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 am afraid everyone I have come across in CAMHS blames everything on resources and makes excuses. If I complained to customers/clients about my organisation so negatively I would be dismissed.

Let's have a look at the funding and service shortfalls AND deal with the organisational, cultural and competence issues within the service and deal with those. When the glass house is reinforced then it's inhabitants may be able to identify where parents could improve when necessary rather than the continual parent blaming and every other blaming that goes on.

Where I live the GP blamed CAMHS, CAMHS blamed the GP and the Commissioners, the Commissioners blamed the GP and CAMHS and the local acute Trust took a very dim view not only of CAMHS but the entire MH Trust.

[quote camhsadolescenttherapist]@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 [/quote]
Of course. We are lacking in so many community provisions.

@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 guess op's poise shows she is probably in the right job!

@KitHenry if your child is self harming and has occasional suicidal ideation they should absolutely be seen and treated, not sure why they were discharged, that's not ok of course

They were discharged because I was told the issues were due to impulsive behaviour rather than a mental health issue. Was told they needed an ADHD assessment but then told they didn’t have ADHD and so they were therefore being discharged. I asked for a second opinion as I disagree with the no diagnosis of ADHD. We were told no purely because school said no issues, which is not even true. That aside there is still evidence of difficulties across multiple settings so still meets the diagnostic criteria. Was told if I wanted a second opinion I’d need to be re-referred as we had now been discharged. Went to GP who refused to re-refer (thanks for that information @MissLucyEyelesbarrow) eventually GP re-referred after I repeatedly explained I had been told by CAMHS I needed to ask to be re-referred. Got to the triage stage was very rudely told that I need to understand that the second opinion I want will be given by the same team who gave the original diagnosis so it was all a bit pointless really and I would be in for a very very long weight. I’m still waiting and yes I’m angry. I’m angry because regardless of whether or not he has ADHD I’m still left with zero support and a child with dangerously impulsive behaviour. When I asked what I was supposed to do I was told told see if any charities could help me. Completely unacceptable.

I know you are not to blame this but I just want to know why CAMHS treat people like this. They don’t even speak to people who are in desperate need kindly. Maybe they can’t help, maybe there is nothing they can do. But I’ll tell you one thing that all CAMHS workers could do which doesn’t require funding and that’s act with a bit more compassion and empathy because that’s what’s really lacking.

[quote Inthevirtualwaitingroom]@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 guess op's poise shows she is probably in the right job![/quote]
Totally!

I am afraid everyone I have come across in CAMHS blames everything on resources and makes excuses. If I complained to customers/clients about my organisation so negatively I would be dismissed.

This is my experience too. I’m not blaming you OP but do you think there is a culture of blaming incompetence on lack of funding? So the service never improves because no one takes responsibility for any failings as we all know everything is due to lack of funding.

@KitHenry

I work in an adult service and would say that sometimes a lack of funding is a short hand for other things.

For example my team is really struggling due to a lack of staff. Its not funding related at our level as we have the money for staff, are recruiting etc. But simply can't recruit to fill vacancies.

The funding issue isn't on our level, but about recruiting people in

@RosesAndHellebores "Let's have a look at the funding and service shortfalls AND deal with the organisational, cultural and competence issues within the service and deal with those. When the glass house is reinforced then it's inhabitants may be able to identify where parents could improve when necessary rather than the continual parent blaming and every other blaming that goes on."

Of course. Where there are organisational cultural and competence issues in teams they need addressing.

I have come on here in support of the op as an ex senior CAMHS therapist. I say ex as I left due to the vitriol, threats, bullying and derision I received from parents, teachers and other healthcare professionals.

CAMHS is far from perfect, it's poorly run and dominated by a culture of "just seeing" people. I'm going to stick my head on the line here and say way too many referrals are accepted. A lot of what came through the door was social issues that was resulting in behavioural problems. Our waiting list was on average 8 weeks for non urgent, 3 days for urgent. We offered specific therapies but the thing about therapy is it's not a magic wand, young people and families need to engage with it, and therapy is hard. Also parents you n can't delegate the parenting of your child to a CAMHS service, if the problem is systemic you need to make changes.
Numerous parents learnt that by presenting at A and E stating their child was suicidal they would get an urgent appt. In actual appointment child tells you they weren't their parents did it as they'd learned to work the system.

There's so much more I could say but I'll leave it there for now. I've worked in forensic units with people convicted of violent crimes and sex offences, on psychiatric intensive care units as well and CAMHS is BY FAR the most draining and difficult work I've ever done. And I hate to say it but I wouldn't recommend it to student mental health nurses as a career until there's serious reform. To start with tighter referral criteria, more intensive social care support and support for professionals discharging families if they don't engage or bully and intimidate professionals.

I should say the treatment we all recieved in our team. There was a mass exodus of about 5 senior members of the team all at once. The working conditions were intolerable and we were all pretty resilient people

CAHMS failed my family so badly over the years that it resulted in all my DC having serious mental health issues as adults. Is there anything I can do do hold any of these people accountable?

@Tulipsofamsterdam I beg your pardon.

My dd was cutting and overdosing and had masked her depression for 12 months until we found out. She is from a supportive, happy home, attended great schools, no issues in family relating to drink, drugs, abuse, etc. CAMHS accepted the referral, offered something inaccessible and inappropriate and closed the case.

A consultant psychiatrist ruled out physical things by running full bloods. Her Vit D was on the floor. Sorted.

She had 4 sessions of therapy and then started anti-depressants and that helped. Then she started restricting food to be thin, more therapy and some day patient therapy. DD queried whether she had ASD/ADHD and full assessments were carried out. She has some ASD traits but a full ADHD diagnosis. With hindsight so many things dropped into place with that diagnosis that had been present forever but BECAUSE she is high functioning and from a good home no ody ever picked it up. When I say high functioning once diagnosed she took three A*A'Levels dropping 6 UMS points and getting into Cambridge where she is on target to take a first.

She manages her anxiety and depression well now and but it was the neuro-developmental disability that pushed her over the edge. There did not appear to be the competence in CAMHS even to consider that.

If she had been from a dysfunctional family, living in poverty, witnessing abuse and addiction probably she'd have fallen off the rails much earlier and the family and social factors would have been blamed.

Because mybdd was from a privileged background she was declined NHS support and appropriate interventions/diagnoses. I thought the NHS was still a universal service not means tested but there to treat illness fairly. It seems not.

Your comments have made me incandescent and illustrate why parent blaming is so rife within CAMHS.

@Tulipsofamsterdam Sorry you had bad experiences with parents but you can’t tar us all with the same brush. Although what you say does explain why I feel many of the CAMHS workers I’ve met treat me with disdain.

Also parents you can't delegate the parenting of your child to a CAMHS service, if the problem is systemic you need to make changes.

Personally, I’ve never tried to delegate the parenting of my child to CAMHS. My experience was that in order to get the referral to CAMHS in the first instance I’d already had 6 weeks of weekly visits from the children’s services early intervention team and attended a 6 week parenting course. The early intervention team concluded that my parenting was not the issue and I needed a CAMHS referral.

@Tulipsofamsterdam and may I add that I don't think anyone in CAMHS that I came across would have been fit to parent a child, let alone one of my children.

Sorry my question didn't really make sense earlier. I'm not sure this will be any better.

I was wondering about children and young peoples mental health more generally - outside of crisis situations.

With adults I imagine seeking counselling to improve well-being is almost always a positive thing. But I wondered about children - who have a parent looking out for their well-being. Is a space to talk to an outsider generally good (eg re divorced parents) - or creating an issue where there isn't one?

I think my DC talk to me and are generally ok. But I wonder who they'd talk to if they needed to talk about me!! (Although thinking about it I imagine my DC flat out refusing to talk to a stranger anyway!)

I wouldn't take my DD's pet hamster to the CAMHS we have here.
Besides, the vets are the surgery are far cleverer.

Of course not all parents are like that, I've met some amazing families who are engaged and proactive. But I do remember the threats if I didn't give the diagnosis that was desired as the label then became the reason for everything.
The ASD assessments were done by a particular team who specialised in that. They were very thorough and detailed and yes did take a while due to the volume of work.
Parent blaming is not what CAMHS is about it's about working collaboratively and trying to understand the whole system that surrounds the child including any neurodevelopmental difficulties.

Very sorry that some of you have been treated with disdain. I have been threatened physically and had attempts to destroy my reputation.

@RosesAndHellebores
recognition of asc has changed immensely

ASC I should say.

I can totally understand why parents tell their kids to say they’re suicidal- an 8 week wait just to get assessed, then a further wait for any treatment, is too much.

[quote RosesAndHellebores]@Tulipsofamsterdam and may I add that I don't think anyone in CAMHS that I came across would have been fit to parent a child, let alone one of my children.[/quote]
Same in ours. Add our GP to that lot, too.

My question- why has a paediatrician told me my DD does not have ASD because she “makes eye contact and has friends,” ignoring all of the other things we have told her?

I saw a post further down about CAMHS professionals working part time so they could work privately elsewhere? Most of us worked part time due to having families and other commitments... Called a life.

Re the 9.30appt thing, that's so you can check your messages, go through your admin, respond to emergencies and make any phone calls that need doing before your first appt. The 9-5 is a bit restrictive and now services are working a lot more flexibly. The after school 4-5 slot is popular with adolescents understandably. If someone is higher risk we would usually see them earlier in the day for their own well being and so we could get any liaison/referrals sorted out for them during the rest of the day.

@Greenmarmaladewhy is it important that she has the diagnosis ?

@Greenmarmalade what about the young people who are genuinely at heightened risks but can't get seen in time because of all the families alleging high risk just to get seen earlier? The urgent and emergency system is there for a reason.