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.

Couldn’t get him to sleep until he came in with me. Now sleeping soundly.

Hi Op, I'm sorry you're struggling with this. It's a really difficult place for you to find yourself too, so make sure you're looking after yourself when you can too.

Your local Mind charity might have a young people's service that can see your son while he's waiting for NHS support.
https://www.mind.org.uk/information-support/local-minds/
Our local Mind has an early intervention team that will see young people quickly for things like anxiety, low self esteem, etc. Sometimes it can make a huge difference for a young person just knowing that someone is taking them seriously, that someone has an answer, and that they're not on their own.

My dd was in a similar situation, left to fend for herself because CAMHS didn't know what to do with her and the GP wasn't really interested. Eventually we had a big breakthrough when I managed to get a double appointment with the amazing nurse practitioner at our GP. She just listened for half an hour and made some very gentle but practical suggestions. She prescribed phenergan (antihistamine that helps sleep - a PP mentioned it but I think for children it has to be prescribed up to a certain age). It takes the edge off the anxiety as well as helping with sleep. DD also had counselling through her school but that took time to organise. If this hadn't been available we would have looked for private counselling.

I'd recommend not waiting on CAMHS to solve the problem. They can do good things for the right young people, but criteria to access services are very narrow, and there can be long waiting lists.

Brilliant he got to sleep! Well done you

They'll simply refer back to locality CAMHS for him to be seen later in the week, if not later than that

Even if they call the crisis team, he isnt in a crisis, the poster is correct about that. Crisis CAMHS might come out and see him but would quickly discharge to locality CAMHS

It would be incredibly unusual for a child that age, with these symptoms to be given medication. It certainly wouldnt be an outcome at A+E, he would have to be seen within CAMHS for some time, with assessment, over several weeks for consideration to that

However other posters citing the possibility of PANDAs are also right, this was my first thought. Needs looking at

Very sorry to hear all this about your son, OP. I had a similar crisis when I was 14 and my saving grace was that DM had Panic Symdrome so shared her Xanax until I was seen.

I'll be honest, I expect him to need medication. Ideally antidepressants that also act into anxiety, but also something short term for the occasional crisis because anti depressants can take months to kick in. If he's resistant to taking it, please make sure he doesn't skip any days. He may not feel it in the short term but ultimately the half life of those meds require daily taking.

Things that aren't medication that helped me during a crisis period:

• Just blurting everything out to someone. I often didn't make sense, but speaking out loud helped me acknowledge my feelings.
• Predictability. Does he have a favourite TV show or movie? Put it on. Knowing what was going to happen helps. It also offers some external noise so I couldn't drown in my thoughts and feelings. Even though I'm an atheist, I would sometimes pray over and over so I would be thinking on the words rather on how awful everything was.
• Having someone close by. I read that he fell asleep next to you and that helped. I'm unsure if it was the human sounds, body heat, whatever, but at some points I would move my bed because I could only sleep being watched.
• Pressure. Either from a firm hug, a weighted blanked or a high pressure shower, feeling "surrounded" calmed me.

My best wishes for your son. If you feel like there is anything I can do to help from across the globe, feel free to PM or ask here.

Our youngest (no anxiety issues) snuck in with me whenever his dad was away until puberty.

whatever works for you all.

Hi OP, hopefully you’ve all managed some sleep. Unfortunately, MH help is so hard to get. Getting information yourself is so important. I agree with others A&E is abysmal with MH, It almost invariably makes things worse.

Here’s a link to a summary of some immediate MH first aid techniques https://www.calm.com/blog/vagus-nerve-reset-for-anxiety

I would also recommend Looking up the Polyvagel theory by Dr Stephen Porges (Debs Dana makes it more practical)

The body keeps the score by Professor VanDel Kolk, although primarily about PTSd maps well onto anxiety.

Everything your son’s mind and body is doing is doing it to try and protect him. It just doesn’t realise there’s no actual danger. It sounds like he’s been through a lot recently so it’s not surprising his mind and body are struggling.

It sounds like you’re doing a fantastic job. It sounds like your DS is a bright lad and knows what help him, so yes if movement/football helps, play into that. Go to the park, kick a ball round.

I often go into freeze then if I’m feeling safe will move into flight so will literally run. If it’s safe allow your son to run somewhere (although be careful as it’s likely things like road safety will be non existent, so round the garden is good).

Hypnotherapy can work well at your sons age.

if he is predisposed to anxiety getting a good grounding in coping mechanisms will help him throughout life. We are all different, we’ve evolved to react differently to the world. Everything will be fine. Your son has a loving supportive family to help him navigate this. It’s difficult to se loved ones going through this, so big hugs to you, and as I said upthread make sure you look after yourself too

@HJBeans just based on your posts about social issues and social anxiety, do you think your son might have autism? Anxiety is commonly comorbid and thinking about ND might open up other soothing methods. Have you tried sensory stimuli like swinging, weighted blankets etc?

This is so heartbreaking.

They usually have mental health team at children’s A and E.

He sounds ND. School anxiety and tics. Poor boy, Kalms used to gel dd.

Is he an only child? Does he have siblings? Cousins? Anyone nearer his age he can spend time with?

The sudden onset and increase in severity plus the tics make me think PANS/PANDAS. I have a friend whose DC has it and it sounds very similar to what your DS is experiencing. There’s a page on the NHS website detailing it - perhaps see if it resonates? I have a teen with MH issues and it’s very hard, you have my sympathy.

Mine went deep into crisis right after starting secondary. Now in specialist education. We had no clue in primary. DC's current school says they see this very often (DC has been diagnosed with ASD and other things since) in ND children who manage to mask through to primary. Once they hit secondary school, the wheels come off.

If you’ve got the money ld take him to a private child psychiatrist.

We found one. She was about £400 quid a session, but really helpful. They can prescribe medication.

@HJBeans when dd was ill with anxiety and depression over ten years ago now, we found we had to pay to get appropriate clinical help in place, which led to therapy, medication and a diagnosis of the underlying issue which was ADHD.

Is paying an option. We found a very good child and adolescent psychiatrist through BUPA. Sadly neither the GP nor CAMHS were particularly helpful and she was cutting, overdosing and witholding food.

So sorry to hear your DS is struggling. The current delays in acute services is frustrating when you are watching them spiralling down in front of you. It’s so difficult not to project when they are struggling with mental health and it can be hard to find a balance between trying to normalise and visibly panicking in front of them.
Has your GP ruled out a medical cause for his escalating symptoms. Hyperthyroidism, over active thyroid, can present with similar symptoms to those you describe including tics. Because he has a history of anxiety they may not have considered other causes. Maybe a visit to your local children’s A&E where they can do a full examination would rule out other causes.
Some of the symptoms you describe, particularly hyperactivity and sleep problems are seen in hyperthyroidism.
Overactivity in many endocrine disorders tends to have a slow onset and not usually associated with a specific cause.
Google the symptoms to see if anything else fits. High levels of thyroid hormones make the nervous system more sensitive to adrenaline so it increases heart rate and sometimes causes palpitations. Body temp often increases and makes you very fidgety. It interferes with sleep and makes you very tired.

I'd try the private psychiatrist option. Sorry he's suffering so much

I’ve reached out to a private psychiatry practice about availability.

Despite waking with a startle he seemed on the face of it a bit calmer today. Accepting long cuddles and sat on my lap for ages during a work call (I was off camera attending a talk) and seemed calm and still. But then he completely melted down when we asked him to leave the house for a short walk in the neighbourhood, screaming and moaning and getting very angry. He was at football practice on Monday, he says he wants to go to a game on Sunday, but he’s unable to leave home now without a meltdown. I don’t know if we’re best to just accept this is a crisis (even if he’s calmer) and forget all normal life until … when? … or try to encourage him to keep doing things. I’m worried about reinforcing for his brain that it actually is dangerous to leave the house if we treat it as normal and rational to not go outside.

So sorry to hear you’re going through this.
It sounds like complete overwhelm.
are there no potential underlying neurodiverse issues? Does the school have a Senco, inclusion staff, school counsellor?

The school should be supporting you around possible Emotional Based School Anxiety.

The GP can prescribe beta-blockers for anxiety relief at this age. They can refer to Camhs, sadly a very long waiting time but you will be in the system.

Right now he needs to rest, have no pressure, sleep and eat. As others have said reassure him this is temporary. It’s his body telling him to stop for a while.

A child psychotherapist would be able to help him work through this and develop coping strategies. It’s very challenging as a parent to teach these to a dysregulated child.

Fab advice !!

he seems to be extremely anxious about leaving the house. It won't help if you asked him to do things which cause his anxiety to go into overdrive. Just be there and do what he can handle. Be his rock and his safe place whilst you wait for him to get seen. Remove all pressure and stress. Please do not ask him to engage in things which clearly cause huge anxiety. It's ok to try to not want to re-inforce certain behaviours but this isn't a problem behaviour. It's an accute MH crisis which really needs to be managed differently (I am having a highly anxious child - speaking from experience).

This sounds suspiciously like ND burnout. The age range is right.

Drop all demands. Even leaving house. Let him do nothing. Don’t challenge or request. Let him sleep and recover. He will pull though but it takes ages.

My dd burnt out. That’s how we discovered she was ND.

I’m a fan of polyvagal theory.

However, when l was stuck in freeze l had hypnosis to bring down the horrible anxiety. It managed to do that, but my fried brain just replaced it with exhaustion.

id had hypnosis for anxiety loads of times with no issues before being in shutdown.

Hopefully chams will see him very soon. It can be around this age that severe and enduring mental illnesses can begin to manifest so it is vital that he has a full mental health assessment.

Thanks all - it’s such a rapid decline and readjustment of expectations and I’m struggling to keep up with what’s happening to him. It would be so helpful if CAHMS / the NHS had some authoritative info on how to support your child while awaiting support which was relevant to kids experiencing severe symptoms. The advise we have around self-help is useful but not relevant I think as he goes further downhill.

To those suggesting ND, this possibility was raised by a private counsellor we took him to for a few sessions (she wasn’t able to set up a regular slot, so it never bedded in) and we duly followed up with GP in the spring who made a request for assessment to CAHMS. They turned it back as not enough evidence, with provision to self-help links for anxiety. His primary school wellbeing support - who spent a lot of time with him, as he’s struggled in primary as well, said she saw no evidence of this as did the GP we spoke to. It didn’t seem the most obvious explanation to us either as there is substantial family history of mental health conditions including gun anxiety on my side of the family. I wouldn’t rule it out, though, and perhaps if we can see a private psychiatrist they could also do an assessment.

He has always been socially anxious - from pre-school - and fearful around groups of people and new places. He can’t stand anticipatory uncertainty - like if we are getting a train or a bus he wants to be there really early in case we miss it - or engaging with things when he doesn’t know what will happen next (movies, shows, looking for a place to eat somewhere new, etc.) But when he is comfortable he forms friendships, is included in groups, is articulate and able to engage thoughtfully with others. He prefers adults or close family friends because he knows they won’t be unkind or unpredictable.