Anyone got experience of using private child psychiatrist for teenager?

[TheCountessofFitzdotterel]

Ds is 17, was diagnosed with autism earlier this year. Suicide attempt last summer during GCSEs, discharged by CAMHS when no longer actively suicidal, having offered no help other than family therapy which he refused and a decider skills course which he had already done.
He spends all his time in bed, barely attends school and never does any work, won’t talk to anyone or do any activities.
He has finally admitted he has a problem and agreed to engage with help.
We are looking for help privately as I am not expecting anything from CAMHS as he is not a suicide risk.
Does anyone have experience of using a private child psychiatrist? How much did it cost and how many appointments did you need?
I contacted a local one and we are looking at £740 for an online assessment which we can afford if we have to but then if it is online it doesn’t make sense to go local without looking more widely or asking for recommendations.
And is it a bottomless pit? I mean we can afford occasional appointments but not to pay £300 weekly.

What is it that you want out of a psychiatrist? You already know he has ASD, is likely depressed hence the attempted suicide so is he not under his GP for this? He’s refused the one thing that could have really helped. I would use my money on finding a good therapist who a) he will engage with, b) won’t assume he’s trans and c) understands disaffected / depressed ND teens.

We initially went via the GP who referred us to CAMHS - is there anything they can do other than re refer to CAMHS?
Tbh I am hoping medication will make him less anxious and more able to engage with talking therapy. We have been trying to get him to engage with talking therapy for years but it is very hard when he won’t speak. He can go for days without moving or speaking.

The GP can prescribe him some fluoxetine. It's not rocket science and medication options are very limited in teens. I would not waste your money in private psych but invest in therapy.

I understood that the gp couldn’t prescribe that because he is a child. Is that not the case?

I mean obviously therapy is a better first step but how do I get him to engage?

My son had online therapy privately, and it really helped. Just having someone to talk privately to, plus with it being online it made it easier. Think it was around £80 per session and he did weekly sessions for a few months

Honestly, I am not down on the idea of therapy, I have been trying to get him to agree to it since last year and often before that, but I have a desperate hope that medication might make him more able to engage with it which is why I think he needs someone who can prescribe to children.

The psychiatrist is the one who is able to prescribe meds to a minor. Also if you need a further / second opinion about diagnosis of MH conditions and/or disorders.

Thereafter, he might be better with a therapist for ongoing talking treatments. The psychiatrist might be able to advise on this.

I think it's better to see the psych in person.

You could do worse than have a (free) chat with Therese Langford of https://www.facebook.com/calmmindhypnotherapy - she specialises in children and teenagers.

OP, my DD is 17, has ASD and sees a private psychologist for anxiety/depression. We got medication prescribed by our normal GP, despite her age, after the psychologist wrote to the surgery explaining DDs background and explaining that they wouldn't get to top of CAMHS waiting list before her 18th birthday (and that in her experience adult MH services are so stretched they wait until crisis point). The GP agreed and was happy to prescribe the meds. So GPs can and do prescribe to under 18s. We also thought we were going to have to pay £900 for psychiatrist app and meds, and were very relieved not to.

Until they are 18 only a child pysc can prescribe anti depressants.

Some GP’s will but they aren’t supposed to.

They are however a bottomless pit. BUT, if our trial of fluoxetine hadn’t failed the pysch began to suspect adhd along with her ASd.

She would never have been diagnosed adhd. And meds were a game changer.

DS saw a private psychologist for a while a few years ago. His request. He had issues with daily migraines and not attending school. We tried a lot of different things to sort the migraines. He eventually asked to see a psychiatrist himself. I had a friend who was a therapist and she suggested a psychologist rather than a psychiatrist as a first step. He saw her in person for quite a while. It definitely helped him. I think from memory it was around £100 a session.

When calling around to get appointments it turned out almost all of the private psychologists in our area were booked up with stressed teens!

We use a private psychologist it's £120 for an hour.

Yes we did for DD after self harming and being suicide risk. She was diagnosed with anxiety and depression and we sought face to face help. It was a Priory Clinic and as far as I remember the initial consultation was £400ish and then once an appropriate practitioner was identified it was £130 per session. She did about ten sessions before they assessed ongoing risk and then she did them further apart and as needed. Gradually tailed off and I can honestly say it was the best money I have ever spent. She is a totally different person today, she’d likely always had issues - selective mutism as a child - but we weren’t experienced enough to understand and tackle it early enough. The sessions gave her coping mechanisms and - although I won’t bore you with details - DH and I often marvel at the person she has become and the things she is achieving compared to the child/teenager she was ten years ago.

GPs can prescribe anything they want to anyone they want. They have access to all the drugs in the BNF.
NICE guidance (and possibly local guidance) would suggest that it should a child psychiatrist who recommends meds to an under 18 but as someone else has said at 17 you will never get to the top of the wait list before he turns 18 and at that point the GP would then be positively expected to prescribe an SSRI before general adult psych would see.
As such many GPs would be able to understand the logic that if you would prescribe at 18 and 1 day then where is the logical difference with 17 and 360 days?
You could point out if they refuse that he is in a service gap and why should you be forced to pay privately to fill that?
If he was ten then obviously it's a different matter.

I'm so sorry to hear about your son.

I'm not an expert, but will share my experiences with 16yo DD.

We saw a child psychiatrist online for an initial assessment, and then subsequently for assessments for specific conditions that were suspected (ASD and OCD, both of which needed a separate assessment. The psychiatrist was able to diagnose panic disorder during the initial assessment, because that doesn't require such a detailed assessment process. Obviously your son may not need further assessments, and you are already going in with more background info than we had, i.e. his ASD diagnosis.). The initial assessment cost about £700 for 90 mins, if I remember correctly. It was very useful for getting an overview of the situation and possible next steps/treatment. We used London Psychiatry Clinic.

The psychiatrist can prescribe medication if they feel it's appropriate. They can write a letter to the GP and then the GP can continue to prescribe it. The psychiatrist may suggest follow up appointments to see how the medication/other treatment is going. The psychiatrist can also suggest lifestyle improvements to follow, e.g. sleep hygiene.

In general, I don't think psychiatrists are the ones who do ongoing weekly therapy type stuff. They can suggest what type of therapy may be useful. They might suggest individual therapists, and may liaise with whichever therapist you pick. The psychiatrist is more there to oversee things and give directions. You don't need frequent long appointments with them.

Thank you to everyone who has posted, there is some really helpful stuff here.
It sounds like if we see a private psychologist and they recommend antidepressants the GP might be convinced to go off label? Our regular GP is quite sensible and ds turns 18 at the start of December.

I asked my dad as he’s a psychiatrist & with me… He says that if it were his child he would be going back to CAMHS, and only pursuing a private if CAMHS failed. The benefit of the NHS is that it’s multi disciplinary and can pull in all the threads that DS might benefit from.

Please dont trust your unwell son’s mental health to someone on Facebook!

To be fair, I haven’t checked this individual, but people can use FB as an advertising platform & network while still being registered professionals.

Just to add to my previous post, we were offered the opportunity of medication. I was very clear that I did not want this. However, I did not convey that to DD and let her make her decision with her practitioner. The reason for that was I felt it would not deal with her underlying issues and she would always be beholden to them if and when she wasn’t medicalised.
She decided for herself that she didn’t want to go that route anyway.
As I said previously, the fact that she was helped to find coping mechanisms was what changed her life - imho. Obviously everyone is different and it might be that medication is the right decision in your case.

For anyone that appreciates updates, we have an appointment for ds with a private psychologist on Monday.

It’s an organisation that also has psychiatrists so if they feel that medication could help him it looks like we could have a one off session with a psychiatrist for £305 to get a prescription.

We had a similar situation to yours last year when our ds was 17. He's had 3 rounds of CBT therapy.

In the end we went with a private psychiatrist as the gp would not prescription AD even at the age of 18, and they would only take on the prescription when he was stable on (after trying 2 different ones and about 4 months on a dose).

We had private health insurance as it is so expensive. He's had about 6 sessions in total.

The medication has changed his life (and ours) so we would have found the money somehow if we'd had to.

I hope it all works out for your ds, it's such a hard time & I sympathise.

@CassandraProphesying u our story was good to read I'm so glad this worked for you.
Can I ask was it a psychiatrist or a psychologist you asked to see at the Priory please ?