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
Sorry, realised my question sounded a bit confrontational, wasn't my intention.
As a teacher I agree the education system has a lot to answer for, both in terms of the pressure it puts on staff and pupils, and in the lack of training for teachers and managers. The greater emphasis on assessment and testing is particularly difficult for autistic kids; nearly every school-refuser I know is autistic. School staff continue to blame parents for not sending them to school and local authorities fine and prosecute families when they should be referring for help.

OP seems to as good at answering questions as our local service are at answering their bloody phone.

@PickAChew

OP seems to as good at answering questions as our local service are at answering their bloody phone.

@PickAChew which particular question do you think I haven't answered?

[quote MissFlite]@CAMHSadolescenttherapist
Sorry, realised my question sounded a bit confrontational, wasn't my intention.
As a teacher I agree the education system has a lot to answer for, both in terms of the pressure it puts on staff and pupils, and in the lack of training for teachers and managers. The greater emphasis on assessment and testing is particularly difficult for autistic kids; nearly every school-refuser I know is autistic. School staff continue to blame parents for not sending them to school and local authorities fine and prosecute families when they should be referring for help.[/quote]
It's difficult though isn't it for teachers, what are they supposed to do . You're right, school refusal is on the increase particularly this year with lockdown... The main thing is we need more early intervention services which are sorely lacking, often when it gets to CAMHS referral stage things have progressed too far

And I totally agree about fining parents, it doesn't work as an approach

Do you think about the young children when not in work, like at weekends, evenings, wondering if they are ok

@TheChaser

Do you think about the young children when not in work, like at weekends, evenings, wondering if they are ok

@TheChaser I see adolescents and yes I always think of them and often worry

Do you think the imposition of huge comprehensives is part of the reason for the increase. One size doesn't fit all and not all young people are EBacc orientated. When I finished school in the late 70s it was still as acceptable to go into floristry, cookery, secretarial work or carpentry, mechanics, horticulture, etc, and there was no shame in being practical rather than clever.

@RosesAndHellebores

Do you think the imposition of huge comprehensives is part of the reason for the increase. One size doesn't fit all and not all young people are EBacc orientated. When I finished school in the late 70s it was still as acceptable to go into floristry, cookery, secretarial work or carpentry, mechanics, horticulture, etc, and there was no shame in being practical rather than clever.

@RosesAndHellebores I couldn't say. I've often seen the opposite in my work, young people who underestimate their academic abilities and shortchange themselves often for class reasons

But I agree with you on one thing for sure, it would be so wonderful to have many more small schools with tiny classes for the more quiet sensitive and vulnerable young people. They really struggle in massive schools

My dd15 has extreme anxiety which has led to school refusal and triggered a tic disorder and ocd since returning to school after lockdown.

This year is a key year as it's her last year of secondary school. We were told it would be 8-10 months before she'd be seen by a psychiatrist. I wasn't prepared for her mental health to deteriorate any further so put the cost of a private psychiatrist appt on a credit card. She's now in early stages of getting medication and recommended CBT alongside the medication.

She's also on the waiting list at cahms for a "resilience group" which may then lead to CBT. What can't she just go straight to CBT if that's what a professional has recommended? Why does she have to jump through more hoops and in the meantime risk her mental health deteriorating further?

It feels like everything is just too late and children and young people are left until they're in crisis and then end up costing more to 'treat' and leaving parents to pick up then trauma that their children have picked up along the way.

"feels like everything is just too late and children and young people are left until they're in crisis and then end up costing more to 'treat' and leaving parents to pick up then trauma that their children have picked up along the way."

@MissisBoote I absolutely agree, therapies such as CBT, family therapy or any treatment like that really should be on offer quickly and comfortably, instead these treatments end up being seen like gold dust, it's ridiculous. So much more can be done, also, with all these treatments if they are preventative or addressing smaller problems rather than fire fighting

@MissisBoote

Obviously not op but also work in mental health.

Sometimes private psychiatrists recommended things not in accordance to what is offered or how its allocated via nhs provision. Its very difficult when someone who is not providing the service recommends something via the nhs.

I would agree that currently services are stuck in a fire fighting mode rather than prevention

@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.

I'm nothing to do with CAMHS but I bet I can explain this. Sadly it sounds like services haven't moved on from my dreadful experiences as a young adult.

A small, "cry for help" OD will be viewed as attention seeking/part of Emotionally Unstable Personality Disorder (formerly known as Borderline Personality Disorder). Even if she doesn't have this diagnosis, or enough of the symptoms, or her symptoms are explained by something else (often ASD) it's often seen as synonymous with "attention seeking" so the label will be slapped on regardless.
Actually, it won't exactly, as under 18s are not supposed to be diagnosed with personality disorders, as they are still developing and it's a turbulent time. So they'll call it "emerging EUPD" which means all the stigma and judgment anyway.

Once this label is applied they view most things as attention seeking to be ignored and not "rewarded" by actually helping the person in distress. Therefore they see it as therapeutic to disengage, a sort of punishment for acting out/give her time to think about her behaviour type thing.

If she feels abandoned they'll love that as it means they can add "fear of abandonment" to their list of "emerging EUPD" symptoms, and so bolster their warped view of human suffering.

@TiredAndBonkers I've never ever heard of that approach. If it's even "an approach". I can't guarantee it doesn't exist but I work day in and day out for many years with suicidal adolescents or those who have attempted, many of whom have the symptoms you describe... and I've never once seen them treated that way or denied treatment

It's worth saying that because people may get the wrong message from what you read, that this is widespread and it's really not

I do appreciate you had a bad experience and I'm very sorry for that

@camhsadolescenttherapist

Really good to hear that approach is not widespread now.
Unfortunately it was - I presume there are still archived articles, blogs, etc out there that detail it was not just my experience. There was a lot on the Mind website for a start. Of particular interest is the accounts of social workers etc. Plus the NIMHE guide "Personality Disorder: No longer a diagnosis of exclusion", published 2003 but the beginning of questioning things so nothing actually changed for a long while. Actually a friend killed herself much more recently than that due to this type of judgemental and unhelpful "treatment".

Hopefully it's disappearing now as the older staff retire and new ideas take hold. I remember being astounded how the general attitude to people suffering/mental health seemed a lot more compassionate and humane than the actual services, it seemed so out of sync... so hopefully it's a case of services catching up with the general trend in society! Perhaps adult services have taken longer to change too.

Yes I agree he may not engage. He isn't even given a chance to though. Just advice to refer again when he's more settled possibly it is a culture thing for camhs in my area.

I agree it doesn't have to ever involve going into the past, but you wouldn't know it the way they act.

[quote user1471530109]@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.[/quote]
I’m a very recently retired Primary Senco so absolutely do know that CAMHS is in crisis in many areas of the country. You’re absolutely right to be angry, but it’s absolutely futile and unfair to direct it towards an anonymous clinician who has probably got absolutely no influence on how the system works.
My one experience of a parent paying for a private diagnosis isn’t great. The psychologist came to see the child in school, didn’t speak to either myself or the class teacher ( who had taught the child for 3 years) but just “assessed” the child for 1/2 hour then met with the parent for 15 mins. She then wrote a report in 15 mins and fed back to myself, parent and class teacher, giving a diagnosis of ASD and ADHD.
The report was totally based on what the parent had told her, and the assessments didn’t entirely point to either of these diagnoses.
As Senco, if I see traits that suggest a communication issue, I implement support to meet the need, regardless of a formal diagnosis. I’ve applied for numerous EHCPs successfully, in fact in the past 5 years the only one refused was one where the parents applied and the child’s needs didn’t meet the threshold.
So, not a parent of a child with SEN, but a whole wealth of experience in dealing with CAMHS,

I think the advice now, particularly with a private autism assessment is to make sure it is done by an multi-disciplinary team, usually psychiatrist and SALT (as it would be in the NHS) and using standard assessment tools such as ADOS and the ADI.
If a school refuses to accept this you are in a much stronger position to fight it.

@RosesAndHellebores

Do you think the imposition of huge comprehensives is part of the reason for the increase. One size doesn't fit all and not all young people are EBacc orientated. When I finished school in the late 70s it was still as acceptable to go into floristry, cookery, secretarial work or carpentry, mechanics, horticulture, etc, and there was no shame in being practical rather than clever.

I agree but I'm not sure it's comprehensives as such but the erasing of the creative and practical lessons which is happening in so many schools right from key stage 1. There is often also the feeling that they are somehow second-class subjects. KIds who excel in those but struggle with maths/English and science tend not to get the same chances to really shine at school. Social media has a part to play too. So many teens (particularly girls, I think) feel pressure to be look unrealistically perfect as well as acheive top grades. Combine all that with hormones and it's the perfect storm!

"I’m a very recently retired Primary Senco so absolutely do know that CAMHS is in crisis in many areas of the country. You’re absolutely right to be angry, but it’s absolutely futile and unfair to direct it towards an anonymous clinician who has probably got absolutely no influence on how the system works."

This is exactly why every other psychologist who has tried AMA has had to have the thread deleted. Lots of rightfully angry people misdirecting their anger at a single, powerless cog in the machine.

Apologies @cahmsadolescenttherapist - the lack of caps meant that only your OP is highlighted. (phone never did get answered, BTW. I shall keep trying)

The trouble is that there really is nowhere to direct the anger. No-one that you can complain to can really do much to help.
Selfishly, I'm relieved my child is already in the system. I feel desperately sorry for anyone whose child spirals into depression or become mentally unwell within the next year or so.

@RosesforMama

"I’m a very recently retired Primary Senco so absolutely do know that CAMHS is in crisis in many areas of the country. You’re absolutely right to be angry, but it’s absolutely futile and unfair to direct it towards an anonymous clinician who has probably got absolutely no influence on how the system works."

This is exactly why every other psychologist who has tried AMA has had to have the thread deleted. Lots of rightfully angry people misdirecting their anger at a single, powerless cog in the machine.

Thanks @RosesforMama don't worry about me though I don't mind people's anger. If there are comments that are personal and unfair I always (like all of us) have the option to ignore them

I have some power and influence at most within my own team and that's it! Remember also generic CAMHS teams tend to have longer waiting lists, while adolescent teams like mine tend to work better with shorter waiting lists.

But I'm not Matt Hancock or Jeremy Hunt so there are limited things I can change

Are you sure camhs actually exist? I am beginning to wonder if they are just a figment of the imagination. Surely after 4 different professionals have referred a child from the child ranging from 7-10 years old they would at least have a referral accepted. I'm not one of these people that doesn't believe that covid exists but I am beginning to have my suspicions about camhs.

OP, not about CAHMS but more asking because of your knowledge/experience of working with young people.
I have found counselling helpful especially after divorce, and I hope it helps me be a better parent - but I do sometimes worry about the impact of my anxiety/depression and divorce on my DC. Do you think it's useful for young people to speak to a counselor if they have had stressful situations to deal with but aren't obviously struggling?

@ImTeamLogan

OP, not about CAHMS but more asking because of your knowledge/experience of working with young people. I have found counselling helpful especially after divorce, and I hope it helps me be a better parent - but I do sometimes worry about the impact of my anxiety/depression and divorce on my DC. Do you think it's useful for young people to speak to a counselor if they have had stressful situations to deal with but aren't obviously struggling?

@ImTeamLogan

Yes of course if they wish to! Sometimes some short term work where they can talk through some things can really help

That sort of support wouldn't be offered at CAMHS though but privately it's very possible