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

@BeethovenNinth I’m an inpatient mental health nurse. First of all, how old is she? If 18, she’ll be under adult services. Secondly, if you believe she is in imminent danger of ending her own life or you believe that you cannot keep her safe then you have the right as nearest relative to request a Mental Health Act assessment for potential admission to hospital. This doesn’t need to be detention under the MHA but can be voluntary if she has capacity. For those saying that she won’t be admitted for an overdose-I am currently looking after half a dozen people who came to us following overdoses, it just depends on the severity of the current suicidal ideation and ongoing risk.
Beyond that, it does sound like medication would be the best option right now to get her to a place where she can access therapy. If she is over 16, antidepressants are an option. Bear in mind that they can increase suicidal ideation when they first start to work due to increasing motivation. Due to her history she would meet the criteria for secondary services (CAMHS, CMHT) but secondary services do require engagement from the service user so medication is still the best starting option to help increase that motivation to engage.
Just as a thought, due to the history of severe self harm and as you are willing to pay privately, I would look up DBT as a potential therapeutic modality. DBT was designed to help people with very big, intense feelings that sometimes lead to self harm/suicidal ideation help manage those feelings and so sounds like it might be helpful. You can get DBT through the NHS but it can be tricky to access without particular diagnoses.
Have you seen Psychiatric Liaison or the on-call mental health specialist in A&E yet? Do explore the above with them if you can. In particular, push for an MHA assessment if you do feel that you can’t keep her safe. My thoughts are with you and don’t hesitate to ask if you have any questions x

DD was very similar aged 18.

She is on the spectrum and gets very locked into ideas and beliefs that affect her mental stability.

We got a really good life coach type support because quite honestly talking about it was not working - she was just wallowing in that.

The life coach did a mix of some talk therapy, hypnotherapy and a lot of ass kicking. It worked incredibly well for her.

He used the hypnosis to completely lock out some of her more harmful coping strategies (she used shame to self motivate which spiralled) and the life coaching helped with setting up decent routines. Edited her disordered eating was completely revolutionised by this part too.

The talk was focused on setting up decent practices too. She also took up a heavily sensory seeking hobby which has been a great distraction and new obsession and so many of her friends are also sensory seeking neurodivergents.

She has set backs now but it has completely changed things.

I think meds and an excellent life coaching might help for your daughter too.

@GaaNeen This is due to an issue called “diagnostic divergence”. Basically, the people doing the diagnosing often don’t agree on what the diagnosis is. People can present very differently on different days and the diagnostic criteria for different diagnoses are very vague. Plus, in the absence of brain scans and blood tests, we’re often reduced to matching behaviours to symptoms to diagnoses, which, short of frank mania or psychosis-and even then there’s some overlap-, leads to a “try it and see” attitude. For example, antipsychotics treat psychosis but also mood disorders and severe depression plus emotional regulation difficulties off label, for example. This is how the psychiatric “sausage” is made, I’m afraid. The human mind is very complicated and different things help different people, but it isn’t always hugely clear what will help whom.

You’re absolutely right.
Yes definitely it must be depression.

They exist together.

But meds were amazing for my child & they truly worked. I’m only saying as OP mentioned Sertraline herself. I know it doesn’t work for everyone of course not. We are all gathering ideas. Every little helps.

OP
I can recommend someone if ever you chose a diagnosis of ND
But it’s a long journey for you from Edinburgh. Most of it was online though.

Helpful insight,
it is highly complex
I have concerns that people like OP may invest time and money in therapists / counsellors / life coaches etc etc who have no ability to understand the biopsychosocial nuances of mental illness -
there is a huge industry with people making a living providing crap psychological support and treatments -

If she’s had two weeks of less than 500 calories she should be with the eating disorders team as an urgent referral. ED team more supportive than CAHMS.

Do not leave hospital til she has had a specialist consultation with a psychiatrist, Fluoxetine was a game changer for my teen who was anxious post COVID, ADD Autistic traits but unwilling to be assessed.

Exactly, when you work in this and associated fields you're aware that there isn't a hard and fast pathway, the girl needs antidepressants/anti anxiety meds, and it may be trial and error for a while until the right treatment is found, but flapping around at the edges and splitting hairs over whether it's caused by this or that is wasting time

Exactly, when you work in this and associated fields you're aware that there isn't a hard and fast pathway, the girl needs antidepressants/anti anxiety meds, and it may be trial and error for a while until the right treatment is found, but flapping around at the edges and splitting hairs over whether it's caused by this or that is wasting time

Does parasuicide not meet the criteria for CAMHS?

It’s all very well saying she’s “done talking” but if she is overdosing there is clearly still much that needs to be talked about - both in terms of what’s going on underneath and practical strategies to manage thoughts and feelings.

Do push for Setraline. One of my children takes it and probably always will. Like you it was a last resort. Sometimes anxiety/depression is just a chemical imbalance and the only way to correct this is with medication. A bit like being bipolar or having diabetes. We had some very dark years but she is happily married with a baby now. There can be light at the end of the tunnel.

Follow the nhs paths where they are trackable but we found private psychiatrist the most helpful element. I would suggest private assessment if possible

Hi OP, can't read and run. I'm not in the UK, so can't advise you on the system, but it's not working where I am either. Similar story, daughter started to struggle around her 12th birthday, will soon turn 17. Thighs covered in scars, a couple of overdoses, weight down and up. You have my heartfelt sympathy.

Have you tried the FB group 'sunflower parent support', formerly 'parenting mental health'? They may have more specific advice.

Something else: I thought lockdown, too many international moves and tensions in the family were behind my daughter's woes; recently, she disclosed a sexual assault she suffered aged 8. I would never have suspected the perpetrator.

We try to get her into nature and to connect with age mates, and we keep looking for therapists with whom there is 'a click'. Recently, she tried something called 'dialectical behavioural therapy', and that seems to have a good track record for long-term self-harmers.

I know you don't need to be told this, but I'll say it anyway: keep going, just do your best. What else can you do? All the best.

Also wanted to add that we are in a very different place to four years ago, with a slow but definite improvement. Now seeing lots of friends, working part time, accessing talking therapy, about to restart education. It’s been blooming hard going for the whole family but we have tried our best to be a steady, supportive and creative presence and know she feels loved and held emotionally.

I have nothing helpful to add but want to say I am so sorry you are going through this and I hope you find help.

We have tried a private psychiatrist for DD who said that as the 4 or 5 antidepressants she tried hadn’t worked plus a Flo headset hadn’t either that he can’t help so are currently looking for another private psychiatrist as I know we can’t give up until we finally find someone who can help.

Good for both of you for traversing this for so long.

So she’s now 17? What does she have in mind for her future if she can be well? You say she volunteers so I guess she has interests? Does she have any ambitions?

I’m not trying to be flippant btw and I can’t speak to the antidepressants question, but if she’s had enough talking I have seen DOING and change do so much for people.

How old is she at the moment, OP?

Also Edinburgh. She's 17? So almost Adult services. When will she be 18? Was it the royal you went to? if so next time if it's safe to do try St johns.

I put my DD on Fluoxetine at 17 - it's been life changing for her. She started on 20mg and is on 60mg now ten years later.

She did stop taking it during lockdown (thought she didn't need it) and took an overdose whilst under the influence of alcohol. It was a good lesson for her and I think she's made an uncomfortable peace with the idea she'll probably always need medication because of how her brain works.

She's recently started therapy too - she's finding it hard but worthwhile.

This might be a odd suggestion but Edinburgh Council has just launched a new adult education program starting next month. Could both of you sign up for a class together? learn a new skill together.

I’m in Essex, not Scotland, and don’t really have any advice. I just wanted to send you a massive virtual hug. I read your post with tears in my eyes. xx

If it is any consolation, I have known teenage girls who were in similar state (multiple suicide attempts, including a jump from a bridge onto a motorway). Those girls are now in their 20s and doing fine. She can and will survive this. My brother had a terrible time in his teens (deeply unhappy, self-harming, totally isolated, etc). He’s now thriving as well. Hang in there.

Have you ever considered taking her away somewhere? Could you afford a week or two somewhere bright and beautiful, like Greece or Rome - just to show her that the world IS beautiful and that it IS worth living. My brother survived because he loved books and art. No matter what your age, you need a reason to go on. It could be anything - a local football club, learning Japanese, looking at the stars through a telescope in the back garden. It doesn’t matter. She needs something outside of herself and the nasty, bitchy little world of teenage girls and social media.

@BeethovenNinth

OP, on the assumption that she is now over 16, is this an option?

https://www.drpetermccann.com/services/eating-disorders/

Yes we have had some truly awful private care. Do be careful.

three sending you solidarity. If you want to PM me then feel free. Even if we vent.

she is smart and capable, full of common sense. She loves children and animals. She has volunteered with toddlers and older children. She also loves make up and I suggested that as an aim for college - ironic given she is academic.

Ive dealt with a suicidal family member and the support is beyond horrific. I'm so sorry you are going through this. A couple of thoughts of things that worked for us and may or may not be relevant.

My family member's mental health problems began in tweens/ early teens. Decades later a different medical problem revealed severe hormone imbalances with was contributing to everything. She is on hormones and has been much more stable with no suicide attempts for years but she still deals with the trauma.

She also did a lot of talking therapy which did help her process some of what happened. She had a brilliant therapist who worked with the family a little too and said they were going to bring up things to work through which may make her worse short term so recommended ssris for that. Family member didn't like them but found they helped when things were brutal and then she weaned off them. They arent for everyone.

After she focused on clearing the conscious aspect of her problems, she did rapid eye movement therapy and found that really, really, really helped. You don't talk during it so maybe helpful for your daughter.

I would recommend the book the body keeps the score.

Around that she built a programme of health and wellness for herself and found cold water swimming and times with animals (riding) was the most impactful.

In terms of working with professionals through cahms and nhs... There are some fabulous people who desperately want to help but they are being ground down. The only way we got anywhere was keeping everything in writing (so if you have a phone call, follow up with an email to confirm what you spoke about). We laid things out very clearly such as 'X has now had 2 suicide attempts and has been clear she is currently having severe suicidal ideation. As a family we cannot currently keep her safe and you have stated she does not meet the threshold for additional support. Can you confirm this is correct and outline the threshold for additional support and next steps.' Basically we were making it clear that we were building an evidence trail for the coroner. You have to apply the dla principle of not pulling punches in your records and talking about the worst day and not trying to soften it. Blunter the better.

I'm so sorry again.