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.

Make sure he stays hydrated and ask for a UTI screen. A sudden escalation of psychological symptoms can be a result of a urinary infection. It’s more common in the elderly but there’s no harm in getting checked.

I know that in adult crisis assessment services they prescribe Promethazine, a sedating antihistamine that you can buy over the counter. I don't know what the age guidance is on it but it may be worth looking at. If you become really concerned for his welfare call your local Crisis Line for advice.

I wish I had proper advice for you OP but only have experience with adult MH services.

I really hope your son stabalise soon

This is very good advice

That's actually excellent advice I once attempted suicide when I had a uti. Its always the first thing I check now if I feel I'm slipping. Another thing op has he started any new meds recently?

Yes, been there multiple times with a teen, and depending what the issue is, they can do and help. It obviously depends but GP can't do anything.

Mental health services is a postcode lottery what will happen in one trust is not what will happen in another trust. Neither of you are right or wrong its just the reality of how unfair the nhs is.

I work in CAMHS. The cold water advice is a coping skill we recommend a lot. Anything with a strong sensory feel should help ground and refocus- weighted blankets, a tight hug, sour sweet, intense exercise, even loud music can help when you’re really overwhelmed. Or make a soothe box with things like squishies, fidget toys, nice smelly things, sudoku etc…sounds basic but when we feel completely overwhelmed simple sensiry things can really help. Practising breathing exercises and 54321 is good but he will need to practice these when calm for them to be effective.

This!

especiallly as OP said manic and jumping at shadows

Has he been going into school still? Is the anxiety school related? Do yuo know what it is about school that is stressing him out so much? Might telling him he doesn't have to go into school for the next 10 days help him calm down perhaps?

If school is the cause of the anxiety then you might have to really think about alternatives to this school as he can't go on like this poor thing. I really hope he feels better soon.

We view a&e as an absolute last resort for dd for mental health. She needs to feel supported and safe to get better and unless she is in active danger, a&e is not going to make that happen.

there comes a point where you just need to move to disrupt and distract. Sour candy. . weighted blanket or a firm hug. You-tube videos Or simple video games.

for us it can help to talk a bit about the cause of the anxiety. Dd and I have similar brains so I often can relate an experience that provides perspective.

once the crisis passes, advocate for a daily med like sertraline and therapy.

He’s not had a strep infection recently had he?

Do you know what had started him off with being like this OP? Look up some CBT techniques to try and engage with him if you can. Understanding his triggers can be really helpful to help him overcome how he is feeling.

I have anxiety, I’ve known that restless and endless fight or flight feeling and I feel very sorry that anyone, let alone a 12 year old feels that way because it’s awful. What helps me is a weighted blanket and doing relaxation on the headspace app and just going to bed to sleep it off honestly. I take medication but it’s no quick fix with antidepressants unfortunately. I hope your son is feeling better soon and you are able to get him some help

Thanks so much, everyone. I’m not been able to reply to messages bit have read them all and can’t thank you enough for trying to help. There’s so much here we can try.

GP couldn’t help - essentially said A&E would only act if he were psychotic / at risk of physical harm and we aren’t in that space. He would be overwhelmed in that environment - and is currently raging he had to go to the GP and they couldn’t help - so we will see if some of the suggestions here help him. The ones about moving to get heart rate to match his feelings in particular may be useful - he says he always feels so much better playing football and feels really uncomfortable staying still / focusing on breath.

He is a bit calmer now - despite raging at us and feeling utterly disgusted that nothing can help, he is at least making sense and was able to lean in for some cuddles for a while, which helps a bit. Again, thank you all so much - this is mumsnet at its best.

Rooting for you and your lovely son OP x

I haven't RTFT sorry, just OP posts.
I don't know if these are suitable but things that might help (my own experience of anxyand my children's)

Nature...if you can get to a woods, or Riverside walk.

You said he likes football, kicking the ball hard hard hard again wall.

Throwing a ball up the stairs as hard as possible.

Screaming a pillow.

Shower if he likes that sensory experience.

Fresh air

Weighted Blanket

Find a music that calms him.

Low lights.
Low stimulation TV

Clay, kinetic sand, slime

Wall push ups

Simple maths equations (engages the opposite side of the brain)

Hop scotch

Swing

I hope your son is calming a bit now, and on the way to feeling better. It's such an awful feeling. Assure him you know how bad it feels and it will pass xxx

Spot on 👍

A hot and then turn the shower very cold. He should stay under as long as he can bear. Then turn to warm again. The shock can create a reset.

Then bundle him up and put him under a weighted blanket. Massage his feet with oil pref scented and strong or moisturiser.

Ask him to focus entirely on his most favourite holiday, and visualise being there. Talk through whether to book it. Go into detail. If he can’t stop moving give him a tennis ball and let him bounce it against the wall. It’s rhythmic and can help re regulate.

The single most important advice is do not panic at all. Complete calm
on your part. Do not panic. He is not seriously ill or going to be, he is safe and well. He is not suicidal there is no risk to life. These are big feelings, but they are just that. I know it is deeply frightening for you - of course it is, but he has you. Reassure him school is off the agenda for now.

We’ve got you @HJBeans❤️

keep us updated and use this space to just talk it through.

Mumsnet recently has been toxic but threads like this make me grateful 🙏

Face into sink of cold water and/or a weighted blanket will activate the parasympathetic nervous system (resting state)

OP I have been where your son is and it's awful. I couldn't focus on breathing either, the more I thought about it the less natural it became and I ended up freaking out that I'd forgotten how.

Does your son understand what's happening to him? I wish I had. Talk him through it, and remind him that anxiety feels awful but it isn't actual danger. He's not going mad, he's enduring a temporary chemical imbalance. This is not his whole life now, though it might feel like it is.

Light exercise for distraction, and anything mindfulness that he can handle like puzzles, drawing or anything creative.

I feel so bad for him, but there's so much you can do to make this less of a life-changing event and more of a bad few weeks.

I've copy pasted info about TIPP, it's a toolkit used in DBT to help stabalise. Lots of the advice on here is based on these ideas. These are ways to regulate the nervous system quickly and get out of fight or flight

• Temperature (cold): Slows heart rate and distracts from intrusive thoughts and intense emotions
• Intense exercise: Lowers stress hormones and increases feel-good neurotransmitters
• Paced breathing: Increases oxygen intake and lowers heart rate and blood pressure
• Progressive muscle relaxation: Helps the body let go of stress and triggers the relaxation response

OP I have been suffering this for two weeks. Yesterday I finally managed to see my GP he prescribed me Mirtazapine 15mg. Took it before bed last night. This morning I woke up 80% better. No fight or flight, shaking etc.
its classed as an antidepressant but it’s not an SSRI. It resets your nervous system (in layman’s terms). Blocks certain chemicals causing the adrenaline etc. if you can possibly get it please do. It’s a miracle pill, I couldn’t believe it and thought it was a placebo effect but have done tons of research today and it does work that quickly. My heart goes out to you, I tried all other avenues, cbt mental health line etc, was in pure hell.
i really hope you can get him some relief soon. Thinking of you xxx

OP just checking he wasn't ill with a virus before this all kicked off?

If he has headaches and other physical symptoms and has jerks on waking I would want a neurological cause ruled out - waking with a startle could be morning myoclonus which is abnormal and can be associated with juvenile myoclonic epilepsy. Episodes of being unresponsive could be a seizure (although if he is fully aware and recalls the episode that is more likely to be psychiatric dissociation not seizure). Either way I'd be wanting an urgent paeds referral. Try videoing episodes and the startle on waking (with his consent) - very useful to show doctors videos of events.

Thanks again, all. For those asking, there was no precipitating illness and anxiety has been a long-term problem. In the weeks leading up to this crisis he’s started secondary school, we’ve had a family bereavement which required me to be away a lot, and he’s witnessed a violent episode involving kids, adults and a dog (!) at his youth football match. He’s also been coping with school anxiety by withdrawing from friends, one of whom then responded by teasing him in all his classes. He’s particularly anxious socially and taking part in the mediation discussion last week was really hard for him (though should hopefully have stopped the teasing). So 95% sure this is a mental health crisis rather than triggered by an illness.