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.

I would also be wary of using terms like 'mild symptoms'.

Do you mean some autistic traits but (possibly superficially) low needs (including low transactional behaviours) and probably wouldn't meet the criteria for full diagnosis?

I would still suggest that an awareness of these traits and accommodation of them could be crucial in protecting future mental health etc.

@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

It sure comes across as a personal attack!

@Primitivo1

I would also be wary of using terms like 'mild symptoms'.

Do you mean some autistic traits but (possibly superficially) low needs (including low transactional behaviours) and probably wouldn't meet the criteria for full diagnosis?

I would still suggest that an awareness of these traits and accommodation of them could be crucial in protecting future mental health etc.

Yes I mean autistic traits but not full diagnosis

I am in agreement of course that a diagnosis has a lot of benefits

@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?

I really can't answer that. It would depend on how much you trust the private psychiatrist and/or the local CAMHS team. 4 weeks more to wait seems quite long, is school supporting in the meantime?

@Soontobe60 have you any idea the mess that CAMHS is in? I am an angry, frustrated and honestly quite desperate parent trying to get help and support for my daughter. A 3 year waiting list is unacceptable. This is the story across the UK. Many are waiting 18mths-2 years which is bad enough!

If parents seek private help they are often removed from the waiting list and then told that any diagnosis or finding from the private clinician doesn't stand. So any support in school would not be available. This is outrageous! We should be demanding better care. But the public often only care about these things if it directly effects them.

Why do CAMHS staff refer to mothers as "mum"
For example I have a letter referring to dd which includes the phrase "Imogen and mum". All others are referred to as Dr xx xx-xx the psychiatrist, Jane bloggs the primary mental health worker. Is it really too much trouble to extend equality to parents, for example: "Imogen and her mother" or even "Imogen and her mother, Mrs Hellebores".

Not all CAMHS teams are 9-5, we have support from the IHT at the moment and they work 7.30 - 8.30 and are a 7 day a week service.

My question @CAMHSadolescenttherapist is what is the best transition approach from CAMHS to adults. My Dd is severely unwell with anorexia and will move to adults in 7 weeks. CAMHS have over promised in terms of a transition and now we're facing a massive cliff edge drop off in terms of support and a likely relapse. I know this isn't CAMHS fault entirely but what does good look like?

PS - if any posters on here have children with eating disorders, you'll find a warm welcome and lots of support on the 'teens eating disorders' thread.

@myrtleWilson

I work in an adult team, I would expect at least a joint meeting.
The gold standard is often a longer transition period where there is co-working which seems to be hard to achieve in the current climate.

Its worth noting adult support often looks different, the specialist eating disorder team for example has much higher criteria thus a higher percentage of eating disorder support is held by the general mental health team.

@Isadora2007 she has answered. The question was "what qualifications do you need to be a CAMHS therapist". She answered that by way of advising the disciplines that make up the CAMHS therapy team. Psychiatrist would mean that you have to have the qualification of doctor. Mental health nurse would mean that you need to have the qualification of MH nursing. And so on and so forth. Now you're asking a different question; her specific qualifications. That's a different question. You can't ask one question, have the person answer it but then accuse them of not answering a totally different question that you haven't actually asked previous to that.

I'm not sure why you're being so argumentative?

@isadora2007 or at the very least, your question was ambiguous. Why not come out and ask what are your qualifications OP?

@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?

We have many many cases of gender dysphoria particularly in young women

We all work differently but I would say the most usual approach is an exploratory one as these young people have many complex problems usually and not just gender dysphoria. The way I personally work is to be neutral, follow where they are, address them as a whole person rather than as a "trans" person necessarily as many or them move in many different directions. They need time and exploration

I think you're pretty brave doing an AMA! I'm sure everyone who works in the system is doing their best in very difficult circumstances, I really am. I know that in different areas of the country CAMHS works in different ways and some are much more efficient and helpful than others.

I belong to a support group for parents who have children with MH issues. Many have autism or other diagnosed conditions. Some have had completely uneventful childhoods with no previous MH worries and have been floored by lockdown, puberty, senior school. Most have been actively suicidal and with only a few exceptions parents have been left to cope alone after being sent home from A&E with perhaps a 3 month wait for psychiatric assessment or even longer for therapy. GPs are not permitted to prescribe for under 18s so little choice but to wait.

Every night there are hundreds of parents in our group terrified to sleep for fear of what the morning will bring. Without exception they are fighting for help for their child. Some have the funds for private treatment so can access medication and therapy quickly, most do not.

There needs to be a complete overhaul of the system but I can't see how this will happen and things are going to get much, much worse.

There is so plenty of talk and awareness now of the importance of looking after our mental health etc etc...which is all very well if it will be improved by a brisk walk in the park and an afternoon of feel-good films and colouring. When your child has to be held back from climbing out of the window a calming app isn't much use.

I don't know what the answer is, I really don't.

Are the people who work in the system aware of how broken it is? How woefully inadequate a list of websites and the promise of a fortnightly phone call is when your child doesn't particularly want to live another day?

@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.

I agree with you.

@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.

We don't use that term "therapeutic break" in our team and I suspect it's a euphemism for closing a case because of lack of resources . I would not close a case if I think they need further support. But I'm aware different CAMHS clinicians follow different models and I can't answer for everyone

@RosesAndHellebores

Why do CAMHS staff refer to mothers as "mum" For example I have a letter referring to dd which includes the phrase "Imogen and mum". All others are referred to as Dr xx xx-xx the psychiatrist, Jane bloggs the primary mental health worker. Is it really too much trouble to extend equality to parents, for example: "Imogen and her mother" or even "Imogen and her mother, Mrs Hellebores".

I hate it when people do that!! That's one of my personal bug bears. Parents are full people, not just mothers or fathers. I hate being called mum and I've never in my life called someone mum!

But on occasion I've heard colleagues do so (rarely)

OP on a recent referral form I had to fill in (which from the wording seemed more like the GP should have done it), there were notes at the end to say who would be taken on and who wouldn't with 4 sections, 3 for specific conditions(ASD, ADHD & eating disorders), the first box gave a clear indication that they would only consider taking a child on if they had moderate to severe issues. What in your opinion would be considered moderate to severe?

And is it typical for these referral forms to have specific sections dedicated to ADHD, ASD & eating disorders? It very much came across like they were only looking to accept children who tick certain boxes.

@MissFlite are you aware that the inquiry for Children and Young People's Mental Health, chaired by Jeremy Hunt has a call for evidence closing on 26th February 2021. Committees.parliament.uk/work/1001/children-and-young-peoples-mental-health

I have submitted my comments.
The national situation regarding CAMHS is a disgrace and provision where I live is dire. DD's CAMH's Nurse laughed when I said she had privately received a diagnosis of ADHD privately. At 17 she was too old.

My dd recovered and now manages her depression, anxiety and ADHD well. She recovered because we had both BUPA cover and an additional £6k to spend on the ADHD/ASD assessments and therapy. My heart breaks for parents who don't have those sorts of funds.

As an educated middle aged woman I have never felt so at sea or marginalised by a system that, here, seemed to run on disingenuity. And was extremely parent blaming and reductive to boot.

@RosesAndHellebores
Yes, thanks for the reminder, that's on my to-do list.
The system is a national disgrace.

I just want to add that CAMHS around here is an absolute joke and I fear for any child in this area who needs help as they won't get it unless they are "actively and frequently suicidal"...that was from our GP, who said 99% of referrals are turned down because they are not considered severe enough.

We went through CAMHS many years ago to access an assessment for DD for ASD, a cardiac surgeon with "an interest in autism" (who came in especially for the appointment she wasn't part of the CAMHS team) did the DISCO assessment and concluded that she wasn't on the spectrum but may have PDA (which shows her level of knowledge as PDA is considered part of the spectrum!). There was no multi-disciplinary team, the GP referred DD to OT who concluded she has significant sensory issues, it was then the OT who referred her to SALT who said she had language issues that (in her opinion) aligned with a child on the spectrum. None of that was taken into consideration and this heart specialist discharged her (we put in a formal complaint pointing out NICE guidelines but it went nowhere).

We were very lucky in that there is an autism charity in the next county that were horrified by DD's treatment and via them we accessed a private diagnosis (with a clinician) who did an ADI-R assessment as well as observed DD on multiple occasions and took the multiple OT/SALT & school reports into consideration before diagnosing her. DD was fine until secondary school when her mental health plummeted, again no help from CAMHS as she wasn't severe enough, again it was the autism charity who put us in touch with a private autism specialist councellor and I am so thankful DD has her in her life, she has regular sessions and I know if there is ever a crisis I can get her an appointment usually the same day. After one such crisis recently DD's counsellor phoned me to say she was concerned as DD has expressed very low mood/suicidal thoughts and advised speaking to the GP, who then gave us a CAMHS referral form (not expecting anything to come of it as she wouldn't be considered extreme enough and she's already having regular counselling)

I would urge anyone if you have the means and can access a decent specialist, then go private, CAMHS is only going to get worse with cuts and ever-growing waiting lists. It's sad because a lot of children would probably be in a much better place if they had early intervention rather than them being left to spiral into very dark places where it takes even longer to help them get better (if ever!).

OP I truly hope your CAMHS is a model place with shorter waiting times than it seems everywhere else has but ultimately this uncaring government has absolutely brought the health service to it's knees and our children are suffering because of it.

What is the best way to trigger support? DD1 (15, SN, Special School) has struggled for a long time. Last summer, DD1 (then 14) was 40kg and 162 cms. A CAMHS worker assessed her and was reassured that paeds were involved, so discharged with advice and ASD assessment referral. Paeds were reassured that CAMHS were involved and discharged, leaving her with just dietician follow up.

Last week, DD1 was 165cm and 37.3kg. She was finally admitted for stabilisation when her standing heart rate reached 144 BPM.

Now we have a team involved, but it's taken a lot of pestering to get there. How do we stop our children falling through the gaps?

@Lougle - that is shocking, I hope your poor DD is feeling a bit better.
In my experience even children who are actively suicidal (two or more attempts) are sent home the same day once they are declared medically fit and the CAMHS crisis team have visited.
Children are often getting to this point as there is absolutely no early intervention at any meaningful level. Schools have no proper training on mental health - a monthly mindfulness session isn't going to solve anything.

@CAMHSadolescenttherapist why are children falling through the gaps?

[quote MissFlite]@Lougle - that is shocking, I hope your poor DD is feeling a bit better.
In my experience even children who are actively suicidal (two or more attempts) are sent home the same day once they are declared medically fit and the CAMHS crisis team have visited.
Children are often getting to this point as there is absolutely no early intervention at any meaningful level. Schools have no proper training on mental health - a monthly mindfulness session isn't going to solve anything.

@CAMHSadolescenttherapist why are children falling through the gaps?[/quote]
@MissFlite I'm obviously not aware of all the reasons

I would guess many factors to do in underfunding / closing down Early intervention services, social care problems that are increasing, education underfunded too and too exam oriented. CAMHS services then become increasingly reactive and fire fighting rather than proactive and preventative. Meaning that "loud" presentations her prioritised and quieter but sometimes more worrying presentations face delay

It is really sad

May I ask if it would help bearing in mind the scarce resources if parents/young people were clearly informed of the tier at triage/first assessment and given clear indications of what therapy/intervention will be available and clear timeframes. It would also be helpful to provide a toolkit for parents signposting to private providers as well as providing techniques and mechanisms to help them support their young people.

FWIW when Surrey Council gave the local MH Trust £2.3m of additional funding for CAMHS the Trust spent it all on an extra tier of bureaucracy and underestimated the number of referrals although they were in line with the national picture.

There was an inquiry. Those in charge have not been held to account.

@camhsadolescenttherapist I do think you have a point about need Vs diagnosis. When I said to school that DD1 was being referred for ASD assessment, they said 'oh I'm glad about that, I thought she seemed like she has ASD...' Well, a) why weren't you telling me? b) why didn't you get on and think about the ASd strategies that might help her?

After the summer, when I told them DD1's weight had plummeted, I got "I did clock her and think she looked thin....". Well why didn't you say anything? Why didn't you ask if she was ok, or ask if we'd seen a doctor?

Her paediatrician, before discharging her, was musing about her weight, mumbling that it 'wasn't clearly ARFID...' He still discharged her.

I love the letter from her new paediatrician. It says 'Anorexia is an observation, not a diagnosis. If someone isn't eating, they are anorexic'. That sums it up, really. Who cares what label you want to give it? You have a child shrinking away before your eyes. Do something.

@Lougle there are two separate issues, the question of diagnosis for which there are many things to say (far beyond the scope of this discussion)

And then the question of emotional support if needed, for example if a young person with ASD struggles with debilitating anxiety, or risk taking in a YP with adhd or whatever

It's all well and good to have the diagnosis, the YP still needs to express and work through their emotions and find better ways to live with themselves