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 yes, so school can understand her better. Yes, so in case she does things in later life that can be better explained with a diagnosis.

Yes, in the desperate hope that she will get some support for her anxiety and personalised strategies we can use at home.

@Tulipsofamsterdam when it’s your own child, I am see why parents need to do whatever they can to get their child seen before the problem escalates into a crisis.

I have a student who is self harming- no help yet for MONTHS. I am extremely concerned about her.

@tulipsofamsterdam - but if it helps families to attend at 9am rather than at 9.30 why can't professionals check their emails, get ready for apps at times when it isn't helpful for clients to meet, ie, in the middle of the day when it slams out up to four or five hours of school. It's about being flexible to meet needs of clients which isn't what happens. I hope youbalso saw my comment about dd and I arriving at 9.15 and the office being locked due to people coming to work closer to 9.30 than 9am - so not dealing with their emails, organising their day in that time.

I have two children with severe Tourette’s. It came on, out of the blue, for them as adolescents.

I never felt they had help coming to terms with this horrible illness. I also felt therapists seemed to blame me for their condition- thinking I was somehow making it worse. Whereas a Neurologist told us they were both at the severe end of the spectrum.

Doctors didn’t even seem to want to take on board that two siblings had Tourette’s and wouldn’t think about either the impact that had on the family as a whole, or the fact that the behaviour one had (stemming from his obsessiveness) annoyed the other because they had ADHD and couldn’t contain their emotions.

Bottom line is my experience of CAMHS is that they don’t manage Tourette’s well. Which is utterly crap because it’s a really difficult illness for a family to live with.

Its probably also worth saying that crisis lead services aren't too helpful out side of a crisis. Someone that presents as suicidal is likely to get support with safety planning, sort term risk assesment and crisis team style involvement

The longer term stuff eg psychological therapies and autism assesment, and planned interventions are unlikely to be offered any quicker as a result of a crisis presentation

The focus will be on getting that person out of a crisis and keeping them alive so if that's not the support they need then its likely to be frustrating

Sorry. I know that s a bit aggressive and not your fault. I just wish Tourette’s got a bit more help and understanding.
I’ve had friends of friends who are actual GPs make throw away comments about ‘having Tourette’s’, if they swear in conversation

@RosesAndHellebores I can't speak for your CAMHS service, we arrived at work at 9 or just after.. usually due to our own childcare school runs etc.... That thing called a life again. Urgent messages and handovers need to happen first thing, not at lunchtime. Plus that's when we have a thing called a "lunch break"! Sometimes if an emergency comes in that needs dealing with immediately we have to call round and cancel all our am appointments. It's just how it is.

@WouldLoveToGoOnHoliday

Tourettes is a really tricky one, because it often doesn't fit mental health services remit as its obviously not a mental illness. However neuro teams don't tend to have their own form of support re diagnosis and after care with the assumption that mental health services will.

We wouldn't expect that if for example a young person had been diagnosed with epilepsy.

There are wider issues re anything mental healthy being pushed toward community mental health teams, and seen as not in the remit of other teams so everyone else seems to step back.

Our experience of CAMHS still gives me nightmares and destroyed our family. We were desperate for help and when we finally got appointments our first 2 appointments were cancelled (but we were not told in advance due to admin error so sat in waiting room having both taken days off work, 3 kids in childcare etc). We made a complaint about this, in writing but didnt complain face to face.

However when we then saw CAMHS professional they decided we were starving DD as we were saying she had no appetite and felt we were emotionally abusing - not sure if it was in retaliation for our complaint but it felt like. Everything we said was twisted round on reports, home visit made and twisted to an incredible level such as you would think in their report they had visited a hovel not a £m caring home full of food and activities. School had reported to me their concerns that she woudnt eat at school and I told CAMHS this but they didnt note it (as if we were withholding food she would eat at school). We were in fear of our child being taken from us such was their approach.

Luckily we had the money to go private and we were able to get a medical diagnosis for DD which explained why she had no appetite and many other issues. However there was no apology at all.

When I later tried to access our file/their reports to put together a complaint they refused to release the documents as they said they would cause me mental distress and within freedom of information there is a loophole that you can refuse for this reason!! I just wanted something to be learnt from the case so no other child suffered in the same way - not to sue. When we involved Information Commissioners Office they released it with key meetings missing - allegedly lost!

Dd was young so they hadnt seen her without us so they were not protecting anything DD had said which could be reason for with holding documents for an older child I guess.

OP - do you think this is fair grounds to refuse access to our file? Is it normal to refuse access?

They were diagnosed by Neurology, but referred to Psychiatry for ongoing care. Because Psychiatrists have more experience with the medications used.

That’s really not good enough for collective anonymity to allow everyone to step back - children and parents are being abandoned to deal with a really awful illness.

@Tulipsofamsterdam I understand about that thing called "life" only to well as I hold a professional, director level role, managing a large team. Of course there are occasional issue with child/care mornings but 19 out of 20 times, probably more if work starts at 9am people need to get their childcare sorted out to ensure they get to work on time. And on time means being available to work from 9am for those who clock off at 5pm. Not arrive at 9am and go to the loo, do your lippy, make tea and settle at your desk at 9am. If staff want to do that they need to arrive at 8.45 so they are ready to start work at 9am and render their full contractual hours.

Similarly if clients find 1w to 2 most convenient then early and late lunches can be taken because the needs of the customer are paramount. My office has always to be staffed between 12 and 2 because that's when others have their lunch breaks. Flexibility. Agility. Responsive.

@Cmhtama

Its probably also worth saying that crisis lead services aren't too helpful out side of a crisis. Someone that presents as suicidal is likely to get support with safety planning, sort term risk assesment and crisis team style involvement

The longer term stuff eg psychological therapies and autism assesment, and planned interventions are unlikely to be offered any quicker as a result of a crisis presentation

The focus will be on getting that person out of a crisis and keeping them alive so if that's not the support they need then its likely to be frustrating

@Cmhtama yes that's not helpful at all when cases are closed right after crisis. I guess I'm lucky to work in a team where we keep up the work as long as it's needed. Sometimes many years. That's balanced out by the reality that some families only engage for a very short time- so it somehow works

@WouldLoveToGoOnHoliday

Sorry. I know that s a bit aggressive and not your fault. I just wish Tourette’s got a bit more help and understanding. I’ve had friends of friends who are actual GPs make throw away comments about ‘having Tourette’s’, if they swear in conversation

@WouldLoveToGoOnHoliday it's a complex and unusual condition so I totally agree more training is needed on it, some clinicians are very good with Tourette's but it can vary hugely

[quote Tulipsofamsterdam]@RosesAndHellebores I can't speak for your CAMHS service, we arrived at work at 9 or just after.. usually due to our own childcare school runs etc.... That thing called a life again. Urgent messages and handovers need to happen first thing, not at lunchtime. Plus that's when we have a thing called a "lunch break"! Sometimes if an emergency comes in that needs dealing with immediately we have to call round and cancel all our am appointments. It's just how it is.[/quote]
@Tulipsofamsterdam the 9-5 thing really varies too. In our team we work flexible hours- I personally prefer to have a few very long days (8.00 am until 6 or 7 pm) and then some shorter days

The service I worked in we were committed to shorter waiting times, with serious consequences if we breached. However to achieve that you see more people for initial assessments so therefore you have less space for longer term work as the bulk of your time is taken up with new cases which generate a LOT of work in terms of liaison and admin. It's not moaning or excuses to say that's how the resources were distributed, unfortunately due to the way CAMHS is organised you can't have both.

@Tulipsofamsterdam

The service I worked in we were committed to shorter waiting times, with serious consequences if we breached. However to achieve that you see more people for initial assessments so therefore you have less space for longer term work as the bulk of your time is taken up with new cases which generate a LOT of work in terms of liaison and admin. It's not moaning or excuses to say that's how the resources were distributed, unfortunately due to the way CAMHS is organised you can't have both.

@Tulipsofamsterdam you're right about the impossible targets.

I find it interesting in this thread how the fact that we are naming the shortcomings and problems makes people assume that somehow CAMHS services don't look at their issues and try to improve. They do. Both things can be true at the same time. Would it best to NOT point out shortcomings when we see them?

What is also clear is the huge variations between teams

@Tulipsofamsterdam well that's the fundamental problem isn't it. After a crisis dd was assessed three times in 8 weeks to make sure she didn't need any immediate support. And the support I was promised in 3 weeks evaporated and yet there was time and money for needless assessments. Total mismanagement but keeps the Trust dashboard looking squeaky despite being exceptionally disingenuous.

Our local CAMHS since 2015 has had at least five managers. They come and go but the permanent team members do not and I suspect it is a particularly toxic team that needs to be split up with the closure of that particular unit.

@CAMHSadolescenttherapist glad you like your condensed hours. I think what is unfortunate within the NHS and particularly clinical trams, there is no comprehension that out in the real world many, many professionals work 8am to 7pm without fail five days a week and check emails and basic admin whilst waiting for the spuds to boil, on the bus, in a queue, etc. And some on a Sunday afternoon.

It really is a different world out there you know.

[quote RosesAndHellebores]@CAMHSadolescenttherapist glad you like your condensed hours. I think what is unfortunate within the NHS and particularly clinical trams, there is no comprehension that out in the real world many, many professionals work 8am to 7pm without fail five days a week and check emails and basic admin whilst waiting for the spuds to boil, on the bus, in a queue, etc. And some on a Sunday afternoon.

It really is a different world out there you know.[/quote]
@RosesAndHellebores I think I just mentioned I work 8-6 or 7 on certain days did you not see that bit?

I don't work condensed hours, I work full time but with flexible hours that actually suits the families well too

Thanks for answering my questions @camhsadolescenttherapist

The tier 2/tier 3 difference is interesting and something I'm trying to get DD to understand as myself and DH are not entirely on board with her recent CAMHS referral via her GP. Our opinion is that yes she struggles (with many things but particularly school anxiety) but she is also receiving regular help (fortnightly private counselling)that from our point of view is working (there was a huge difference in her MH before/after she started the private counselling). She does have the occasional extreme few days (where she will feel very low/have suicidal thoughts and may self-harm) but that is always precluded by a very upsetting event (boyfriend dumping her for example) and she just needs to learn how to cope with those emotions with our help as well as her counsellor's. We could be wrong and she could be hiding things extremely well from us, but on the surface she seems fine, with as I say occasional low points but she has help in place (albeit privately) so I expect her referral to be rejected.

As for the form it just made me think of DH's friend who use to work in adult mental health, he took early retirement because he couldn't handle "focusing on certain disorders" each quarter and how so many people were not getting the right treatment (or treatment at all) because they didn't check certain boxes. It just made me sad to think that something similar may be going on in our local CAMHS, hopefully, it is just sub-teams as roses mentioned.

Also can I just ask is it normal for a GP (not DD's regular doctor and is seemingly new to our surgery) to make a referral after a 20-minute phone call with a teenager? No input from us initially (obviously we have filled in the referral form) or input from her school or even her counsellor. Whereas before with her regular GP, they wouldn't even make the referral because they knew she wasn't severe enough and was already receiving help both in and out of school and explained this to her (it's been DD asking for referral each time for "more help with her MH")

@RosesAndHellebores
I would argue some of the inflexibility about working hours does come from under staffing issues.

We have to recruit multiple times to fill one 9-5 vacancies so if the one decent candidate we get says they wish to finish at 3 then we will likely to accept that.

In order to run a 7 day service you need to have enough people working on each day, and unfortunately if the staffing isn't there then its better to run a safe mon-fri service.

Obviously flexible hours eg working later much better suit some peoples arrangements and might be desirable for some but you have to have enough of those people across the team.

Cahms in my experience has better recruiting then adults but there's such a limited number of applicants that's its hard to dictate to them.

Well if that's the "real world" you can keep it. I work flexibly and always have done. Primarily so I can manage work and family. I started work at 9.10am so my kids didn't have to go in breakfast club which they hated. I was very clear about what working conditions I was prepared to accept in terms of my family and I make no apologies for that.

But if you tell your clients you run a 9 to 5 service as a bare minimum you have to be available and fully open at 9am.

@AzPie

In my experience, practitioners that are newer to the client tend to have a lower threshold for referral. A gp that knows someone well may feel much more confident in their understanding of the risks involved and the current treatment. After a 20 min call its tempting to want to get someone else involved so you can share that decision with them, even if you know its likely to be refused sometimes in my experience gps want to feel like they have "done something"

@AzPie... I can't answer all your questions but just to say if she's recieving private therapy it maybe that CAMHS won't see her after an initial assessment as having more than one therapist/type of therapeutic input can be at best confusing and at worst damaging.

It may be that the GP was covering their back so to speak and being thorough due to risk, most healthcare professionals will understandably take a risk averse approach just to be on the safe side.