I'm a CAMHS adolescent therapist AMA

[CAMHSadolescenttherapist]

I have worked for many years in a CAMHS adolescent team in the NHS. We get referrals mostly for high risk and complex presentations: self harm, suicidality, emerging psychosis, intense anxiety, long term school refusal, family crisis and (recently lots of) gender dysphoria. This last year has been intense in our team, with many changes.

As the title says ask me anything. I've name changed for this.

What qualifications do you need for this role?

What year did you start this job?

Discuss how much of an impact does social media have on youth of today.

@BluebellsGreenbells

What qualifications do you need for this role?

CAMHS teams work with a multidisciplinary model. Thus include different professionals. In recent years we have of course had cuts in funding so it varies from area to area.

But good CAMHS adolescent team will include consultant psychiatrists, child and adolescent psychotherapists, clinical psychologists, mental health nurses, family therapists and perhaps some social workers with an interest built over years in Camhs work. In our team we have all of those.

What do you think is the best approach for a young child with ocd?

@FTEngineerM

What year did you start this job?

Discuss how much of an impact does social media have on youth of today.

I've been working in this and similar teams for about 10 years and then years of training before that

Social contagion in adolescence and different "cluster" presentations have always existed and changed. Social media is a huge part of our discussions with families and young people. I would say it plays a role often in the way things like self harm or ideas about what it means to be anxious get communicated amongst groups of young people. But if you go beyond the social media narratives, each young person is different.

Has your role changed due to lockdown?

@solittletime

What do you think is the best approach for a young child with ocd?

When you say young child do you mean primary school age?

One thing to say is that in primary school a level of obsessionality is very normal while in other ages not so much. So you would need a full developmental history before thinking of an approach

How do you cope when the service can't help a Young Person? E.g. when they are deemed to not need the service or when they simply won't engage (or often more accurately their parents won't engage).

What are the best and worst things you see parents doing to support children and young people with their mental health problems?

Possibly better phrased as what do you wish all parents knew about supporting the mental health of their children and young people?

@Ylvamoon

Has your role changed due to lockdown?

Yes! We have had to adapt and be flexible. I've worked throughout seeing certain young people in person (wearing masks) but there are other young people I see on video and some prefer phone too.

What are the current waiting times in your area for seeing CAMHS once referred?

Curious - and concerned - because I have seen posts on mumsnet from parents of what seem to be very unwell children being told there is a very long waitlist.

@TinyGringotts

How do you cope when the service can't help a Young Person? E.g. when they are deemed to not need the service or when they simply won't engage (or often more accurately their parents won't engage).

That's too different things.

In terms of triage and not being able to accept referrals that is the biggest discussion almost everyone working in the nhs has. It's very distressing. I don't know where to start with that one. We need more resources... but we do try our best to accommodate as many families as possible.

In terms of engagement. That's the whole focus of our work. The main main goal is engagement. Some families and YP come just to talk through a crisis. Others stay for years. It really depends. It's sad when they can't engage. We often try different approaches or therapists and usually it works ok. But of course as you say some won't engage. With adolescents it's easier as they can bring themselves and many do even if parents won't come

@TheSockMonster

What are the best and worst things you see parents doing to support children and young people with their mental health problems?

Possibly better phrased as what do you wish all parents knew about supporting the mental health of their children and young people?

Being flexible as a parent Firm but kind Keeping lines of communication open but not forcing it Everyone makes mistakes all the time Remember when the most silent rejecting adolescent talks to their therapist all the time about their parents and how much they need them Most things pass and it's important to normalise / not pathologise. People change Humour and lightness of touch are your best tools Ask for help! From friends / family or if needed professionals. Just talk it through

If someone with no relevant experience wanted to work in mental health services, what is the best pathway for them to take and what can they do to gain as much knowledge for the role?

@BaronessVonCake

What are the current waiting times in your area for seeing CAMHS once referred?

Curious - and concerned - because I have seen posts on mumsnet from parents of what seem to be very unwell children being told there is a very long waitlist.

It depends on the presenting problem sadly. In our team it's two weeks and we always stick to that But that's because of the type of problems In other teams unfortunately its many months. It's a terrible reality that upsets me hugely as it does all CAMHS clinicians

My personal view (not all would agree) is that CAMHS teams also lose a lot of time and resources with diagnostic processes when in fact those families would be better served by being seen more quickly as in the end even if a child has ASD traits the treatment wouldn't be that different. Sometimes diagnoses are useful for school support but often it's because parents insist on them

If you've been seeing patients throughout the lockdowns, why have wait times gone up 50%?!

My 11 yr old dd has been waiting for almost 2 years. I was told yesterday it will be at least another year. Since she's been on 'the list' it has gone from 18mths, to 2 years and now 3?! Wtf?!

I know and understand your case loads will have gone up and lockdown will have caused issues. But this is simply unacceptable. It wouldn't be acceptable in any other NHS discipline. I was also told in yesterday's phone call that I should hold off getting a private diagnosis if I can as it won't be accepted

When CAMHS refuse to see a child who desperately needs help, and we're advised to go private, who can we complain to?

@GoddessLocs

If someone with no relevant experience wanted to work in mental health services, what is the best pathway for them to take and what can they do to gain as much knowledge for the role?

Most people study psychology as a stepping stone or maybe nursing

Then after that you need to specialise and get a professional qualification and that takes many years

@user1471530109

If you've been seeing patients throughout the lockdowns, why have wait times gone up 50%?!

My 11 yr old dd has been waiting for almost 2 years. I was told yesterday it will be at least another year. Since she's been on 'the list' it has gone from 18mths, to 2 years and now 3?! Wtf?!

I know and understand your case loads will have gone up and lockdown will have caused issues. But this is simply unacceptable. It wouldn't be acceptable in any other NHS discipline. I was also told in yesterday's phone call that I should hold off getting a private diagnosis if I can as it won't be accepted

I've never heard of a 2-3 year waiting list in CAMHS so I can't comment on that I'm afraid

@user1471530109

If you've been seeing patients throughout the lockdowns, why have wait times gone up 50%?!

My 11 yr old dd has been waiting for almost 2 years. I was told yesterday it will be at least another year. Since she's been on 'the list' it has gone from 18mths, to 2 years and now 3?! Wtf?!

I know and understand your case loads will have gone up and lockdown will have caused issues. But this is simply unacceptable. It wouldn't be acceptable in any other NHS discipline. I was also told in yesterday's phone call that I should hold off getting a private diagnosis if I can as it won't be accepted

About the private diagnoses

They are often not accepted because sometimes (not always of course) private diagnoses get done extremely quickly and don't follow the needed steps

@MotherOfGremlins

When CAMHS refuse to see a child who desperately needs help, and we're advised to go private, who can we complain to?

I wouldn't know the answer to that in terms of formal routes

I do want to say CAMHS thresholds as well as social services thresholds have gone up due to austerity and lack of resources. That is a tragic reality and not the fault of professionals. If I were you I would join any campaigns for more funding in school and NHS mental health

As a parent I would go back to my GP in that case and insist on a re-referral. I would also work with school who have their own resources. Often when CAMHS get a referral repeated times it will get flagged up

I find that hard to believe when there are threads full of parents saying the same thing on here.

Everything comes down to money. I get that. But the service is clearly not fit for purpose. I am a secondary school teacher and I have not heard if one case where CAMHS have been helpful. In fact there are so many students waiting for appointments during their 5 years at secondary and many leave school without being seen or get so bad that they end up leaving school or become an non-attender. We are failing our young people.

Thanks for answering my question @camhsadolescenttherapist

Why aren't children seen if their behaviour is very unsettled? I work in children's services and referrals are often bounced back when a child is very up and down, for example a looked after child recently having huge outbursts, hitting teachers, running away - camhs came back saying work can't begin until the child is more settled. To me it's clear the trauma he is grappling with is behind his behaviour, and he needs the work now to enable him to begin to settle. I agree maybe delving into his past right now wouldn't be appropriate, but theres lots of other therapeutic work that could be done to help his current presenting problems ease enough that he could do the deeper stuff. It drives me up the wall how often we get this. This child in the end we had to work really hard to get funding for a commissioned service instead. I'd really love to understand the reasoning behind these referral refusals.

@user1471530109

I find that hard to believe when there are threads full of parents saying the same thing on here.

Everything comes down to money. I get that. But the service is clearly not fit for purpose. I am a secondary school teacher and I have not heard if one case where CAMHS have been helpful. In fact there are so many students waiting for appointments during their 5 years at secondary and many leave school without being seen or get so bad that they end up leaving school or become an non-attender. We are failing our young people.

You have not heard of one case where CAMHS has been helpful?

I find that very hard to believe. Unless you have an extremely under resourced CAMHS service in your local area. In my experience most families are helped hugely by CAMHS. We don't of course manage with everyone which would be the same with every profession.

CAMHS services do not normally have 2-3 years waiting lists. I know that the Gender Identity Service (Tavistock) does have a huge waiting list.