no consultation with a psychiatrist, no previous talking therapy). I don't think this is a great idea.

It is not news that the NHS is trying to save money. Putting people on ADs is sometimes a money saving tactic in situations such as the OP's. I agree with her that ADs should not be prescribed until other treatments have been tried in a case like this, where the depression is not severe.

Shallishanti Tue 13-May-14 10:38:29

the NICE gidance seems clear enough, ads should not be given to yp with mikld depression in the first instance. Watchful waiting and other interventions, diet, sleep, exercise and talking therapies.
ADs are drugs, they have side effects.

fasparent Tue 13-May-14 12:39:15

LA has parental right's with BP's , Is open too discussion and compromise, all round . Also have too check through. everything and I mean everything, have had children placed on medication grossly overprescribed giving children and baby's adult dosages , some resulting in organ damage , limiting their lifestyle living, have too look at secondary complications too drugs, as improvement too quality of life with drugs. LA's will be culpable of wrong decisions so important too discuss at length, taking into consideration child will be with FP's for most of the time , and they will know the child better than most.

NanaNina Tue 13-May-14 14:11:46

Don't worry Gymbob about that rude post from eightyearson - it isn't your fault! I see she/he hasn't returned. I don't usually "out" myself as someone suffering from a mental health problem (depression and anxiety) on threads other than MH threads, where there is so much support and no rudeness at all. My depression is intermittent and between times I am fine.

I agree that I don't think there's anything to be gained by continuing to post Gymbob - I'm sure you've heard enough of others' opinions on the matter.

MyLadyAnita Thu 15-May-14 16:19:58

Gymbob - My advice would be to put your objection in writing, give your reasons, and then BACK OFF. You will have done all you can by doing this and can do no more. Make a note of who you wrote to. Be factual and no opinions. Keep a copy.

If you go on a mission, even if with the best interest of your foster child at heart, you will end up bruised and hurt and this will be no use to your foster child.

She will survive this and so will you. Time will probably prove you right but you cannot fight the professionals.

fasparent Fri 16-May-14 11:05:56

In addition be sure your LA provides you with a drugs record chart's (Official One) and record everything in diary children's log. Also speak school regards too their drug policy, and qualified staff if administration of drug's is required during school time.

Gymbob Sun 18-May-14 14:50:43

UPDATE: Met with psychiatrist. The psych spoke to my fd alone for 10 to 15 minutes, so that constitutes 'a full assessment' before prescribing (NICE guidelines).

My fd is already receiving talking therapy from another source (NICE guidelines as first line treatment), so she qualifies for AD's. Further talking therapy may be too much as she is already engaging in one lot, so she qualifies for AD's.

Because she may not engage in CBT she qualifies for AD's.

Result: AD's if she wants them, it was so obviously a foregone conclusion. Fd also told psych she is anxious (news to me), so she recommended one particular drug. She also told psych that birth mum suffers from depression and short term memory loss (news to me). Rang CAMHS next day to tell them fd has decided on AD's, then rang (new) social worker to pass on the news. She said 'WHOA, hang on a minute, I need to see about this'. Rang birth mum, who said 'WHOA, hang on a minute, I need to see about this'.

So I have inadvertently lit the blue touch paper, and now I am standing well back confused.

MerryInthechelseahotel Sun 18-May-14 21:49:33

I think if I thought it was going to be a foregone conclusion I would have spoken to the new sw and bm before the appointment tbh What is going to happen now?

Gymbob Sun 18-May-14 23:07:43

They knew about the appointment in advance obviously, it was only my opinion it was a forgone conclusion...but they knew that too....

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