DD overdose. The system is broken? Any advice?

[BeethovenNinth]

I have posted about DD before. Broken by lockdown, anorexia age 12, school drop out, burn out, self harm extreme. We are five years in.

we have repeatedly been told she doesn’t qualify for help and have tried various therapists ourselves.

she is out of school and self learning. Very lonely. Seems ok recently ot so I thought.

due to intense sadness last night she took an overdose of aspirin. I suspect a cry for help and she phoned childline who got her to phone 111. (She didn’t think to wake any of us). I suspect A and E will just kick us out soon.

we are a loving family but this is a huge setback.

we are Edinburgh based, desperate desperate for the right help.

private psychiatrist? Do we suggest sertraline? Anyone in Scotland have any good suggestions?

thanks from a broken mother

@FoodieDenchor ADHD or both

Roses - what clinic did you use please? I will remortgage the house if I need to….

pumpkin - that very helpful and thank you. I might PM if ok?

Ours was through the psychiatrist.
GP may not be allowed if too young

My dd is 18. Covid and lockdown completely changed my child.
We are also travelling some of your road.
All the best x

We have also walked this walk (minus the anorexia, but with other complicating factors). My advice would be that medication is essential - DS is very clear that he wouldn't have survived without it. It took time to find the right anti-depressant medication (he tried Fluoxetine, then Sertraline, then Mirtazipine and is now settled on Venlafaxine - he had side effects from Sertraline and Mirtazipine, and was shifted from Fluoxetine because it wasn't touching his anxiety). He also takes propanolol (a beta blocker) which he finds incredibly helpful - without it he was having multiple panic attacks each day.
Therapy-wise - the only thing that has helped has been a highly skilled, very experienced, neuro-affirming clinical psychologist. He saw her weekly for 3 years. Plus weekly speech and language therapy and weekly occupational therapy (he is autistic).
In order to get all this in place, he had to see a psychiatrist privately, although now he has moved to a fantastic adult service and has a great NHS psychiatrist who he just sees for check ins every 6 months.
The therapies were part of his EHCP (special educational provision in England), and he attended a highly therapeutic independent special school.
There is no way on earth that a CAMHS worker, counsellor, youth worker etc would have had the knowledge and skill to support him. He needed a multi-disciplinary team, who worked together at every stage.
Someone above recommended 'Partnering not Parenting' - unfortunately the charity has had to be dissolved, and the courses are no longer availble. But Suzanne's book 'Never Let Go' is still available, and I would also recommend this. Naomi Fisher also has good advice on reconnecting with teenagers in burn out, which we found equally applicable in mental health crisis (although NF has made some questionable choices around supporting Uta Frith and is persona non-grata with the autistic community at the moment for good reason).
Basically, as a parent, we have to be no pressure, walking alongside the young person, giving them agency, supporting them on their own unique journey. Whilst simultaneously working furiously to advocate for them, find services, arrange some kind of education, fight for healthcare, and spend thousands of pounds in pursuit of making the relevant agencies follow the law and do their jobs.
It has been the hardest season of my life, by a very very long way. There are thousands of us living this journey, but it is also incredibly isolating because it is so far removed from the parenting experiences of other people we know. Progress is incrementally slow, but I wish you so much strength.

Camhs is unfortunately very hit and miss and without the option to not “gel”with the therapist or identify the right therapist. Sounds like meds may be an option combined with some talk therapy, but you will almost certainly need to go private. Have a look at The St Andrews Practice - they are a multidisciplinary practice with a range of specialisms, and if they can’t help may well be able to advise on where to look in Edinburgh.

OP’- I walked a similar path, without the anorexia
I would absolutely go private -
with Psychiatrist
go on medication - they will advise which one, dose and monitor side effects
and give a diagnosis -
what is the underlying disorder that is presenting as anorexia or self harm -
what disorder is she attempting to cope with by these behaviors - a psychiatrist will
be able to assess / diagnose / start treatment planning
CAHMS - too under resourced
people here will be suggesting this and that therapy, someone will chuck in EMDR is amazing etc ( can be very de-stabilising for some) etc etc
but a good thorough assessment and formulation / diagnosis / treatment plan is what you need from an actual consultant psychiatrist-
don’t waste time / money on anything less -
best of luck

She won't get sectioned for an overdose like this, and im guessing she is now too old for camhs. SSRIs are not the only antidepressants so I would request something different from the GP at the moment. I'm a great believer in medication, therapy is fine if you're well enough and it doesn't cause overload, but it can be exhausting

If you can afford private I'd do that. Dd (nearly 10) has been on and off camhs since 6. But they failed her when she was at her worst, was agoraphobic, school avoiding and using suicidal language. They wouldn't see her because she was awaiting neurodevelopmental assessment (finally diagnosed with autism and associated anxiety in March). We'd done all the parent led and cbt interventions, anxiety workshops and would have even considered a time limited, well monitored medical intevention (anti anxiety medication) just to get her to the point of re-engaging with life again. But it was made clear that was not an option.

She's finally in a much better place again, but is increasingly showing signs of ARFID which we're keeping an eye on. The list of foods she'll eat is diminishing and while on holiday we're lucky to get one decent meal a day down her. But she/ we have a much better idea now of what is driving it all and are able to speak openly with her about it. But in truth, getting her this far has had nothing to do with outside support and everything to do with us researching everything to a ridiculous level, improving our knowledge and understanding and applying self help strategies.

Mental health support for children is completely broken. Go private if you can.

Why do you say she isn't autistic but has nuerodivergent traits? Neurodivergence is often missed in girls.because most of the diagnostic criteria is based on a typically male presentation - if you haven't had her properly assessed it may well be worth it..

As an ex mental health nurse of 20 years, the system is broken and you won’t get help. Not a criticism of you, but the more you do, the less they will offer. They will just say mum is caring for her so she is safe. They won’t care if this breaks you.

Assuming from your posts that you can afford private, I would absolutely do this. Sertraline isn’t the only option.

The medication is likely to help OP. It doesn’t have to be forever. But better to medicate and deal with side effects, than make a cry for help that is more successful than she intended.

is she still under 18? aWhen she has got over this crisis, she needs to figure out if she really now feels she wishes her suicide attempt has been successful. Psychiatrist seems like a good idea. Assuming she didn’t, she needs to develop strategies to defer her decision to commit suicide, if it happens again.

I would also say to her - it’s a really bad idea to buy pills. If she wants to get better , if she wants to feel hope and happiness again, she needs to avoid storing any meds anywhere in the house - you should keep them under lock and key. Ditto sharp knives, scissors. Get rid of bleach (no one needs really) and any other potentially toxic stuff.

I'm in Scotland and CAMHS were utterly useless.

You mentioned your daughter has ND traits but isn't autistic. Is that because she has been assessed or just your opinion? Autism and ADHD (especially in girls) can balance each other out. Shows up as anxiety and a lot of internal ADHD symptoms- racing thoughts, internal hyper focus, RSD etc.

The underlying diagnosis is important because treatment for anxiety might be something like CBT plus sertraline. Whereas treatment for anxiety related to AuDHD might be a non stimulant ADHD med (CBT can be problematic with ND).

Grow and Thrive are amazing and work with a lovely Psychiatrist: https://www.growandthrive.uk/contact. You can have an initial ND screening without having to go ahead for full assessment.

she doesn’t think she is autistic - and there is definitely not ADHd.

completely fine until lockdown and high school. Sociable and happy. I still don’t understand it. It’s like her brain just changed. We did a test for PANs/PANDAs but that appeared to be negative. It’s like the Covid virus itself inflamed her brain.

neurodiverse traits now such as aversion to heat, insects and crowds. Highly socially anxious.

she doesn’t want a diagnosis - adamantly against it. In any event we have had no help so her view is - what difference would it make now?

but I feel like medication is our only option.

if this could be done holistically then it would be great but I’m unsure where to turn

It's really common for what used to he called high functioning autism/aspergers not to be apparent until high school in girls.

My only advice is that an overdose was the trigger that got a CAMHS involvement for a friend’s daughter, after years of fobbing off. Maybe it is in their guidelines?

She might not want a diagnosis -
but how on earth are you going to access the right medication if you haven’t a clue what the problem is ??
think physical health - you need to know what the problem is before anyone can treat the problem- mental health is same -
there are many medications for mental health that work in differing ways -
no help before so what’s the point now ?
that type of overwhelming negative thinking is going to be symptomatic of whatever the underlying problem is -
does she have:
clinical depression
EUPD
Trauma
severe anxiety disorder
co-morbid presentation ?

you are stabbing in the dark if you try to side step a thorough psychiatric assessment -
they will include a holistic approach-
sleep, diet, lifestyle, exercise, social and interpersonal functioning

@sunshine244it certainly is common.
Similar story re lockdown.
High School too.

A label isn’t for everyone but we found it very helpful and now have a deeper understanding on why there’s certain behaviours. My child isn’t quite an adult but likes her labels as they have set a pathway so she can address different aspects and have self acceptance. We find the labels have been beneficial and for the EHCP. These conditions last a lifetime.

Anorexia can come back of course. There’s a therapy called DBT maybe newer than CBT? Not sure.

Anyway the ND pathway - if interested in the future- we spent years and years wasted, definitely recommend private. But be careful who you choose. NICE guidelines are essential to follow. We chose one that worked for the NHS now private.

@GaaNeenstart with anxiety meds I think then gather the other things to help.

Again I’m not a doctor

It worked for us.

Thanks Gaa.

i totally agree but I don’t know. No one will help. No one. On her last anorexia relapse my GP asked me to leave the room - as I cried and begged for help - as her weight was ok and A and E said she was ok.

i genuinely am utterly broken and lost.

I have just told A and E that I am suicidal (I am not) to try get her some help. When we were last here she had cut too deep and told CAHMS would he in touch who phoned us to offer sympathy and suggested a youth club. If she was my only child I would probably run away. I mean this genuinely,

what on earth are we meant to do?

she no longer engaged with talking therapy. The first was lovely and said she was highly socially anxious but not autistic in her view. The second told me she was fine (she isn’t). We have tried several since then and she says she is done talking about it.

I think she is depressed after years of isolation. She is close to her sisters and they have gone back to school and she is lonely.

if you met her in the house you would meet an intelligent, articulate teenager who suffers v low self esteem and huge social anxiety. She did her back to school but was sexually harassed by a boy - I could weep for her

I'm afraid we are in London.

Vis a vis the ADHD, please keep an open mind. DD had the ADD variant and it was only when the psychiatrist ventured it that the pennies dropped into place. She was quiet, a bit dreamy and masked well. Because she was high performing academically, sometimes utterly brilliant, no flags were raised.

DBT is for EUPD -
it is a form of CBT developed by Marsha Lineham for patients with borderline personality disorder, now called EUPD
the label or diagnosis or problem formulation is key to identifying the right support / treatment required
nice guidelines are also dependant on the diagnosis / label -
or which nice guideline are you going to follow ? The OCD one ?? The PTSD one ? The depression one ?? You get the picture !

i don’t understand how when it’s physical health everyone is on board with the assessment and diagnosis-
but when it comes to mental health, people assume you can get away with side stepping that bit !!

what rationale for starting anxiety meds if you don’t know that anxiety is the underlying problem ??
what if it’s depression ?
or emotion dysregulation??

Book a private psychiatry appointment-
i would use psychiatry UK

Been through something similar with my now young adult. Edinburgh Practice Dr Mark for private psychiatrist, private prescriptions and their therapists are solid too.

I hope you get some help and relief it is awful for you both. The feeling of helplessness is the worst.