To need emergency help for my son’s mental health?

[HJBeans]

Posting here for traffic. DS (12) is having what we think is a mental health crisis with extreme anxiety. He has always been anxious, this has ticked up since starting secondary and gone into overdrive the last two weeks. He’s clearly physically in fight or flight all the time - sleeping lots of the day utterly exhausted, then waking with a huge startle and jumping at shadows all day. We’ve had support from the school getting him in part days, but he’s not been able to attend at all the last two days as he’s going downhill so quickly. He’s developed motor tics and today has been manic, unable to stay still, and not able to be calmed at all. He’s been to the GP yesterday and we’re on an urgent referral to CAHMS, but we can’t calm him at all today and he’s getting more and more distressed. We’ve called Young Minds, who pointed us to self-help resources, and 111, who’ve sent us back to the GP. At what level of distress and unsettled behaviour do we take him for emergency help? He’s complaining of a stiff neck as well as headache and sick tummy, but the latter two are constant while he’s anxious and the neck likely related to the tics, tension and constant motion. But could this be physical? Can anyone give him medicine to help calm him? It’s terrible seeing him suffer and we don’t know what to do.

If he can sit still hold your hand in front of his face and get him to blow it away in long steady breaths (assuming no breathing or heart/bp issues)

try box breathing in for 4 hold for 4 out for four hold for 4. Get him to move on to making the out breath longer by 1 until reach 8. This should calm his fight or flight. Use the word safe.

his processing part of the brain will likely have shut down, don’t stand over him or move quickly, don’t try eye contact. He might not be able to speak or understand speech. Soothing noises, soothing voice, it’s mainly about the sound and your body language. But show him he’s safe

If he feels separate to his body don’t worry it’s completely natural, the mind sometimes runs if the body can’t. Standing bear foot on grass sometimes helps or running through a body awarenesss exercise

Thank you. I’ve been trying to get him to do box breathing through the day and he won’t engage. He seems unable to be still / focus enough to do it. But I’ve not heard of blowing my hand away, so I’ll try that one.

It’s been going on at a higher level for a week and a half with almost no rest for him and I think he’s utterly exhausted and unable to take anything in.

If he feels separate to his body don’t worry it’s completely natural, the mind sometimes runs if the body can’t. Standing bear foot on grass sometimes helps or running through a body awarenesss exercise

It’s a survival mechanism for the thinking part of your brain to shut down to allow the automatic part of your brain to react quickly without overthinking getting in the way. His mind is trying to help him, it’s just perceiving threats that aren’t present objectively.

The main thing is to try to compensate for the large amounts of oxygen taken on board - try getting him to sigh, anything to breath out longer than he’s breathing in

Humming may also help, esp low notes

Box breathing, alternate nostril breathing and massaging his earlobes.
If he'll allow you to just cuddle him, that may also help. 💐

I would take him to A&E, preferably a children’s hospital.

We have a very good one just down the road. Usually have a low bar to visiting if I am seriously worried, but don’t know how to judge what I’m seeing as mental health rather than physical health. He’s also terrified of going to hospital. DH taking him in for an emergency GP appt now, so hoping they will advise.

That's not the usual advice anymore.

111 now have a MH option and will advise what to do.

If you’re staying home and can, try and make sure you’re as calm and relaxed as possible - take the time to tend to your breathing, listen to a relaxing meditation. Often our own nervous system gets heightened if we are around others struggling so make sure you tend to any effects it’s having on you.

I hope your son gets the help and support he needs - misplaced anxiety is so debilitating- but please make sure you look after yourself too.

Most trusts have a children and young people's crisis intervention team, but you usually need to be referred by a professional. If you get nowhere with the GP id call 111 and see if they can refer or, see if they can book an out of hours GP who can then refer. Once referred, they aim for a 4 hours time limit to carry out assessments.

Thanks, everyone. It was the 111 MH line which directed us back to the GP so will see what comes of this.

I hope you can get some swift help. Camhs crisis line? We called once for DS when he was about 16 - they were good ‘in the moment’ and calmed things down a bit. He was already known to camhs which helped.
Bresthing helps a bit but they have to want to engage.
Having DC with anxiety is hard and takes its toll on you too.

He doesn’t have a choice here, he has to engage with the breathing. Be calm and be firm.

Learning strategies at this age is essential. They won’t dope him.

Do they ever give medication to help calm the fight or flight? He’s not woken without a huge startle and panicked looking around for a week and a half. He seems to sleep soundly but is in fight or flight for every waking moment. He’s more and more unsettled with it and now jiggling / moaning / moving all the time. It’s clearly physical / chemical, and I don’t see how we can get him to calm using techniques until he has a break from the panic hormones. I suffer from anxiety myself and have had bad periods, but never to this extent and never lasting days without a break. It’s horrible.

It may be worth looking at PANs/PANDAS (there is a good facebook UK Support Group with insight and advice), especially if this has come on relatively recently and definitely if he has had strep/covid/high temp/exposure to mould recently. It can cause behaviour just as you describe.

There is some brilliant advice on here.

I would absolutely avoid a&e unless there are delusions/ psychosis I’m afraid. I wouldn’t want my son in the institutional part of the system.

i hope the GP has been helpful, and I hope there is some suitable medication to help him get some sleep

Sorry I know this sounds bananas but try getting him to go for a jog with you or doing star jumps. Anything to get his body moving in line with his heart rate. I used to have terrible panic attacks with a racing heart /startles and this really helped me. I figured it out on my own.

Anything like breathing exercises or body awareness just drew my attention to how out of control I felt and made it worse.

Alternate nostril breathing helped as a next step.

There's probably nowhere else to turn but the GP at the moment unfortunately.

This, they can use you to regulate.

Have a look at the butterfly hug. This is another method of self soothing and settling the nervous system.

Had he had a recent infection or has anyone in your house?
Have a look at pans/pandas. The suddenness of this crisis rings a bell along with motor ticks and some of his other symptoms
https://pandasnetwork.org/pandas-symptoms-checklist/

On the pans group, some parents find ibuprofen helps to bring inflammation down.

In addition, please get his folic acid, b12 and vitamin D checked.

Your poor son, I've been there, love reassurance also helps xxx

This isn't a MH crisis in terms of secondary MH provision, that would be psychosis for instance or overdose with suicidal intent, not extreme anxiety.

He's on the urgent CAMHS list, you've had the appropriate advice from 111 and although it's extremely distressing for you and DS, he won't meet criteria for crisis intervention.

And it's unlikely that when seen by CAMHS, he'll be given medication immediately.

You've had some great advice here in helping him to manage his anxiety and that's the way forward for now.

I would definitely go to a and e

There will be a community crisis team that your gp can refer you to. If it continues into tomorrow without easing, I’d recommend taking him to A&E.

if he can't calm down go to a&e. I have been there multiple times with a mentally very unwell teen. They are usually not the most urgent cases so expect a longer wait but that's what I would probably do.

The hospital I work in has a children's A+E and there is a small mental health team who are on call for children and young people (teenagers). I would think most hospitals have this.