AIBU or are CAMHS really REALLY SHIT

[Anonquestion]

I feel like I have been trapped in some sort of nightmare with them. My daughter is now 14 yrs old and was first seen by them 3 years ago when her behaviour started to severely deterioarate with the move to secondary school. We first did brief solution focused therapy with her, 6 sessions over about 5 months due to staff being off sick, on AL etc. It made absolutely no difference, if anything it made herore anxious. This was followed by 'family therapy', which she hated; a lot of pressure was put on us to have it filmed for staff training which made things worse. This was with another 2 members of staff, one was an ex-pschiatric nurse the other had a degree in psychology. We were then told there was nothing more they could do but send us on a parenting course run by the early intervention service, this was absolutely shite, really obvious stuff like 'don't hit your children', 'try not to lose your temper', stuff which we already knew. Me and my husband feel very strongly that our daughter's got ASD and she is now being seen by someone else (another ex psychiatric nurse) who is trying to get her seen by a doctor for a diagnosis and also maybe looking at giving her some anti-anxiety medication. The whole time we have been treated so badly, the first two years as though her behaviour was due to really bad parenting - we're not perfect but I really don't think we are that bad. All of her behaviour suggests to me she has aspergers, I have worked with other teenage girls who have it who are so similar to mine; coped well up to adolescence but now really struggling, meltdowns, routines extremely important, can't change plans, v inflexible thinking, reeling off sentences which are direct quotes from books, lack of eye contact, obsessions with different hobbies then dropping them suddenly etc. I just feel if anyone actually spent some time with her and got to know her it would have been pretty clear. Instead we are treated like Munchausen's parents for even suggesting she may have ASD, treated like we are terrible parents. I'm at my wit's end now and don't know what to do. I can't believe how awful our experience with CAMHS has been. Am I being unreasonable?

[Anonquestion]

Crusoe yeah, the parenting course was such a fucking waste of resources, we had to take annual leave to attend as it was in the middle of the day, just thinking about it enrages me!!!

[snowgirl29]

Anon yes you can apply for it. But they ask for reports (well ours did anyway - didn't follow through with application) from paeds and a section in the form the senco had to fill in. I knew this would be fruitless so I didn't bother. This wsd from the same senco who went absolutely hatshit at me when my GP had the audacity to write a letter asking them to do a statement for DS just repeatedly shouting "He's not severe enough" .
He's since moved schools and his senco is much better. She's fab with him and also doesn't think its down to shit parent syndrome.

[inabizzlefam]

They are a complete waste of time and money. My DS was at risk of permanent exclusion from school. What did they do? Took him swimming at the local leisure centre (I could have done that), then closed his case.
Crap, useless, waste of time and taxpayers money. Needs to be scrapped asap.

[MajesticWhine]

Makes shocking reading. DD1 has been under CAMHS for 6 months or so for depression and anxiety. I think we have had a better experience than most people on here. I am not sure any of the therapy is helping, but I can't really fault the efforts of the staff, even though we don't always agree with what they are doing.

[snowgirl29]

It shouldn't have to depend on a postcode lottery or whether you get one of the good lot though should it? Or whether your face just 'fits' and they help you regardless. They should all treat all families the same initially.

[hamabeads]

DS2's behaviour deteriorated rapidly at school recently and we are very lucky he wasn't excluded. The nest day the school and I sent a joint letter referring him to CAMHS. Within the week they phoned me. But after listening about his problems they told me they couldn't help as he didn't have a diagnosis of ASD. Although he is diagnosed with ADHD and ODD. So they have passed me on for help from The Autistic Society. A week later I got a letter discharging us from CAMHS. We hadn't even seen anyone! I was not happy! So I phoned them and explained how bad things were.... Still waiting for some support though!

[inabizzlefam]

That's what they do. The school and/or you get them involved, they visit you at home, visit DC at school, then the next thing you know you get a letter saying they can't do anymore to help and close the case. Have had this 3 times now.
Bloody useless.

[AllegraWho]

Blimey, your CAHMS does visits ? Some people have all the luck.

[hamabeads]

But we haven't even seen anyone! I have had a 15 min phone call and then they have washed their hands of us.

[snowgirl29]

Blimey your CAMHS does visits not exactly no I wasn't clear in my post.

CAMHs referred him to a 'behaviour and emotional support' team who then came and did a home visit thing.

[snowgirl29]

InABizzle they never visited DSs school. They relied on the biased impartial sencos class observations.

[yorkshapudding]

I work in CAMHS (dons hard hat ), although not for much longer. I have resigned and am currently working out my notice. CAMHS has always been grossly underfunded but an unprecedented increase in demand combined with relentless cuts to staffing and resources over the last few years have stretched us to breaking point. It is an absolute fucking mess.

Because so many inpatient beds have been cut, community CAMHS are managing children who are simply not safe to be in the community. Our service operates between 8am and 5pm mon-fri yet we're expected to maintain the safety of acutely unwell young people who, a few years ago, would have been admitted to a specialist inpatient unit for round the clock care due to their level of risk. We have no crisis team or on call overnight cover (too expensive apparently) and our numbers are hugely depleted because they're trying to save money by not replacing people who retire, leave or get promoted.

Our Tier 2 CAMHS service (which provided early intervention and preventative work for kids with mild/moderate anxiety and depression) went out to tender and the NHS lost the contract. Unfortunately, the organisation that won the contract (because they claimed they could offer it much cheaper) are terrible so local schools and GP's refuse to refer to them. Consequently, we are swamped with referrals for Tier 2 level stuff that we are no longer commissioned to provide (and therefore not allowed to provide) so we have to turn the families away, which means the kids don't get support so their mild/moderate problems eventually become more serious and we end up seeing them as urgent cases or in A&E months down the line. Talk about false economy and completely unfair on vulnerable children and families who should be receiving early help instead of having to wait until they are in crisis.

We used to have a team of staff who did ASD assessments, now there's just two people (one part time) and the waiting list for an assessment has crept up to two years which is a fucking disgrace. We used to do post diagnosis groups and individual work for kids who have confirmed ASD but now we're no longer commissioned to provide that work so these poor families wait over two years for an assessment, get a diagnosis but then they're not actually offered any ongoing support to manage the ASD

Our time is taken up almost entirely with fire-fighting (kids who should really be in hospital, kids who have reached crisis point because they've sat on a waiting list with no support for 12 months so their moderate depression has tipped over into psychosis etc) leaving little room for ongoing therapeutic work or tackling the ever growing waiting list. I regularly end up having to look at the list of kids on my caseload and weigh up "who do I think is the least likely to attempt suicide today?" to decide whose appointment I should cancel because I have to drop everything and respond to yet another emergency that we don't have the staffing levels to manage safely and effectively. We used to have a liaison team that did all the self harm assessments at A&E made up of five full staff. That's been cut so now we have to share these out on top of our casework, hence why some of you may have found yourselves waiting on paediatric wards with your DC for days waiting for someone to come and assess them.

And all the while, we have the commissioners berating us for being inefficient, expensive, for not discharging kids quick enough, imposing unrealistic targets that we have no hope of meeting. Then when we don't meet the targets, we get fined. Because obviously taking away even more of our funding is sure to help us to improve!

I can't do it anymore. As much as it pains me to leave a job that I love, I can't carry on like this, waking up at 2am feeling sick with worry for the kids on my caseload because the system does not allow me to give them the care I know they need and deserve.

To all of you who've been on the receiving end of poor practice, ridiculous waiting times or have had to go private in order to help your DC, I'm sorry. The above is not an attempt to defend, justify or excuse any of the problems raised on this thread. I just think people deserve to know what's really going on in their health service.

Sorry for the massive essay. Frankly I could write a book about all the shit that goes on

[Bearpeep]

DS is 6yo and was referred to CAHMS by the school nurse. She observed him in school and observed that he has poor eye contact, would visibility tense and relax, was fidgety, would smile at thin air and was talking at his peers rather than with them. She also observed that he saves all his frustrations and anxiety for home, so will blow up at home over things that happen at school. That he likes routine and structures. That he lacks awareness of physical and social boundaries and that he has next to no sense of danger. She felt he had strong indicators for ASD.

At his first CAHMS appointment they observed him and said he has strong traits for both ASD and ADHD so were going to assess for both.

He had a group OT session, I had a home visit and he had a school observation. We also had to fill in some questionnaires and so did school. School wrote on theirs that they did not think it was relevant or appropriate.

CAHMS came back to say that they cannot make a diagnosis of ASD or ADHD. They read out their report and stated that DS is a happy, sunny boy with a big smile who plays well with his peers and is a joy to be around. Then they read out an extract from my list of concerns that stated DS gets angry over inconsequential things, that he becomes violent and that he laughs in their faces when his siblings cry over something. They then said that it's our negativity that is causing his issues.

They've recommended a positive parenting course. She also gave me tips at the meeting and for every single tip she gave me I was able to reply "we already do that", "we've been doing that for years" or "we tried that for several months and he hated it". I then asked her why, if it's down to poor parenting, why my other children don't exhibit any of the behaviours we're concerned about and are completely different (they're very similar to one another in terms of behaviour, attitudes, reactions, whereas DS is exactly like my autistic brother was at this age). She couldn't answer the question.

I'm keeping a diary of my own observations, logging everything that seems relevant then after September once he's settled into the new school year I'm going to take it to the GP and ask if there is anywhere other than CAHMS that he can be referred to.

[RipeningApples]

yorksha based on your post I have sympathy. But where I live the CAMHS staff don't even work full days. Therefore the intellectual argument is lost before it begins. If a service is offered 9-5 the incumbents can't really whine that they are overworked when nobody is available before 9.30 or after 4/4.30. Esp when the manager doesn't work Fridays. When a service is so slack it's really really hard to have sympathy for workload. My dream has always been to work 9.30-4.30 and get full-time money!!!

I am sure you, from posts work v v hard bit it is clear to me that a lot of CAMHS emplyees are working to suit their own needs rather than the needs of individual patients. God forbid they might be expected to render a full time contract for full time money. It is a scandalous disgrace.

Makes note to write to Grayling again because there have been no improvements here. N.O.N.E.

[yorkshapudding]

Ripening, I'm not after sympathy and I'm certainly not interested in getting into "intellectual arguments", or any other kind of argument for that matter. I am simply providing factual information about what is going on in my area and other areas I have links with in case anyone might be interested.

I am intrigued to know how you can be so sure that your CAMHS staff are claiming a full time wage whilst not working full time hours though. Just because the service is 9-5 surely that doesn't mean all the staff will be contracted to work those hours. Whether or not people agree with it, NHS staff are entitled to request flexible working hours and in every CAMHS team I've worked (four in total, in different areas) a significant number of the staff have been employed on a part time basis. Even if they were contracted to work 9-5 how could you be sure they aren't in appointments, school meetings, child protection conferences, home visits, clinical supervision, assessing young people at ED etc. at those times? If you do have evidence that people within this department are working part time hours whist employed on full time contracts you should write to your NHS Trusts counter fraud department as they would be very interested to hear about it. Not only is it gross misconduct but it's defrauding the NHS and therefore the taxpayer.

[yorkshapudding]

Bearpeep, has your DS been assessed by an Educational Psychologist? School would have to refer him and they are sometimes a bit reluctant due to the expense but if you specifically request it then, based on what you describe, it will be difficult for them to justify saying no.

[stilllovingmysleep]

Like Yorkshapudding, I also work at CAMHS. There are so many issues raised on this thread that I don't really know where to start but I too want to say that I'm very sorry CAMHS experiences can be so negative (in some cases) or inconsistent / a postcode lottery in others.

However, as Yorksha says, CAMHS is painfully underfunded. My team too has the same problems although I suppose compared to other teams I think it's a really good one. There are many issues though. One is obviously to do with underfunding of CAMHS PLUS the problems we face being incresaingly complex, due to benefits cuts, increased poverty (=with mental health, inevitable, consequences), underfunding of social services which means we get al lot of those cases, mass closure of many inpatient wards / adolescent inpatient services (which means those cases, as Yorksha said, come into CAMHS) & various other problems along those lines which I won't bore you with. This is not me complaining, it is the absolute reality CAMHS faces and I doubt any CAMHS worker would question this picture. The result of all this is that the cases we receive have to be very carefully screened by our triage team to make it into CAMHS and usually they're more high rish / emergency cases rather than routine low level distress / difficulties (where lots of excellent preventative services could be offered). In my area, as in many other areas, there is persistent underfunding or Tier 2 services--meaning school psychology / community teams / charities for children, meaning that we get those referrals but our triage team rejects them. A lot of you have mentioned receiving some phonecalls & then your case not being accepted into CAMHS (after a very initial screening); well that's probably what you're experiencing, it might be considered a Tier 2 case which needs ongoing but perhaps not emergency support & it's not considered a CAMHS case.

By the way I don't agree with any of this and not defending it (and no one in CAMHS would defend it), I am just presenting the picture to you in case it's useful info.

There are some comments you've made though that I do want to clarify & disagree with (in some respects).

CAMHS workers come from various disciplinesnursing / psychology / psychotherapy / family therapy / psychiatry / and some are social workers. One thing to consider is that there is no 'one size fits all' mental health model at CAMHS, there is a plurality of approaches. Some of you had bad experiences with family therapy or with parenting courses & I hear that. However, I want to say that there is a wealth of excellent literature / very useful theories and some excellent, talented clinicians in family therapy and it's a method that does help many many families. (I am not a family therapist myself but have worked very closely with family therapists). I couldn't disagree more with the idea that exploring family situations is the same as 'blaming' the parents. It is not the same thing! Family therapists are trained for years and years to observe & think about the complex dynamics in families & that can prove very helpful in some cases, where sometimes some small shifts in family members' behaviour or way of seeing each other may move things along in a surprising way. I am not sure also why anyone would think that we as parents (I'm talking here as a parent too and not CAMHS worker only) don't have a role / input on our children's mental state? Of course we do and it's only right that we do. Human beings evolve & exist within relationships, so thinking with a kind and experienced clinician about these relationships & taking small steps to improve them can go a very long way. No diagnosis will help improve relationships / set behaviours in a family on its own and there are no magic 'strategies' that can take a problem away. God knows most of the families I work with (many of them for years) have read the books & know the strategies & I'm not going to insult them by implying their difficultiesoften entrenched & complexwill be solved by a list of tips which they can easily get in a book. By the way, we do offer strategies and advice too, I don't have a problem with that per se: it's just such a small part of our work and it's a misunderstanding of our work to think that mental health professionals just offer strategies and a diagnosis. In my experience, the families who I have worked with that were helped the most shared one characteristic, which is openness & curiosity to think about their family & their child in ways that they hadn't considered before, together with a professional, in a trusting, close relationship. The families that I often find harder to helpalthough often I do manage eventually--have very set ideas about what is wrong with their child & demand a particular diagnosis which they have decided on beforehand without really being interested in the expertise that the person they see brings and their different view. In some cases, yes of course a child may have ASD or whatever else, but each child & family are different, and as I said a diagnosis doesn't actually solve any problem at all on its own, it just gives us some more information. Plus, you have to take into account as well that many mental health professionals have a valid & serious disagreement, that needs to be at least discussed, with the over-medicalisation / over-medication / over-diagnosing of young people who are still developing & have lots of scope for change. Believe me, young children do change much much more quickly than adults, provided they receive proper help (which as I can't stress enough does NOT involve a list of strategies!)

A last small point. In terms of CAMHS workers not working 9-5 etc or not being accessible, I have to agree with Yorksha. A lot of us work flexible or part-time hours. We are also at our desks only at particular times of day, as we often go to meetings, are in appointments, are doing assessments etc etc. It is a very unfair criticism of CAMHS that they're not working 9-5! Or that a manager 'doesn't work fridays'--that particular manager may be working a 4 day week or whatever. You can say many things about CAMHS workers and may of course have all sorts of valid disagreements with aspects of the care you have received, but the idea that they're lazy and sitting around not doing work is so far from the truth that it's almost funny (were it not tragic).

Anyway, I hope this has painted a picture that helps clarify some aspects of work at CAMHS. I of course can only represent myself in writing this, can't speak for others!

[snowgirl29]

yorkshapudding I'm sorry you've gad such a stressful time and you've got to leave the job you love.

and GPs refused to help them I'm sorry but I don't entirely agree with that one. My Paed is adament this is down to shit parent syndrome despite my elder DD being a perfect child. Even after showing my DSs diary of times he'd expressed suicidal intentions and carried them through. They closed the book and gave it back to me without a word. It took me to go to NHS England before my GP could get me an emergency CAMHs appointment, and it was him that got the bollocking for it, not the Paed who is responsible for his care management at the time. Whilst I accept it is underfunded and understaffed, the above didn't happen because of underfunding, it happened because of poor assignment and poor care. I really do think that when services are under pressure they should cut their cloth accordingly so to speak, getting rid of useless parenting courses that aren't even appropriate for children with additional needs, and that CAMHs are probably paying plenty of £ for, should be the first to go IMO.

[snowgirl29]

RipeningApples our old shit senco expressed their suprise at ua getting a CAMHs appointment, stating that our area used to just leave the phone off the hook because they were that laden down with caseloads I think the fact we had to go to the top of the NHS just to bloody get one went right over her head.

[snowgirl29]

No diagnosis will help improve relationships / set behaviours in a family on its own

Sorry but I don't entirely agree with this, I had a friend who really struggled with her DC for years, the minute he was diagnosed by a sensible professional, he was prescribed medication, which in turn improved his behaviour no end. He's like a different boy. Shame those five parenting courses the Mum was sent on beforehand didn't have the same effect the diagnosis and medication had for him.

[stilllovingmysleep]

Snowgirl, there are no magic solutions in mental health.

Medication helps in some cases (which of course it does sometimes), in many other cases though it really doesn't even begin to touch the problem and doesn't work. Mental health is not a physical problem. It is very complicated & has numerous causes. It is also the very rare case that can be named in a clear-cut way eg 'depression' on its own, and then this can be dealt with ONLY with medication. Human beings and families are very complicated!

I have worked for example with a large number of depressed and suicidal adolescents over the years, some of which were also taking antidepressants, others weren't. Whether they had a diagnosis or not was irrelevant to the treatment provided. What made the difference was not the medication (although that at times gave them a much needed 'lift'). What made the difference was 1) their engagement in therapy 2) a good fit with the therapist 3) the family's support of the adolescent's treatment. There are many parents who don't support & sabotage their adolescent's treatment, sadly, for many reasons. So support for the parents is an extremely important part of the 'package'. Ultimately it's a question of whether the young person and family want to engage with the professional, whether this particular professional is experienced & a good fit for them.

The diagnosis in my view rarely answers any issues and is not the same as treatment. It does help though with accessing educational support or in some cases it helps a family receive benefits eg DLA, and these pluses are not to be underestimated. But I am very wary of categorising a young person and labelling them, I don't think it's helpful although I do do it as we all do at CAMHS, but I always tell families to take the diagnosis as part of the puzzle and certainty not the whole picture.

Mental health is not like broken bones, there are as I said above no 'clear strategies' or medications that absolutely solve the problem, if only it were that straightforward.

[snowgirl29]

stilllovingmysleep but that's my point. It wasn't a Mental Health problem with my friends son, I'm just evidencing the wrong signposting. If his Mum wasn't shoehorned into CAMHs in the first instance, then one, he and his Mum would have got support a lot quicker and two, CAMHs would have had a slightly less workload, if cases like those, were assigned to the right people in the first place instead of repeatedly being sent in CAMHs direction for them to deal with.

Whilst I'm sure you do have dome parents who are completely unco-operative from start to finish, but as parents yourself, you will know that most parents are more than willing to engage and work with services they are referred to.

For instance, I myself , have never refused to work with anyone, and gone to everything that I've been asked to, CAF meetings, CAMHs assessments, parenting courses, the lot. I was even sent on a parenting course for children with ASD & ADHD, I was sent on the latter despite DS not having a diagnosis, and I bit my tongue and chose not to correct very obviously misguided advice to parents of children with ASD & ADHD by these professionals. Why did I not challenge what I knew to be completely the wrong advice given to parents in that room who's DCs did have a diagnosis? Because I didn't want to come across as uncooperative.

[stilllovingmysleep]

Snowgirl what do you mean 'it wasn't a mental health diagnosis' with your friend's son? What diagnosis did he get that didn't fall in the field of mh? (Curious). Was it dyslexia or a learning difficulty? If it was something like adhd that falls very mush into the mental health field, as does autism, despite the fact that there are a number of treatments available.

[yorkshapudding]

Whilst I accept it is underfunded and understaffed, the above didn't happen because of underfunding, it happened because of poor assignment and poor care.

Do you not think the two are connected? When a service is systematically starved of resources care is inevitably going to suffer.

There's a lot of anger on this thread about CAMHS "wasting money on parenting courses". None of the four different NHS trusts I've worked in have funded parenting courses, they've been funded by the council or social care (so completely separate from the CAMHS budget) and CAMHS just refer to them although obviously I can't speak for other areas. A lot of parents think that being referred for a parenting course is about slating them as parents which is simply not true. Some parents badly want and need strategies to help them manage challenging behaviour, improve communication with their DC and respond consistently to their behaviour/distress and many CAMHS services aren't commissioned to provide that work. I've had a lot of parents turn up to assessments specifically asking to be referred to these courses and have heard some really positive feedback. I've also had a lot of parents tell me that they can't manage their DC's challenging behaviour and that they need strategies to deal with it but then when I've suggested these courses they've been furious with me. Something I hear a lot is "DD/DS is the one with the problem so why should I do a course?" There's no intervention that's perfect for every family and we have to work with the (increasingly) limited options we have available to us.