DS is 10. In the past we have queried if he is on the spectrum and he recently had an initial assessment. It was deemed that whilst he had some minor traits, it wasn't anything of concern and the doctor felt it was not worth pursuing further.
For background:
During the height of the pandemic he struggled with the disruption in routine etc and became angry, upset etc on a regular basis. On one occasion he was told off for his poor behaviour and as a result he took a dinner knife and said he was going to cut his throat. It was clear that this was more about getting us to react rather than an actual attempt at self harm. He chose a blunt knife rather than a kitchen one and just waved it around. Over the next few months we had a few more episodes of this, all very much along the lines of "I'm going to hurt myself" but nothing that would suggest he was actually intending to do it. We did seek help at the time but with everything closed down and the added fact that we live in a rural area where resources are few and far between we weren't able to speak to anyone. The issue resolved itself and we put it down to the pandemic.
Generally he is a happy child but he does have a ferocious temper and gets angry very quickly at very minor things. He is also incredibly intolerant of his younger sister.
Fast forward to the last few weeks and DS has frankly been a nightmare to be around. He has been snappy, moody, horrible to his younger sister, rude, and just generally unpleasant. I think hormones have started to kick in but also it was a very long term during which he picked up a few viruses so I've tried to let as much go as possible, putting it down to him generally just being under the weather.
However, today we told him and his sister that after lunch we would go for a short walk. We were indoors all day yesterday with the rain and most of today again with the rain so we felt that when the rain broke it would be a good idea for everyone to get fresh air etc.
DS kicked off big style, shouting and shrieking that he didn't want to go. I tried to reason with him but got nowhere. He then stomped off to his room but yanked on the bannister so hard that it snapped. I told him his behaviour was awful and at that point he went into the kitchen, took out the big carving knife and held it against his arm, saying he was going to kill himself. At this point I started to cry out of shock and when he saw this he became extremely distressed and apologetic.
I just don't know how to handle this. Previously I've always felt that his threats of self harm have been more about getting a reaction, but this seemed a lot more serious. It also came out of nowhere.
I know I can request a CAMHS referral and I will speak to our GP about this but I doubt very much it would go anywhere. There is no private provision in my area, as I said it's very rural and you can't even get a private face to face GP appointment anywhere near here. Plus I think DS would refuse to engage with anyone.