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.

I’ve got quite a lot of personal/family experience of this type of thing, and unfortunately the only thing I think would help would be diazepam, but it would only help while he’s taking it, and it isn’t prescribed long term.

Realistically there is very very little help out there via the NHS.

It sounds like your DS needs to see a psychiatrist and a counsellor with regards to putting some medication and ongoing therapy in place. What is available via the NHS is either nonexistent/insufficient/insultingly useless.

If you have the resources you should arrange a private evaluation.

The similar situation in my family was shockingly unsupported by the NHS even at the point my family member was being sectioned.

Despite the fact she's been advised by 111 - the NHS service which also deals with mental health to not do that and seek support via GP which is already happening and he's already got an urgent CAMHS referral?

And her DS specifically said he doesn't want to go to hospital?

Please be careful about your advice, it is wrong in this instance.

All that would happen is he'd wait in A and E, becoming more and more distressed only to at best, a MH professional in the next few hours (the CAMHS hospital assessment teams work at the latest till 10pm) who'll send him home with anxiety management advice or he'd be sent home anyway as there would be no available MH practitioner to see him after regular hours as many only work till 5pm.

This isn't a MH crisis in the eyes of secondary MH services.

GPs are generally useless at a time of crisis. They are very limited. I would take him to a children’s a&e and be very clear on why you are there - list full symptoms and examples, and keep repeating you are scared for his personal safety as he is suffering a mental health crisis.
You will be fobbed off until you make enough fuss that you’re taken seriously. The child needs to be seen by a psychiatrist urgently and given treatment

It’s extremely unlikely that he would be given any kind of medication. You could go to A&E but it’s a busy, noisy environment.

Have you ever seen the GP with a child with a MH crisis? Please tell us how that went. You obviously talk about something you have no experience with.

Agree with previous suggestion to see if exercise such as a run will help.
His brain wants to escape danger, if his body follows through it might ‘complete the cycle’ and allow him to re-set and calm down.

Has he tried sticking his face in really cold water it does like a body reset. Another good one is grounding where its 5 things he can see 4 things he can touch, 3 things he can hear 2 he can smell and 1 he can taste I always find this quite helpful

Oh your poor son -
he sounds utterly overwhelmed
your best bet is to get him into Cahms
check what the wait times are for
triage of urgent referrals
assessment and then treatment
if the wait times are horrific - go private - even if u put it on a credit card
psychiatry UK is good - the psychiatrists are often CAHMs specialists
NHS services are tragically overwhelmed- so always ask how long … when you are referred for anything ….
prioritise his sleep, diet, rest, comfort and safety
reduce screen time and increase comfort things - weighted blanket. Favourite movies, etc

Hi I’m so sorry this sounds scary.

A cold flannel to the face can help to pause and re-connect and then allow something like the breathing techniques. The breathing ones can’t work if he won’t engage.

similarly is he eating/drinking? Would a cold drink help or crunch some ice to regulate?

someone mentioned a run - it’s cold today in a lot of places so would he go for a walk/run in the cold air.

then come back and use a weighted item and snuggled for body contact and safety.

he may feel his body is disconnected so the exercise and/or ice may help to pause. The the deep pressure for safety and to feel his body if that makes sense.

how about some white noise in the background for stability? Might need to play quite loudly weirdly to overtake any audio hallucinations he may have.

im not a medical professional so feel free to free to ignore - but how about an antihistamine? They can sometimes calm. If he’s had before and know it’s safe then might help take the edge off

if no choking risk then a chewy sweet or something to calm his breathing/body.

smells to awaken him and reconnect breathing. Or to calm. Got any olbas oil or essential oils?? Or coffee under his nose.

sorry for the random list - jut thinking of some quick fixes you may have available to you.

longer term I’d go low stim/low demand and not attempt school for a while.

I’ve been here and still fighting this daily.
setraline saved my life. I was put on diazepam but was paranoid and it was just horrible so I came off them. I couldn’t stop the anxiety and heart rate. I thought I was dying. The out of body experience is what caused it it was AWFUL!! I wouldn’t wish that on anybody.
I really hope he’s ok. I’m doing loads better now this was me to a T last year. He will move forward from this. I hope the gp has helped xx

I wouldn’t send him to school but would let him know that this is a panic attack and although it’s very frightening, nothing bad can happen. Reassure him that he’s not going mad. It sounds as though he’s highly sensitised. Try chamomile tea - two teabags in a mug, let it steep with the teabags in it until it’s cool and then get him to drink it all.

Adrenaline lowers blood sugar significantly so give him something sweet to eat.

CAMHS will not consider this an emergency, so you need to do mental health first aid.

Have you tried taking someone in mental health crisis to a&e?
What would you be taking him for- what do you think they’d do to help?

that's not an antagonistic question btw- as someone who has been through it recently I do wonder what you see as the risks and advantages for a young person like this to be in a&e?

Oh gosh,@HJBeans, I'm so sorry this is happening to you and your son.

I'd take him in ASAP.

They will be able to give him medication to calm him down while they try and figure out if there's an underlying physical cause (e.g. PANS/PANDAS as others have said).

If not, an A&E admission can sometimes fast track for other support depending on the area.

Sending love to you both x

It's definitely not ideal but, given the absence of an alternative, it's probably the best option for getting support and, potentially, medication to calm things down. He can't just be left like this.

If you can afford it, a private psychiatrist. It’s the only thing that helped my 12 year old (medication)

https://www.rcpsych.ac.uk/docs/default-source/members/devolved-nations/rcpsych-in-scotland/faculties/pandas-pans-presentation-mlim.pdf?sfvrsn=69a979a_2

This is a reputable source.

Although this does sound like severe anxiety, I’d be asking the medical professionals to rule out anything physical (stiff neck, upset stomach, headache can all be signs of physical illness). They need to do blood tests. This might also be helpful in that he’ll be reassured that doctors are taking him seriously (even if there’s not a lot they can do if it’s mental health related).

Exercise will help as others have said and I’d be looking into melatonin or promethazine so he can get into a deeper sleep. Once he can get some restorative rest, he’ll be calmer.

a child in my life recently did exactly what you suggest.

a section was suggested- there was no bed, and no knowledge as to when their would be one. The solution was to keep them in a&e for the days it would take- no treatment, that’s for the psychiatric hospital.

he was told he would likely be in adult wards/hospital and certainly in adult a&e (in a corridor, watched by the police watching either sectioned adults

this is common btw.

at one point it was even suggested the police might need to take him to the station for safety.

The parent left-the next day saw the Gp. The GP said “thank god you didn’t leave him there. I can’t tell you how badly that would’ve gone”

just to make it clear- I don’t believe OPs son is in that level of MH crisis. However, consider what they will do at hospital if he is. It very likely isn’t what you expect.

it’s something that should only happen when it’s truly needed with no alternative.

I was going to mention this ^ Do look at that website, OP. It might not be PANs/PANDAS but it’s sensible to get it ruled out.

Yes, I know these things do happen and seems to be highly variable between areas. Mental healthcare in this country is absolutely abysmal at the best of times, but when its children who are affected it absolutely fucking stinks, doesn't it?

I agree -
a +e’s are woefully awful places especially for mental health issues -
it would be only in life / death situation I would take my child for a mental health issue to A+E -
Utter last resort -

GPs can prescribe propranalol for anxiety...don't let them fob you off.
You can get promethazine from the chemist for sleep.
Try getting him to submerge his head into a bowl of cold water for 20 seconds (or as long as he can) to reset his vasovagal response.
Sniffing isopropol alcohol on a tissue can help with nausea.
I'm so sorry for him, and you, op.
I'd agree with not taking him to a&e...it was utterly pointless for dd and very distressing.
If you possibly can, try and get a private psychiatrist who can diagnose and prescribe.

From what she has said I agree with my advice and you can agree with yours!

I have personal experience of this

@HJBeans Please don't listen to people diagnosing your ds- that's for the psychiatrists to do.
Now he needs urgent help. I have been there with DS1 (also started at 12 y old) at child psychiatry urgency and what they give to calm a child down (who is clearly suffering) is: Cyamemazine (Tercian), also known as cyamepromazine.
It will make him a bit sleepy but no long term effects. I now give him (15 y old) his dose every evening because he will not be able to cope without it. Autistic, heavy OCD and anxiety.
Mental illnesses often debuts with puberty so now this. Then again it can be reactional or other neurological factors behind (as for my ds him being autistic is the main problem and the mh problems are related).
All this will need to be evaluated by professionnals- not by mn posters. But please get him first emergency help because he must suffer. I wish you all the best and a big hug for you 💐

Can he do something to disperse the adrenaline? Can someone take him out for a jog or do some intense aerobics in the house or something.

Trying to relax when your body is surging with adrenaline is hard. If he can use it up first, he might find it easier to relax a little afterwards.