CAHMS - Absolutely Fuming

[BathshebaKnickerStickers]

Sorry, wide awake in the middle of the night because I’m so angry.

My dd - almost 17 - was urgently referred to CAHMS last month because of suicidal feelings and plans.

She had an initial appointment quickly which was an appointment with a very nice nurse to do a background and initial information about how she was feeling and why etc.

She was then posted out an appointment for March.

Sorry, school and the gp both said sorry March is too far away, she needs seen before then, GP intervened and she was due a virtual appointment on Monday afternoon. She was told it wot be done via FaceTime.

She took the afternoon off school so she could be at home for this appointment.

No-one contacted her.

I asked her if she had maybe missed an invitation to a “virtual room” that she had supported to join at her appointment time - no all she had was a text confirming the time - no “joining” link.

No-one contacted her by FaceTime - I’m going to FaceTime someone it’s essentially an outgoing call I make to their number...

No-one phoned her - they have her mobile.

No-one phoned me - they have my mobile

If it was a virtual room that she was supposed to join rather than a FaceTime call, surely when she didn’t jjoin someone should have called - it’s a new system so they must understand that maybe people haven’t used it.

This is a suicidal 16 year old who now has had 2 urgent GP referrals in 6 weeks - the initial one and then this appointment being brought forward.

No joining instructions if it was a virtual room rather than a direct FaceTime call.
No call to her to find out where she was if she had failed to join
No call to me to find out where she was (she was of course sitting at home waiting for the phone to ring.

I am beyond furious. Obviously calling them first thing tomorrow but expecting to be told there is nothing they can do now until mid January or whenever.

Are they so jaded that she is “just another suicidal 16 year old”?

How did it go op?

why are we not training staff to work in these areas?

I don’t think it’s a training issue more these jobs are undesirable. High risk, high stress, low pay, dealing with people in crisis every day. For staff it’s emotionally exhausting and often they get physically injured too. It’s not the nurses fault so many positions are empty and facilities underfunded.

Constant complaints from patients and parents that the service isn’t good enough, staff don’t spend enough time with patients or show enough compassion, the facilities aren’t good enough, they want better aftercare, they disagree with the medication or diagnosis of EUPD or their child doesn’t like group therapy. Or they want their child sectioned and threaten to sue the doctor if child self harms at home. Of course some parents are lovely but a lot have very unrealistic expectations or are abusive to staff.

Better pay might attract more professionals to work in services like CAMHs and community MH teams. But I don’t know anyone who has stayed in those jobs more than a couple of years.

It’s not difficult to Google online psychotherapy or ask your GP to recommend a private psychiatrist or therapist if you feel help is needed earlier.

@HikeForward regrettably, in my experience, the quality of the CAMHS staff I experienced could not merit higher pay. Add to that the very rigid 9 to 5 practices and there is zero argument for any firm of additional allowance.

It would also be helpful if an investigative journalist could research the proportion of part-time CAMHS staff who also have private practices I imagine it's a shockingly high figure even more prevalent among counselling organisations such as Heads Together to whom many CAMHS services are now subcontracting counselling/therapy partly to deal with clients demand for such services AFTER school and after parents finish work. CAMHS can't meet client needs because CAMHS staff will not work beyond 9 to 5.

And yes I agree HikeForward it is possible to secure private provision but as I have said before at the early intervention stage parents are very much in the lay camp and need some facilitation.

Finally if there is an expectation people can secure counselling/therapy privately and that it is NOT readily available on the NHS there needs to be absolute clarity about what the NHS will and will not fund moving forward.

If I took my dd to A&E with a broken leg, she would be triaged by a nurse, sent to Xray, the Xray would be reviewed by either a nurse practitioner or junior Dr and she would be put in a temporary cast pending review by a specialist Dr in clinic within a few days. If I took my 17 year old dd to A&E because had cut or taken a non life threatening od, A&E would admit to a paediatric ward with a 1:1 RMN through agency pending CAMHS review - the next day (because they don't work beyond 9 to 5). That stay could run to 2/3 nights because CAMHS have such restrictive working practices at huge expense to the NHS. The CAMHS nurse would likely then assess as good to go home and low risk 3 days after the crisis with the young person saying they are 10 out of 10 tops just to get out of hospital. The CAMHS nurse refuses to listen to speed of escalation because yp no longer in crisis. The NHS has just wasted £2k and the yp is put on a 3 month waiting list and there is no capacity to escalate for a 2nd opinion from a suitably qualified psychiatrist. Oh and for good measure the 16/17 year old could be assessed by the Mental Health Liaison Team on site from 9am until 2am every day but paed A&E aren't aware an assessment is available in the ED with a CAMHS follow up on CAMHS premises within a day or two so burn public money anyway money anyway.

The entire system is a shambles and my patience is spent insofar as inflexible, out of date, opaque CAMHS staff are concerned and NHS overall needs to join the dots and sort out the unholy mess labelled CAMHS and which in reality would be better known as CAHNTS.

I would really gently like to say, I think you should lower your expectations of CAHMS. The service is chronically stretched and underfunded. The 'bar' for actual concern is way above where your dd is currently at.

It very much sounds like you think this is the solution, and I hope it is for your dd.

Due to recruiting being competitive, All services need to be "attractive" to new recruits.

The service I work for (which is 9-5) has rolling vacancies where basically we are never fully staffed, by the time we recruit a new nurse, another has left. I would imagine even less people would apply if it was anti social hours

As someone mentioned before increasing your hours would mean hiring more staff to ensure adequate cover throughout. Even if you could attract applicants then you would need additional funding for this as well as antisocial hours payments etc

There definitely needs to be more incentives to work for mental health teams. I would argue that it's a vicious circle where the working environment is stressful, there are lots of frustrations that are due to poor staffing etc that you cant give the care you want so staff leave or go on longterm sick starting that cycle again.

There are only a fixed number of qualified people to fit the posts and locally there are definitely more posts than suitable people. Staff then have the ability to pick the job that suits them, it might be ward work where the pay is better (due to overtime/antisocial hours) or less stressful environments

Certain places also get bad rep, in my area its community services so applicants dont apply. Thus community services become really stressful thus people leave/vacancies arent filled thus it becomes even worse. The downside to the nhs is that pay and perks such as mat leave, training etc are broadly the same across the services, why would you be come to work in a team notorious for burning people out/where the work load is high when you would get exactly the same money in an alternate team that doesnt have similar pressures?

I dont know what the solution is. Probably bringing back funding for mental health nurses etc tuition fees to get more qualified staff so there are equal amounts staff and vacancies. We need to be encouraging people to stay in posts (possibly with higher wages) as With better staffing then retention would be better.

What's particularly frustrating where I live there is one CAMHS locality team that is just shocking compared to the other five teams. It has had at times six times more complaints than the other teams, 5 managers in 5 years and one can sense the team toxicity. If I were a snr manager in that trust I'd close it and distribute the staff to other locality teams.

My CAMHS trust was reviewed in 2015 and given £2.3m which it spent on an additional tier of bureaucracy which was evaluated as unacceptable. It went into an independent review in 2018 when it was deemed as failing young people and having inadequate services that were unresponsive to client needs. It is on the skin of its teeth with the commissioners and mid 2018 the CQC graded it as good. One can only shudder at what is required to get "needs improvement". I can only assume the SMT is masterful at data manipulation. I honestly believe that this organisation would have been dealt with were it outside the NHS

It would also be helpful if an investigative journalist could research the proportion of part-time CAMHS staff who also have private practices I imagine it's a shockingly high figure So would you rather all the part timers left? Would that help?

@Bluegreen70. Your lack of compassion for s suicidal teen and her mother is breathtaking.

As OP said I'd expect them at the very least to go through with an appointment that they promised!

If I took my dd to A&E with a broken leg, she would be triaged by a nurse, sent to Xray, the Xray would be reviewed by either a nurse practitioner or junior Dr and she would be put in a temporary cast pending review by a specialist Dr in clinic within a few days.

Well I think you would be lucky. Two of my kids have had broken legs, one was a 3 year old and we were told no one in xray dept, probably nothing, come back tomorrow if you're worried. I took hime back and it was broken.

DD hit by a car, paramedic pointed to a point just below her knee and said I think there is a fracture there. She was xrayed, irrate doctor told us she was making a fuss about nothing, make her walk even though she was crying in pain if she stood up. We bullied her to walk for 4 days, then got a call asking to take her back in for a review. Told that a Radiologist had reviewed the xrays and she had two fractures.

Two different hospitals, one a general one a specialist children's hospital with an international reputation.

The health service is in crisis and has been for years.

We have had a Christmas miracle and actually seen a CAMHs psychiatrist!

Only been waiting since February (and have paid a fortune in private treatment in the meantime). You are in a no-win situation, CAMHs waitlist is too long but as soon as you go private you are less vulnerable so lower down the list.

Daughter is being investigated for bipolar so we needed to see the psychiatrist to get the medication. It has taken an increadibly long time and has been very stressful.

Op, how is your daughter doing now? And also, how are you holding up?

@xmaspuzzlenc how odd that you think a suicidal teen is way off the bar for cahms. That is a ludicrous assertion.

If that’s the feat cahms see it then that should be a national scandal, but it certainly shouldn’t be.

That is wholly unacceptable ancientgran. In the first circumstance I'd have taken my child to another hospital and in the second I'd have held my ground and requested review by a more senior Dr. I would certainly never have bullied a child of mine into walking if they were in pain.

However I am not going to argue with you but find your experience surprising as we both have grown up children.

@RosesAndHellebores

I wonder if that is what's happened to that team then. It gets a bad reputation thus people leave/ dont apply as they can work in the other teams, which means that one team cant improve with turbulent staffing.

In private business you would get a trouble solving team to come in and re establish the team but as its nhs that manager wont get paid any.more than the manager of an established team.

I'm not sure where you are but if we merged my team with the next team along then it would leave some of my patch 40 miles ish away and at least an hour and a half drive from the other base.

Wouldn't be a problem here Notdeliasmith - densely populated County and other teams are no further than 10 to 15 minutes either way and they are all off the beaten track and tricky via public transport.

If my child was suicidal I wouldn't be waiting for CAHMS - I'd be going private. My good friends son self harmed 2 weeks ago. Private therapy is going on a credit card. Sorry, but I don't really get why you are so dependent on the idea of CAHMS when you know you'd get better and quicker treatment if you paid for it.

That is wholly unacceptable ancientgran. In the first circumstance I'd have taken my child to another hospital and in the second I'd have held my ground and requested review by a more senior Dr. I would certainly never have bullied a child of mine into walking if they were in pain. We were told that because of the bruising on her knee it was important to keep her mobile so we did.

With the 3 year old, by the time we waited hours in A&E it was about 10 pm, he was tired and so we took him home to bed where he slept the sleep of the exhausted for 10 hours. The following morning he had breakfast and we took him back. We could have gone to a busy A&E in a general hospital and sat there till 2 or 3 in the morning but I think we made the right decision.

Obviously you would make perfect decisions but that isn't the point is it, you asserted what would happen if you took a child with a broken leg to hospital and I'm telling you that won't necessarily happen.

Of course you find it surprising because it hasn't happened to you and you couldn't imagine it would, you were secure in the knowledge of what would happen, that security was misplaced.

@Wannakisstheteacher

If my child was suicidal I wouldn't be waiting for CAHMS - I'd be going private. My good friends son self harmed 2 weeks ago. Private therapy is going on a credit card. Sorry, but I don't really get why you are so dependent on the idea of CAHMS when you know you'd get better and quicker treatment if you paid for it.

Because not everyone can afford private treatment. I'm sure the last thing OP needs is a comment like that.

And therapy as a result of self harm is different to a suicidal teen. You're being ignorant.

I just want to add I've seen some amazing treatment in the NHS. I was rushed into theatre for an EMCS, they didn't even let me husband say goodbye, as they ran me down a corridor I lay there thinking how impressive they were and I woke up with a healthy baby. I also got admitted for a cardiac condition and they were absolutely brilliant. However that doesn't mean everything but CAHMS is peachy. Things vary for many reasons. Two of my children were treated on the same ward within 12 months, one had brilliant treatment and we couldn't have got better if we'd gone private, the other was abysmal and her surgeon asked me to monitor her wound treatment as he wasn't happy. Is that ward great or terrible? Hard to tell isn't it.

CAMHS are notoriously underfunded and stretched. Like with any service I've heard some horror stories and some good outcomes.

But I'm unsure why the thread has descended into good and bad stories of the NHS and why OP is not going private (which imo can be as problematic ).

OP is asking if it is unreasonable that DD was given an appointment and then ignored. Bizarrely enough if this was something like a friend agreeing to meet and not showing or w teacher agreeing to email and then not doing so you would all be up in arms. So why not now?

If DD was not given an appointment or on a waiting list I would understand these stances . But what she is talking about here is very different.

@wheresmykimchi

Firstly. He carved "I want to die" into his arm... So I don't think I'm being 'ignorant' to draw the comparison

Secondly. What is more important than help for your suicidal child? I'd sacrifice Christmas dinner, presents, get a credit card. Whatever it took to get urgent help.

[quote Wannakisstheteacher]@wheresmykimchi

Firstly. He carved "I want to die" into his arm... So I don't think I'm being 'ignorant' to draw the comparison

Secondly. What is more important than help for your suicidal child? I'd sacrifice Christmas dinner, presents, get a credit card. Whatever it took to get urgent help.[/quote]
It is ignorant to compare any one case to another.

I think in our heads , we all would. But the reality can be quite different, as I'm sure you know.

@wheresmykimchi riiiiight. OK then 😂😂😂. You probably shouldn't be comparing the stories you've heard of the NHS then as it makes you sound like a bit of a hypocritical twat.

I agree with wheresmykimchi. However ancientgran between them my DC have suffered: a broken ankle, a very badly broken leg, two broken arms, a broken collar bone and a broken nose. On each occasion NHS care has broadly been described as I have described above. I think you make too many assumptions.

I'd sacrifice Christmas dinner, presents, get a credit card. Whatever it took to get urgent help.

Well unless you live on caviar Christmas dinner might get you an appointment or two but won't get you a course of treatment.

You are speaking as someone with choices and access to credit and the ability and knowledge to navigate a system which seems designed to be difficult. Most people can't afford private treatment, especially for long running courses of therapy such as are common in psychiatric care.

I think you are the one making assumptions Roses, you assume that what you have experienced is what always happens. Sometimes it does but sometimes it doesn't. Some people get good MH support despite the pressures on the services, some don't. You seem to think it is all very black and white when like most things in life there are shades of grey.