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.

@Inthevirtualwaitingroom

Do you get much support for yourself?

@Inthevirtualwaitingroom yes absolutely. Good peer support structures within team and supervision

@goldielockdown2

Over the last few years, we've been trying to get a referral for our increasingly troubled son. The GP says it's up to the school, school say it's down to the GP, the school are now saying it isn't possible due to Covid. What can I do? I'm failing my son, I can't even get a referral. Even if he gets a referral, the waiting list in our area will take him almost to adulthood when he'll be too old for services I'm sure. He's been told in the meantime to make his own appointment with a GP as it 'isn't your business what he does'. Wtf. What 14 year old would want to make a GP appointment off their own back, especially one with the challenges he's facing?

@goldielockdown2 I'm not sure why the GP can't make a referral? you can insist they do

@camhsquestions

I have name changed for this too. A person I know was telling me that she spent a few months in hospital in a unit for teenagers, the others had anorexia and some had psychiatric things like schizophrenia. She maintains that she has no idea why she was there because she says she was never told but it seems like an odd setup because staff would take individuals out alone in their cars and if she didn't toe the line she'd have her wardrobe locked and would have to stay in her pyjamas. She's a medical professional now herself and doesn't have mental health issues as far as I know, well apart from stress like you all must have right now.

Is this really what it was like, it all seems very, very wrong if that's what went on.

@camhsquestions this sounds really strange and I can't possibly know what went on there. Each case is different

do your admin team get support, for taking calls, which can be distressing

MissLucyEyelesbarrow you're absolutely right. What else can a parent do though in that situation? If I was that parent, that's what I would do as I'm not sure what else can be done. I'm not an NHS manager, not in charge of triage. I wish like you do that CAMHS had wide open doors.

I have every sympathy for the underfunding that CAMHS experiences but it is not acceptable to come on to social media and tell people something untrue- that demanding a re-referral will get them seen sooner. Unless CAMHS has been lying to every GP in the country, this is not true.

You are putting GPs in an impossible situation - we will now get angry parents thinking that we have been lying to them when we decline to re-refer when, in fact, we have been doing exactly what CAMHS has asked to do. It is irresponsible, especially at a time when GPs are so busy with the vaccine roll out.

For every parent reading this, I want you to know that, as a GP, I have repeatedly been told by CAMHS not to re-refer patients as it slows down the system for everyone. Either CAMHS has been lying to me or the OP is talking out of her arse. Either way, I am furious on behalf of all my patients who have been waiting years to be seen.

@Inthevirtualwaitingroom

do your admin team get support, for taking calls, which can be distressing

@Inthevirtualwaitingroom good a question. Generally in our particular team admin staff are integrated within the team so things are naturally discussed

But yes you're right it's a good point

@MissLucyEyelesbarrow I have said repeatedly that I am not in charge of triage or an NHS manager. I have also said tier 2 interventions are often the best solution but, tragically, there are not enough of them.

If I was a parent and my child was worsening and the problem persisted I would go back to the GP and say look, the issue isn't resolved. What other options do we have? School support? Private therapy? Community counselling? A re-referral to Camhs citing a worsening picture?

That's what I would do as a parent. I never said and how could I that CAMHS would definitely accept a re-referral - how could I know that? I just said that the only option I can see myself in that situation is having another discussion with GP rather than suffering alone

What do you suggest?

I have some mental health disorders that run in my family.

If a child is genetically high risk what is the best prevention or support?

@camhsadolescenttherapist thanks for your reply, but that's what I have done. We've gone back to the GP, and even tried another GP. Your last post to PP insinuates that parents aren't doing enough. The school are useless.
Thanks for making me feel worse, I thought you might suggest something I and other parents who are just waved away could try.

@georgarina

I have some mental health disorders that run in my family.

If a child is genetically high risk what is the best prevention or support?

@georgarina I'm afraid I'm not able to answer that, as it can really vary depending on condition. But in general I guess you could keep in mind the same things you would do for any child to look after their well-being. I wouldn't personally treat them as potentially higher risk as that might never happen and that approach has its own pitfalls

@camhsadolescenttherapist but the problem is that GP won't refer privately. They leave parents to it on their own. It is a circle of never ending doom unless you have enough money to throw at it and appoint a private psychiatrist who takes an holistic view.

Within 20 miles of my house 400 BCP accredited therapists come up. I called a few and was either regaled with their own mh issues or because she was actively cutting and od'g they felt she should be under CAMHS and they would be unable to help. 2 years in as a lay person one becomes smarter vis a vis selection and knows about Relate and to identify counsellors working under umbrella organisations etc, but at the start of the journey parents are at sea. Add in the fact that counsellors/therapists are a bit like shoes in that you need to try a few to find a comfy pair - and that isn't adequately addressed in the NHS, with parents having literally to beg for change when it isn't working.

Do you agree there has absolutely to be a vetted signposting system to high quality therapists that parents can contact when the NHS is incapable of providing commissioned services efficiently and within an acceptable and agreed time frame.

You have admitted it's a postcode lottery. I'm trying to do something about it. What are CAMHS practitioners doing about it across the length and breadth of the nation? All I've ever heard are excuses and multiple bleats about resources but no amount of resources replaces the fundamental need for a service to get itself organised and to be accountable for its multiple failings.

[quote goldielockdown2]@camhsadolescenttherapist thanks for your reply, but that's what I have done. We've gone back to the GP, and even tried another GP. Your last post to PP insinuates that parents aren't doing enough. The school are useless.
Thanks for making me feel worse, I thought you might suggest something I and other parents who are just waved away could try. [/quote]
@goldielockdown2 I don't believe parents are not doing enough, quite the opposite. As a parent myself, I can't see what else I would do in that situation except for discussing again with GP and school

I can't answer to your point that "school is useless". We know the system has serious problems. I'm not able to solve them all myself, nor can you

@camhsadolescenttherapist You posted earlier that re-referrals can lead to escalation; now you're backtracking. Well, which is it?

You keep saying you don't get involved in triage, yet you confidently tell parents to demand a re-referral. If you don't know how triage works in your service, don't give advice and false hope.

Do you have one tiny clue how much the underfunding of CAMHS affects primary care? How much risk we are holding for you? How many appointments are spent with desperate parents who already blame us as GPs for the wait? You have the luxury of only seeing people who have made it through the referral system. I have to look after everyone else, and I have nothing to offer them because there are no other services in most cases. You sound extremely naive about the availability of other options - there aren't any for most people.

How dare you come on here and tell parents that I have been lying to them when I say that there is no point re-referring - which is what I have repeatedly been told by CAMHS?

Really interesting and informative thread, OP - thank you.

@MissLucyEyelesbarrow I'm afraid in the same way parents blame you, you are now blaming me. I don't feel I can really respond with this level of aggression. I don't have all the answers; none of us do. I'm very aware how much GPs hold. I wish it wasn't the case

@MissLucyEyelesbarrow

dont give op such a hard time, she has answered well i believe, and to the best of her ability. take your anger to your MP

@MissLucyEyelesbarrow, you are a GP? take your anger to the commissioners, no need to attack on here

@CAMHSadolescenttherapist @camhsadolescenttherapist
Can CAMHS overturn a paediatrician decision not to diagnose ADHD because parent and school CONNERs form did not match. Paed told us that if school had matched our answers she would have diagnosed him. their answers contradicted themselves. Now waiting for Psicon to assess him and hopefully give us some answers.

We have also been told that ADHD is genetic and if me or DH were to be assessed and found to have it then DS would be diagnosed - is this correct?

CAMHS is not fit for purpose. Families sit on waiting lists for years and years. If waiting lists are so long that families can’t access it then what exactly is the point of the service?

CAMHS staff need to stop whining about how busy they are, parents are sick and tired of hearing it. Managers need to redefine what services it CAN offer and manage expectations.

[quote MrsKJones]**@CAMHSadolescenttherapist* @camhsadolescenttherapist*
Can CAMHS overturn a paediatrician decision not to diagnose ADHD because parent and school CONNERs form did not match. Paed told us that if school had matched our answers she would have diagnosed him. their answers contradicted themselves. Now waiting for Psicon to assess him and hopefully give us some answers.

We have also been told that ADHD is genetic and if me or DH were to be assessed and found to have it then DS would be diagnosed - is this correct?[/quote]
@MrsKJones I'm afraid I have no idea. I work in an adolescent team that deals with high risk presentations mostly, we thus don't have involvement with neurodevelopmental assessments

@CAMHSadolescenttherapist I’m impressed with your poise in the face of being personally blamed for all the failings of a huge system! You are a better person than me for being able to stick with this thread and reply so calmly and helpfully.

I couldn’t agree more with what you say about t2 provision. T3 gets such a hard time, yet, with proper funding and planning, so much more could be done at t2 to prevent children and young people from becoming unwell.

@MissLucyEyelesbarrow Your aggression towards op here is really unfair. Take it to commissioners and work with your local team to improve access. I can only speak for the service I work in, but we absolutely do welcome re-referrals from GP’s. Our intake team relies on good quality referrals and works closely with our referring community, including gp’s, with that shared goal. There are huge differences in provisions and procedures across the uk nations. It’s really unhelpful of you to suggest that your experience is the only one. Please be mindful of not putting families off trying to access support.

@Parrish, I completely agree.

Just some of the CAMHS inefficiencies/deficiencies where I live.

1. Lost the first referral.
2. Inflexible hours 9am to 5pm.
3. No email contact, presumably to limit interactions.
4. With first appointment more information about a member of staff's life threatening orange allergy than what to expect.
5. 9am to 5pm service cannot provide a 9am appointment because the first slot is at 9.30am. Hardly customer service oriented. (I shall add that we arrived at 9.15 for dd's first apt and the front door was locked and we watched staff drizzle in between 9.20 and 9.30). Hardly impressive for a service that whines about resources.
6. DD assessed and person didn't introduce themselves - I had to phone later to find out.
7. Told dd would be offered CBT but no time frame. I asked about private referrals and got the eyeroll.
8. Person lost our contact details and had to be chased.
9. DD offered group therapy which was inaccessible and inadequate. Noting dd had started a new school and achievement anxiety was noted but this took out 6 two hour sessions of a new A'Level and would have caused more problems than it solved.

10. Asked an alternative and declined. 11 wrote to GP saying case was closed as family had refused a referral - not true. 12. Manager told me she wouldn't review the decision because I had said we could take private route if helped with referral/recommendation. CAMHS and GP refused. Told me to go right ahead and complain to MP. I did - an intervention switched on in nano seconds. 13. Formal complaint to PALs - took forever and they whilst they apologised there was a litany of excuses. DD had to agree to the complaint - another hurdle for an unwell 16/17 year old and adds to the disservice this group suffer.

If we hadn't had a lot of money I think she would have become so unwell she would have dropped out of school and at what cost to Society bearing mind she is now in her final year at Cambridge. Principally due to the private ADHD diagnosis that the CAMHS nurse laughed at!! I won't bore you with the incompetence of the 2nd interaction.

We live in Surrey. CAMHS here is an utter disgrace.

CAMHS staff need to stop whining about how busy they are, parents are sick and tired of hearing it. Managers need to redefine what services it CAN offer and manage expectations.

The staff you speak with won't have any input into how resources and delivery are managed at a top level, I am sure they are soul numbingly frustrated with the lack of resources too.

@Parrish

To my knowledge I don't usually "whine" about things, it's not my style. I also have never claimed I am more or less busy than other professionals in intense jobs. I work long hours but I also look after myself and monitor things to make sure I'm ok and can function

I highlighted inadequate Tier 2 services, not enough good school counselling, not enough early years interventions and social care problems

Plus not enough CAMHS resources.

Do you feel these problems shouldn't be pointed out? At their heart, I think, lots of these problems are to do with wider issues in society that we at CAMHS can hardly change

@Pandapotato "I couldn’t agree more with what you say about t2 provision. T3 gets such a hard time, yet, with proper funding and planning, so much more could be done at t2 to prevent children and young people from becoming unwell. "

And social care! That's the area actually of most problems and underfunding