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.

He sounds even more ND after your last list. Possible ADHD

OP in the short term i’d ask your GP to prescribe him some propranolol, to break this cycle. And I’d get him in front of some private psych help ASAP. The NHS won’t kick into action very quickly im my experience.

I feel you’ve been let down by CAHMS, GP and school here.

Anxiety is typical of ND. Plus the things about change and anticipation you mentioned.

Some dc mask it. But it bursts out. All 3 of those professionals should be totally aware of masking. He’s now reached tipping point. In these kids it typically reaches tipping point in year 7-9

Hi OP,

it sounds really tough for you as a family. I am a psychologist and o work in CAMHS. I also do neurodevelopmental assessments.

when I read your post initially I actually assumed your child was neurodiverse and things have maybe got on top of him.. totally common when young people move to secondary school.

the description you’ve given around the anxiety is really important, that is absolutely anxiety but it really does sound like anxiety linked to neurodiversity. Obviously I don’t know if he has a history of trauma, which would also potentially have anxiety manifesting in that way.

he sounds very deregulated and as though he’s having ND meltdowns to me, it doesn’t sound as though he is in a mental health crisis- more that it’s an escalation of anxiety related to lots of changes/transitions. The solution is probably going to be to calm his nervous system by making the environment less stressful for him rather than giving him direct therapy right now. Instead of sitting and waiting I would recommend learning about this now.. make everything as predictable as possible for him (visual aids/keep things consistent), allow lots of opportunity for coregulation as that seems to be working ,if you can afford it get some help as a family (family therapy), try to get a referral for the neurodevelopmental pathway. I don’t understand how that would be rejected based on some of the things you said, GPs don’t know about assessments you can absolutely push back on that. They would want to consider the possibility of trauma vs ND. You could also try to pay privately if that would be an option for you.

school refusal related to anxiety is absolutely grounds for the school to be working very closely with you to understand this. Again, it immediately does make you wonder about neurodiversity as that isn’t uncommon. In my service we would escalate an ASC assessment if there was a risk of school placement breakdown so if you did get a referral it could be quick.

Also OP, you say no familial history of ND, but significant anxiety.

This may be undiagnosed ND.

Thanks - this is really clear and very helpful. No history of trauma (that I know of, and we’re very open with each other) and all you say makes sense. The GP did put through the referral for ND assessment, it was CAHMS that turned it down. They have gone back now with an urgent referral for anxiety but mentioned the query on ND. When we see someone - either privately or through CAHMS - I will push for assessment to have clarity on whether this is an element of what’s happening for him.

I’m so sorry he’s going through this. With how quickly things are escalating and the fact you can’t calm him at all, I’d go back to 111 and explain it’s getting worse, or take him to A&E if you’re really worried. You know him best, and if it feels like a crisis, it’s okay to get emergency help.

Try looking up ‘Right to Choose Clinical Partners’ and their waiting time for ASD assessment is shorter than the list in my local area (although still long, unfortunately).

My 12 year old is awaiting ASD assessment - they present with similar anxiety symptoms. It won’t change anything quickly in terms of symptom management but will help to access support at school etc if a diagnosis is made. We paid for a series of CBT sessions which really helped - also ask the school for a referral to the local MHST (Mental Health in Schools Team), we were given a fairly swift assessment with them and they came to the school to administer anxiety management sessions and also gave us online sessions for parents to help deal with anxiety.

I know it is overwhelming and difficult - please know that with the right help, things will get better and it sounds like you are being a great support at home.

Update here: we’ve had an appt through the post for “Tier 2 CAHMS” which on reading the descriptions of the tiers seems one tier down from the problems DS is having. But maybe it’s a screening service?

We’ve also heard back from a private CAHMS practice about an hour from us that would allow him to see a child psychiatrist, which feels the level of expertise he needs. It will be stressful speaking to people about this for him, and leaving with only more self-help resources would be really demoralising for him and us. But we don’t know the timescale for this, it could be months, so we are in a take all the help we can access stage I think.

DS is slightly more functional and has started an amended timetable today - just a few classes a day. He’s miserable and feels sick, but doesn’t want to stay away entirely. It’s so hard not to know what’s the best for him.

If anyone has any knowledge of CAHMS Tier 2 and/or private psychiatry for unwell adolescents I’d love to hear anything about what we could expect. And I’d especially love to hear any ‘happy endings’ as have been looking at the stats for longterm mental illness in adulthood for kids who have crises this young and they’re really sobering. I just want my kid to be able to feel happy and safe - it’s torture not being able to give him that.

I found CAMHS useless on any level.

Adolscent pysch much better, v helpful.

I don't have an adolescent, my child was in infants when their MH journey started (developmental trauma/CPTSD) and CAMHS were useless for us. After trying them, we had to go private, which is financially crippling. The difference in help and impact is amazing.