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.

@Mynextname

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.

@Mynextname yes we very much do exist. I'm very sorry this has been your experience

I think it's possible also a postcode lottery?

Thank you for all you do. I have two children under CAMHS, other than the waiting times, I have found the, amazing. For our area, neuodevelopmental is separate, and that's a bit more hit and miss. One child they were great with the other was a nightmare.

Camhs has been great, it's nice we have some support going forward. With the other side of things once my children got diagnoses we were discharged looking like wide eyed deers.

@camhsadolescenttherapist

Posting again as I think you may have missed my other posts, questions are;

What in your opinion would be considered "moderate to severe" for a referral to be accepted?

Is it typical for a referral form to have specific sections dedicated to ADHD, ASD & eating disorders? It made the whole form come across like certain boxes had to be checked or it would not be accepted.

Azpie
Re the specific sections: more likely that certain common conditions have dedicated teams whereas generic issues go into what we call "core camhs", so it's more about triage and getting info to the correct subteam. At least that would be the case here.

OP, what’s your analysis for the rise in girls presenting with gender dysphoria? Is it always dysphoria or more about other issues? Are your team documenting the stats on this rise?

I’d also like to know your qualifications, I’d be very interested to know that.

One of my children has impulsive behaviour to the point where he will often harm himself/attempt suicide as he is upset in the moment. CAMHS said not depressed or anxious or anything but due to impulsivity and needed ADHD assessment told me not to worry as once given an ADHD diagnosis I would be able to get medication. Had the assessment (within CAMHS) and told he does not have ADHD so discharged. Meanwhile I still have a child who is dangerously impulsive. Do you think this is acceptable?

I think the qualification issue is relevant. When dd broke her leg, a nurse triaged and ordered the XRay which was then evaluated by a fully qualified Dr and the treatment plan was discussed with me from a risk perspective and ultimately, she was a mm off plates and pins, we mutually agreed there would be an attempt to avoid open surgery and in the first instance the fracture would be manipulated under GA.

Compare and contrast with CAMHS where a nurse trialed and assessed and evidently reported findings to a multi-disciplinary team to ensure the right interventions were recommended. The time frame was wrong, the report was littered with errors, the nurse laughed when told dd had adhd (diagnosed by a consultant psychiatrist) and then lied and said she had never told me therapy would be delivered over the summer holidays. That nurse may be post grad level 7 but very possibly via an access route and neither particularly well educated nor very intelligent. And certainly my views were disregarded and I have no idea what half baked claptrap the told the multidisciplinary team. And therein lies the fundamental problem.

It's miles away from parent consulted and negotiated decisions being taken between an articulate parent and appropriately qualified Dr (senior reg) relating to physical health care. It just doesn't stack.

Do you agree op, that nurses who work in CAMHS have far too much power over the dissemination of information and ultimately decision making and parents are unable to cross check what is being shared with the appropriately qualified decision makers (paychiatrists).

Roses
That sounds very difficult but please don't assume yours is a universal experience. The camhs I work in does not triage in that way whatsoever.

So are you saying RosesforMama that all young people in your service have direct access to an appropriately qualified doctor? In CAMHS my dd never saw a doctor. Only nurses. Significant contrast to physical health.

The triage isn't new. Ds1 had to go through triage over a decade ago. Thankfully, the psychiatrist overruled and did recognise that rather than inconsistent, his presentation is complex.

@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

Thank you for the answer. I suppose I was assuming something more nuanced - that up to a point a parent looking out for their welfare, approachable trusted teachers etc are what is needed and I was trying to work out when different professional help is the appropriate route.

@RosesAndHellebores

So are you saying RosesforMama that all young people in your service have direct access to an appropriately qualified doctor? In CAMHS my dd never saw a doctor. Only nurses. Significant contrast to physical health.

No. Triage in my area (autism diagnosis ) is multiagency and as part of it a lead clinician is identified. This is a trained person; might be a psychiatrist, clinical psychologist, highly specialist speech therapist etc. Core camhs also have multiagency triage meetings where again a lead is identified based on presenting need. Most are clinicians but there are a couple of camhs practitioners. I think the ADHD clinic has some nurses who support medication clinic and there is a small LD nursing team camhs do some joint work with but they aren't "core".

There is more to camhs than adhd and asd.

My DD has been seeing CAMHS for 3 years now. Initially CAMHS thought she had autism then ADHD. We were then told she didn’t meet the threshold for any of these. She was diagnosed with emotional dysregulation. We got this diagnosis 2 weeks ago and DBT was suggested.

What can I do to help DD? What can she do to help herself? No doubt it will be ages before the DBT starts.

One of the worst things for me other than the time it’s taken to get a diagnosis is to hear CAMHS call my DDs self harm cuts ‘superficial’. No mum wants to hear that, especially when my DD went to CAMHS 3 years ago with self harm on one leg. Fast forward to now and she has cuts on arms, legs, stomach and back. A cut is a cut.

The health and social care system feels broken, some parts more than others. There are many good and experienced people within as well as well... not very good ones too. My experience of a CAMHs school liaison officer was good, I was pleasantly surprised; still waiting for a referral to be accepted. Anxiety and Trauma due to school has caused School refusal. LA are pushing for a SEN school. I cant see how this will be possible if anxiety isn’t managed..

Emy childs presentation will not meet the criteria.

Our CAMHS is dire, it's sad there's so much disparity.

@PickAChew

There is more to camhs than adhd and asd.

Yes indeed. Since I spend half my work life there I am aware of that. Hence my mention in a number of posts about core camhs and specialist clincs. I only mentioned the specialist bits I am most aware of.

Sadly I’m another who has never heard a good thing about CAMHS locally to me.
My child was discharged after 1 useless session so I ended up paying privately for treatment.
I was very fortunate to be able to do this but many aren’t hand have to wait a good couple of years for an appointment.
There is now a waiting list of people willing to pay hundreds of pounds privately at a local practice as their children have been let down by CAMHS.

@AzPie "What in your opinion would be considered "moderate to severe" for a referral to be accepted?"

That is a hard question unfortunately. My personal view would be that in an ideal world, as I would like it to be, problems should be seen by well trained professionals at an early stage before they become moderate / severe (which usually means entrenched over a period of time and worsening)

However the way CAMHS teams are structured these days, they are seen as a tier 3 intervention, meaning that the difficulties accepted are already at the "severe" end of things. This presumes there are adequate tier 2 interventions eg school or community counselling (which are offered by clinicians trained at a lower level but still good). In some cases there are indeed excellent school counsellors or mentors with whom we work and we offer consultation or just be aware of a particular young person in case they worsen. But they can be adequately held within tier 2 services and only come to us if the problem worsens. Or becomes more complex needing a multidisciplinary team.

That is the ideal. In practice though things are very different. What happens is that there are not nearly enough tier 2 offers meaning that parents feel that CAMHS is letting them down when in fact a whole system is letting them down.

So there should be more campaigning for more CAMHS provision (which we need) but even more campaigning is needed for good quality tier 2 provision eg within schools and communities and also I would add- we need much much better social care

@AzPie "Is it typical for a referral form to have specific sections dedicated to ADHD, ASD & eating disorders? It made the whole form come across like certain boxes had to be checked or it would not be accepted."

I've never heard of that

It may be that the particular team as @RosesforMama said has sub-teams?

@Isadora2007 "Same really as asking what qualifications do you have- and I note she’s not actually answered. 🤷🏻‍♀️"

And your point?

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

The core professions within a CAMHS MDT (multidisciplinary team) are clinical psychology, child and adolescent psychiatry, child and adolescent psychotherapy, family therapy. I am one of these.

Then sometimes we have mental health nurses who often do the crisis support work but some therapy and assessment work too as they often have built excellent skills over the years. Rarely we have some social workers within our teams too who build experience over time

Why isn’t their more focus on nutrition?

There is evidence for example about vitamin D helping with mood and omega 3 essential fatty acids helped with other disorders.

We need to look beyond talking therapies to the nuts and bolts basics of nutrition and mental health

I'm currently in hospital with my DD (15) after she has taken an overdose of paracetamol. She has become increasingly agoraphobic over lockdown. She was experiencing panic episodes at school or in groups or when she went out with friends before but now she won't leave the house. We are going to be seeing CAHMS this am. How can they help?