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.

@RosesAndHellebores

I work in a 9-5 service. That means out appointments don't start till 9.30 and last appointment is 3.30

Protected admin time is important because if that 3.30 appointment that finished at 4.30 needs referrals, emergency plans etc then that person is already working later than 5. Its no good to see someone at 5 then say we'll we can't do anything now because we are now shut.

I know you disagree about not having appts at 9, and we do offer the rare one. But we get incredibly important overnight emails, have to check on crisis that occur the day before and have handovers. To walk straight into an appointment would mean really important things would get missed (as well as the possibility to cancel 9.30 appts if someone is sick, or something has happened caseload wise)

What is also clear is the huge variations between teams

This is true. I have two children with ASC (all my children are neurodiverse) both diagnosed by CAMHS but by different teams within CAMHS. One has the most lovely doctor who has continued his care post ASC diagnosis and is one of the few CAMHS workers I have met that I feel listens and and is compassionate. The other was discharged after diagnosis with zero support, when I asked for support I was told CAMHS did ASC diagnosis only and there was no funding for post diagnosis support. When I asked for the treatment my other son had been given which had been helpful I was told ‘CAMHS didn’t offer that’. Which was clearly untrue as my other son has that treatment from the same CAMHS. I find it staggering how different the care and treatment has been for two of my children with the same conditions within the same building, the only difference being which team they were initially allocated.

Do you know when dc are just 'going through the motions' and if so what do you do about it?

Ds1 saw a camhs counsellor at the start of last year. Only in person a handful of times because then lockdown happened, rest of appointments were phone based. He reported feeling positive after each session but would not divulge what was said (he was 16 at the time). He was discharged after about 4 months.
Months after it ended he confessed it hadn't really done him any good, he told her what he thought she wanted to hear because he felt he needed to "pass" therapy. He's nowhere near 'fixed' and not really able to use the coping mechanisms she apparently taught. The books she asked us to buy have gone unread (by him). He's still anxious, sleeping a lot, not left the house (even into the garden) since before Christmas. I want to help him but don't know how.

Why can’t staff get to work at 8:30am for a 9am start? Or 8am for an 8:30am start? Why can’t there be two shifts one starting early and one finishing late?

I have children, I have a life, I still manage to start work at 8:30

@KitHenry i dont think arguing over the times is helpful or relevant to this AMA

Sadly the service is designed to suit the needs of the staff not the customer/client/patient.

Do you ever worry about the iatrogenic effect of CAMHS on young people with 'emerging EUPD' (or similar)?
I definitely would have met most of the criteria as a late teen young adult but this had resolved by approx age 25 when my emotions/personality matured. Do you think there's a risk of pathologising natural mental development and taking it down a route it may not have otherwise? I worry about our young people self diagnosing themselves with mental health problems at a point in their lives when their identify is forming, becoming more fixed in their minds than it might have needed to be.

Why can’t staff get to work at 8:30am for a 9am start? Or 8am for an 8:30am start? Why can’t there be two shifts one starting early and one finishing late?

Then they'd finish earlier anyway, it would the same amount of hours.

@WetJan I think that's a really good point. Despite being trained in 3 distinct therapies I don't always think it's "good to talk" it can almost reinforce and grow problems to diagnostic level significance when they don't need to be. There's also a modern phenomenon of pathologising normal emotional responses to difficult situations. A lot of adolescents have eupd characteristics just by the nature of being adolescent, impulsivity, identity confusion, erratic emotions, black and white thinking. This is why CAMHS needs to be a specialist service for the treatment of significant mental health problems, rather than the catch all mop up which it currently is.

Again I understand some families have had to jump through excessive hoops to get an appointment. Our service was different with an ethos of "seeing everyone". Trouble is if CAMHS wasn't the right service for them at the initial assessment they didn't like being discharged as their difficulties in their minds were already in the illness zone.

Despite being trained in 3 distinct therapies I don't always think it's "good to talk" it can almost reinforce and grow problems to diagnostic level significance when they don't need to be. There's also a modern phenomenon of pathologising normal emotional responses to difficult situations.

That's an interesting thought @Tulipsofamsterdam and helps with my wondering about therapy and children (not in crisis).

@Inthevirtualwaitingroom it is relevant because a PP asked why they couldn’t get an appointment before 9:30.

A PP had remarked that when they worked at CAMHS they worked part-time hours because they have a life and often didn’t get to work until after 9am as they had to drop kids off at school.

Whilst I understand the explanation that a 9-5 service can only accommodate appointments between 9:30-3:30, I’m asking why the service can’t have longer hours? For example 8am to 6pm or even 7pm? Not really unusual or unreasonable.

Hi Op.

I thinkni have had a better service by luck than anything else. My Ds got in tye backdoor for cbt for phobia - he since has a diagnosis of adhd then Asd, this has taken 4 years.

My question is what is the general opinion of parents.

My own experience is you almost have to prove you aren't a crap parent before you are believed.

Also dispute me standing in camhs reception crying no appointment- school call say its safeguarding seen within a week.

I really find dealing with a child with challenging needs fighting the beuracracy makes it twice as hard

@Starlightstarbright1 "My own experience is you almost have to prove you aren't a crap parent before you are believed."

How do you know they believed that?

You see it's very easy for us parents- I identify with that feeling as a mother- to assume we are at fault when our children struggle. However it's a huge jump from there to assume others believe that too. If a CAMHS clinician views all parents generally as "crap" then that would be a crap CAMHS clinician! My view is that parents are a huge part of the solution and it's very important for us at Camhs to be working closely with them- and in my experience the young people who have the better outcomes are the ones where parents get engaged with the work

[quote camhsadolescenttherapist]@Starlightstarbright1 "My own experience is you almost have to prove you aren't a crap parent before you are believed."

How do you know they believed that?

You see it's very easy for us parents- I identify with that feeling as a mother- to assume we are at fault when our children struggle. However it's a huge jump from there to assume others believe that too. If a CAMHS clinician views all parents generally as "crap" then that would be a crap CAMHS clinician! My view is that parents are a huge part of the solution and it's very important for us at Camhs to be working closely with them- and in my experience the young people who have the better outcomes are the ones where parents get engaged with the work[/quote]
Because I was told that I was seen how I patented- meltdowns in cbt , I work in childcare so was told they knew it wasn’t parenting issue...

I also know people who have had to go through parenting courses before their child has been assessed.

@KitHenry there is no point asking that question of OP. All services are different. The one I work in, and many others, do offer earlier and later appointments. You need to ask whichever service you are dealing why they are structured as such.

@CAMHSadolescenttherapist agree with you so much about parents. Engaging with the whole system is vital for successful outcomes. My personal experience is that some parents can feel like you are judging their parenting by wanting them involved in change. Once we (and I say we as it is as much my responsibility as theirs) overcome that barrier and all start working together, things get much better.

@Tulipsofamsterdam such an interesting comment about pathologising normal adolescent responses. Generic education about mental health, wellbeing and resilience is so lacking in the UK. Many of my teenagers friends have diagnosed themselves with something, despite functioning pretty well and never having seen a professional about the issue in question.

@CAMHSadolescenttherapist or @camhsadolescenttherapist

I've chosen not to answer to be 100% sure I maintain anonymity as there are not that many of us

Really? Not that many of you in the UK? Okay then.
So you’re not clearing up what actual qualification a “therapist” working for cahms actually has. But it’s not in nursing or psychiatry clearly. Okay then.

I find the pathologising comment interesting too.
One of my kids is now 16. As a young child around about age 6 he went through a phase of disliking germs on his hands but we were able to rationalise and talk this through with him. Nowadays he showers daily with lots of soap and washes his hands assiduously after the toilet, with soap, for a minute or so. He says he feels to a certain extent compelled to do so, but has been able to rationalise with himself that it's just an intrusive thought (he's obviously done some research!) and "since I realised that it bothers me much less". He asked if he should be assessed for OCD and we had a long chat. My thrust was that whilst I could see where he was coming from, I could also see that a) he had the ability to step outside those thoughts, rationalise and minimise them and that is probably not dissimilar to treatment advice and b) it doesn't interfere with his life: he isn't constantly washing, repeatedly washing, missing scheduled activities to wash etc. I told him having "if I do X then Y" and "If I don't do A then B" thoughts are not uncommon. It's whether it's got out of his control and stopping him functioning that is the key thing that might tip it into OCD. (We also talked about a need for referral, waiting time etc). In the end he was happy with that so I am in a sort of "monitor the possibility that thus may become a problem" holding position as a parent....whilst worrying that I am also being neglectful in not seeking an immediate referral.

Do you think, OP, that our current stance seems reasonable? And that this could just be part of his personality rather than a condition that needs diagnosing?

@Diverze "Do you think, OP, that our current stance seems reasonable? And that this could just be part of his personality rather than a condition that needs diagnosing?"

To me, reading what you've said, it feels totally reasonable! Normalising things and accepting the small pockets of "madness" we all have inside us is a big part of feeling at peace with ourselves. In addition, Intrusive thoughts and small compulsions are incredibly common- in fact there has been research done showing almost everyone has SOME intrusive thoughts. Some people are probably a little more "obsessional" than others which on its own is not a huge issue, it could be as you say a personality structure.

The question is always- how much does a problem create obstructions in everyday life and enjoyment? Then you may need to intervene. Otherwise it's important to learn to live with ourselves I think, with our ups and downs and our idiosyncrasies

@Isadora2007 if you look at the mental health legislation for the part of the uk you are from, that will tell you what professionals are eligible to provide mental health assessments. Alongside those, in many services I’m aware of, you will have therapists accredited by professional bodies such as BACP. A lot of my colleagues have a core profession and a therapeutic qualification. You really don’t need to go to town on the OP about her decision not to tell you her personal details to answer your question. There are many more layers to mental health services than nursing or psychiatry.

@Isadora2007 I’m confused, why are you so insistent on the OP providing her CV for you.

Someone, qualified, has decided she’s suitable for the position of ‘adolescent therapist’ and that’s the job she’s done for a decade therefore clearly highlighting she is suitable.

Thank you @camhsadolescenttherapist @CAMHSadolescenttherapist for answering my question yesterday. I am trying to establish what to do about my DC and social media, he’s only a baby so not soon but I think the foundations are laid early for how a persons relationship with technology and social media develops. Me and DP will of course display how I’d like DC to approach long before they’re able to have their own accounts. I want them to know their worth extends to more than what some ransomed says anonymously on the internet.

I have worked in education for 30 years. I agree that I have hardly ever seen anyone helped by CAMHS. To be fair, there is one mother I know who says it helped her family. No one else really.

I think the issue is the expectations people have. You get a skin problem you go to the gp, you get medication for your skin problem, it probably improves. People expect the Same of mental health Provision. It doesn’t work like that.

A child says they are suicidal, they go to CAMHS. There is no medication or cure for being suicidal, or anxiety, or school refusal.

There was a thread on here recent skating the Samaritans in a similar way. People ring the Samaritans expecting doe fort if treatment or cure, rather than understanding that it’s just a listening service.

CAMHS is similar. You can try this or that, but they can’t change anything fundamental.

So inevitably, people put all their hopes into finding some sort of ‘treatment’ to ‘cure’ their child, but rather than understanding that the treatment and cure goes not exist, they blame CAMHS for not providing it

@Rowenasemolina "A child says they are suicidal, they go to CAMHS. There is no medication or cure for being suicidal, or anxiety, or school refusal. "

There are no direct quick fixes it's true, but people can and do get better over time, many many do

@Rowenasemolina thank you that's a very insightful post. IF someone meets the threshold for a diagnosis the treatment is very much about strategies to cope, and the work is hard. If you're depressed and doing nothing you need to force yourself to do some graded activity or the treatment won't work. In anxiety disorders you have to put yourself in unpleasant and triggering situations in order to habituate to them.

Much of CAMHS work is managing complex risk and interpersonal difficulties which are multi systemic in their formulation. There's no prescriptive therapy or medication for these types of presentations and the solution HAS to be multi systemic and involve family and school. It's often feels quite crisis driven and chaotic. DBT is cited as the therapy for managing emotional dysregulation but again it requires a lot of hard work and implementation in between sessions. The motivation isn't always there. The therapy sessions are more like the planning bit really... The actual change happens in between sessions when people put the strategies and ideas into practice. There's no CAMHS magic wand but families are understandably desperate so it's hard to accept there's no prescriptive treatment that will take it all away.

Someone mentioned parenting courses. The NICE guidance is that a parenting course be undertaken to see if there's improvement before any other intervention for behavioural problems. There's no shame in attending a parenting course, the local ones are excellent and run by highly qualified and highly skilled professionals. I'd have loved to have attended one myself!