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.

[camhsadolescenttherapist]

@Jenala

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.

On principle I think I agree with you. It's good to have a CAMHS professional in these networks if possible. But young people won't always engage

Just to say- CAMHS work and therapy is NOT only about "delving into the past". Though that may come into it.

[Pandapotato]

Coming on to give you a fellow camhs person high five @camhsadolescenttherapist. You will get trashed on here and will be expected to take responsibility for waiting times across the country, even if you work in a team that is performing well.
Good luck, make sure your hat is hard & keep up the good work. We are all doing our best in a terrible situation 🙂

[RosesAndHellebores]

Why do CAMHS inly work 9am to 5pm when the UK no longer has a 9am to 5pm culture?

Why is money available for overnight (sometimes 2/3 nights) acute admissions to childrens' wards pending CAMHs assessments when there was no money for an intervention that may have oriented the crisis? Also why are there not more CAMHS nurses available at weekends to ensure admissions are discharged as swiftly as possible?

Why does CAMHS close cases after the first therapy session when it can't possibly know the outcome yet say they cannot assist with signposting to private referrals to support lay parents because they don't know outcomes.

Is there resistance to change in the system from within because so many staff work part-time and run private practices alongside their NHS work. Presumably part-timers could be full-time bearing in mind the vacancy levels but don't because it wouldn't be in their best interests personally?

[izzy2076]

My question is about the inconsistency of response when the child has an autism diagnosis and poor mental health. I'm a senco. I've been told in some cases that there's nothing you can do as certain behaviors are simply attributed the the ASC and in other cases CAMHS have been fantastic with children with autism and have been able to offer therapeutic intervention. Why is there this inconsistency and why in some cases do camhs reject dealing with asd and poor mental health?

The CAMHS practitioners I've worked with have mostly been fantastic. There seems to be much more of a collaborative approach recently when working with schools.

[camhsadolescenttherapist]

@Pandapotato

Coming on to give you a fellow camhs person high five *@camhsadolescenttherapist*. You will get trashed on here and will be expected to take responsibility for waiting times across the country, even if you work in a team that is performing well.
Good luck, make sure your hat is hard & keep up the good work. We are all doing our best in a terrible situation 🙂

Thanks @Pandapotato. I do feel for people who have to wait when their child is struggling. But yes that hasn't been caused by NHS professionals

[camhsadolescenttherapist]

@RosesAndHellebores

Why do CAMHS inly work 9am to 5pm when the UK no longer has a 9am to 5pm culture?

Why is money available for overnight (sometimes 2/3 nights) acute admissions to childrens' wards pending CAMHs assessments when there was no money for an intervention that may have oriented the crisis? Also why are there not more CAMHS nurses available at weekends to ensure admissions are discharged as swiftly as possible?

Why does CAMHS close cases after the first therapy session when it can't possibly know the outcome yet say they cannot assist with signposting to private referrals to support lay parents because they don't know outcomes.

Is there resistance to change in the system from within because so many staff work part-time and run private practices alongside their NHS work. Presumably part-timers could be full-time bearing in mind the vacancy levels but don't because it wouldn't be in their best interests personally?

None of what you say has been my experience. I can answer more specific questions but the picture you paint is not what I see on the ground. The CAMHS professionals I know are dedicated and often work long hours. In our team we certainly don't close cases that easily! We work flexible hours often (so many of us offer 8 am and 5 pm appointments and even evening clinics). We also have out of hours teams.

So you're generalising and describing examples of bad practice that are not what most people aspire to.

[Diverze]

"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"

Hi OP
I disagree that diagnostic processes are not important, but they should not be solely hosted by camhs. Our area's autism diagnostic service is a multiagency community team that includes SALT, ed psych, clin psychs, OT and psychiatry.
Fundamentally, autistic people need to understand their neurodiversity and find their peer group and if you only think of autism as a set of behaviour problems that need rectifying regardless of cause then that is a very sad situation. People have a right to know who they are and to understand themselves. An autism diagnosis entitles a person to protection under the equality act and this is extremely important especially in adulthood and as a working autistic person. Autistic people are very vulnerable where they are not protected in law, because of neurotypical interpretation of their communication differences. Unless you have a diagnosis there is no protection. Are you very young in role that you haven't realised this?

School support is eased by a diagnosis, yes, but it also guarantees reasonable adjustments, and hugely opens up the possibility of PIP which may be vital if you are unable to work or can work only in a limited way. With his autism diagnosis I was allowed to accompany my 20 year old who cannot speak to new people when he had to go to hospital recently. Without that diagnosis I would have had to wait outside the hospital and he would have been unable to advocate alone for the medical support he needed. With his diagnosis he is able to attend a specialist college course specifically for autistic youths. Without the diagnosis he would not be able to. Please do understand that a diagnosis goes WAY beyond the very depressing view that some professionals have, that parents only want a "label" in order to assuage themselves of guilt that their child's behaviour is their "fault". My son's behaviour has never been a problem; but my God I am glad he has the legal protection of a diagnosis.

[camhsadolescenttherapist]

@izzy2076

My question is about the inconsistency of response when the child has an autism diagnosis and poor mental health. I'm a senco. I've been told in some cases that there's nothing you can do as certain behaviors are simply attributed the the ASC and in other cases CAMHS have been fantastic with children with autism and have been able to offer therapeutic intervention. Why is there this inconsistency and why in some cases do camhs reject dealing with asd and poor mental health?

The CAMHS practitioners I've worked with have mostly been fantastic. There seems to be much more of a collaborative approach recently when working with schools.

Totally agree with you. I personally really enjoy working with young people with ASD and there's a lot that can be done to help them

[user1471530109]

OP, you clearly haven't read many if the CAMHS threads on this forum. It seems the norm in this country for waiting lists to be 2 years. I am feeling having been told yesterday that we will be waiting 3! How is that acceptable?
There is clearly a phrase I need to say to get her seen. If she's not suicidal (apparently climbing out if upstairs windows and threatening to jump and having to be pinned down is not enough) she won't be seen. It doesn't matter if she is violently attacking her little sister or me. Bin fact I was told I must never leave her alone in a room with her sister. How is that possible?!

I was flippant with my comment about not knowing a case where CAMHS have helped. But honestly, I'm thinking really hard here and I am struggling. The wait time is so long that most of our vulnerable students have left school before being seen. Or like I said, get so bad that they no longer attend.

I understand your defensive. But the service is embarrassing.

[Pandapotato]

@CAMHSadolescenttherapist
“Thanks @Pandapotato. I do feel for people who have to wait when their child is struggling. But yes that hasn't been caused by NHS professionals”

Absolutely. It’s terrible when you have to tell families that there is a wait. Since covid, our service has gone back to having a waiting list for therapy. We hadn’t had one for years. It’s heartbreaking for all involved.

[camhsadolescenttherapist]

@Diverze I am not "very young in role" no.

I also never claimed diagnoses don't have their place. There is however a huge debate and discussion about the role of diagnosis, when it replaces the need for therapy and support. It often does in my experience. A diagnosis helps in the ways you describe, but sometimes can have the opposite effect- ie someone with mild symptoms getting labelled and then family getting really stuck on the diagnosis as an explanation for everything. So it really depends on an number of factors

And I agree diagnoses would be best conducted outside of CAMHS

[Isadora2007]

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.

I think the question was what qualifications you have to be a “therapist” with cahms. Not what the team was made up of. Wondering why you didn’t answer?

[Bluesername]

What would you like to see NHS mental health services do with more money if it were available?

What guidelines are you expected to follow on gender dysphoria? Does anyone get 'cancelled' if they don't have the same views on this or other topics?

[camhsadolescenttherapist]

@user1471530109

OP, you clearly haven't read many if the CAMHS threads on this forum. It seems the norm in this country for waiting lists to be 2 years. I am feeling having been told yesterday that we will be waiting 3! How is that acceptable?
There is clearly a phrase I need to say to get her seen. If she's not suicidal (apparently climbing out if upstairs windows and threatening to jump and having to be pinned down is not enough) she won't be seen. It doesn't matter if she is violently attacking her little sister or me. Bin fact I was told I must never leave her alone in a room with her sister. How is that possible?!

I was flippant with my comment about not knowing a case where CAMHS have helped. But honestly, I'm thinking really hard here and I am struggling. The wait time is so long that most of our vulnerable students have left school before being seen. Or like I said, get so bad that they no longer attend.

I understand your defensive. But the service is embarrassing.

I'm not actually defensive. I'm sorry you have had bad experiences. One person (me) cannot answer for everyone going wrong in the world, all I can do is describe my experience.

[SallyAnn32]

How did you get into this role? I work in a pastoral role and would love to get into this field as CAMH is a passion of mine.

[camhsadolescenttherapist]

@Isadora2007

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.

I think the question was what qualifications you have to be a “therapist” with cahms. Not what the team was made up of. Wondering why you didn’t answer?

I did answer. All these professional roles have their particular routes to qualify. Eg clinical psychology qualification, child and adolescent psychotherapy qualification, psychiatry qualification etc

These are on top of a basic degree so are all postgraduate

[user1471530109]

No. But you work for a service which is failing the very people it was designed to help and support. You've come on here to be asked questions! You must have known surely that those questions would be likely from parents who are struggling and desperate because of your organisation's underfunding/mismanagement. Absolutely this is not your personal fault. But if a parent had an issue with the school I work at I would have to listen and pass on concerns. There is no way my dd's story is unusual. It was only a week or two ago there was a whole thread full of stories much more harrowing. CAMHS is not fit for service. That is not a personal attack on you

[Diverze]

" ie someone with mild symptoms getting labelled and then family getting really stuck on the diagnosis as an explanation for everything"

Disclosure: I work professionally in the role as well as having an autistic adult child.

I don't believe in "mild autism". That tends to mean that a person's transactional behaviours are low and they cause little inconvenience to those around them. It's not about the person's own experiences. If a person isn't affected day by day they shouldn't be diagnosable as that is one of the criteria.

If you are autistic everything you do needs to be seen through that lens, because it is impacts your perceptions, experiences and constructs. You don't do - I don't know- social relationships autistically and maths like a non autistic person. Autism impacts everything. It's not a tap you turn on and off. That doesn't mean autistic people have no autonomy; just that their autonomy is autistic. I do believe that everything an autistic person does needs to be viewed through that lens. And that lens is neutral, not negative.

[alliejay81]

Thank you for the work you do OP. I can understand people's frustration with a system that doesn't work for them but they need to understand you're only one small cog in a large machine and have come on here to help not be lambasted!

Anyway, I have a 12 year old, who has separation anxiety. It existed a bit before covid but is definitely worse now (can't be left on own for even 5 mins, checks to see where you are if you put bins out etc). He can also be generally anxious and get overwhelmed (he recently but his arm when in this state over homework). I don't think he needs (or would get) a CAMHS referral at the moment, but are there are techniques you could recommend to help us support him please? Basically, what should I be googling?!

[Crapbuttrue]

What can I expect as a parent with post-diagnosis support for a high school child with ADHD as well as meds?

[Isadora2007]

i did answer. All these professional roles have their particular routes to qualify. Eg clinical psychology qualification, child and adolescent psychotherapy qualification, psychiatry qualification etc

These are on top of a basic degree so are all postgraduate

No you still haven’t answered. What is YOUR qualifications? Yours specifically. Not your team. What was your route and actual qualifications- not sure how else I can ask- or why you’re evading?

[RosesAndHellebores]

The service where I live now needs support from the school as well as the parent and GP for a referral to be seen. Do you not think that young people should not have to disclose confidential health issues to their school inorder to obtain NHS support? In my opinion schools should educate and Health Professionals should treat and/or heal.

[Primitivo1]

Diverze

I disagree that diagnostic processes are not important, but they should not be solely hosted by camhs. Our area's autism diagnostic service is a multiagency community team that includes SALT, ed psych, clin psychs, OT and psychiatry.
Fundamentally, autistic people need to understand their neurodiversity and find their peer group and if you only think of autism as a set of behaviour problems that need rectifying regardless of cause then that is a very sad situation. People have a right to know who they are and to understand themselves. An autism diagnosis entitles a person to protection under the equality act and this is extremely important especially in adulthood and as a working autistic person. Autistic people are very vulnerable where they are not protected in law, because of neurotypical interpretation of their communication differences. Unless you have a diagnosis there is no protection.

just brilliantly articulated.

OP thank you for the work you do, but this is so, so important.

[Theredjellybean]

Can you explain the rationale in "therapeutic break from services"
This was done to my dsd who was having a small relapse in her anorexia. After five weeks of being told by cahms psychologist it was minor blip... My dsd took an od... Small cry for help one... And response was to pull all her therapy and we were told this was therapeutic.
As my dsd felt abandoned by her therapist it certainly was not therapeutic for her.
I understand this is a commonly used theraputic tool but fail to grasp how it helps, except re in force to our young people that they are not worth helping.

[Mrhwbin]

We have an initial CAMHS assessment in about 4 weeks for my 16 year old with severe anxiety, agoraphobia and school refusing. We also have the option of accessing a private psychiatric assessment. Should I give up the CAMHS referral and go private?