*TW* Camhs and self harm

[Oscarwinningtears]

DD is 16 and I've recently found out she's been self harming, she's had a really tough couple of years and I knew her MH wasn't great, just didn't realise it was this bad. It was a struggle to get her to the GP and she was really anxious about telling anyone except me but we went today and the GP referred her to camhs.

She's now in a total state worrying about what 'action' they're likely to take when they know about the SH, seems convinced they'll admit her or even section her and won't listen to my reassurances because she knows I have no direct experience with camhs and she's heard/read some horror stories. I've said I'll post here to see if anyone who's actually been in our situation would be willing to give her an idea of what might realistically happen when camhs do get in touch, although we're both aware that might take a while.

I hope it's ok that I've asked here, I wasn't sure what else to do to reassure her tbh.

In our area she would get an inital assessment appointment and then be discharged with a few links to websites.

Nothing. They will do absolutely nothing.

Nothing at all

Even if she was desparate to engage she might, after a long wait, get some signposting onto online support or other websites.

If she doesnt want to engage they wont engage!

For self harm, they will say its not a MH issue, its just behaviour or habit formed out of a way of managing emotions.

OP, I would get support with safe self harm, to allow her to manage these feelings and actions safely while she works through how to process emotions in a different way.

professional experience here - depending on the detail and the context, she may be offered an assessment and either some support or signposting to more suitable service. Often they want children to have accessed early intervention type support first (is her school a Mental Health Support Team school? They offer low intensity CBT that is often recommended first if they can access it).

Self harm alone doesn’t mean they’ll offer support let alone section. Some children might benefit more from counselling, some might need family support, some might need specific mental health support.

By the way what horror stories has she heard?

Because where I work you csnt get CAMHS involved properly for love nor money. And when they do, their favourite description of self harm or suicidal behaviour is that its behavioural and habitual. Theres no actual therapy on offer, sometimes very rarely there might be group work for anxiety. As if an anxious teen wants to turn up and do group work with other anxious teens.

If you google you might be able to find the CAMHS criteria in your area

The last time I made a referral to CAMHS (worked in Children's Services - left about 2 years ago) I was told that they were only working with children who had an active suicide plan.

Mental health services in this country are abysmal. They need far more resources poured into it.

It's the main reason I left the job. I just couldn't take having parents ringing up every day, crying and begging for MH support for their child, and all I could do was direct them to the Young Minds website, and other online resources.

In your daughter's position, I doubt they will do anything. When I left my job, the wait for an initial CAMHS assessment was 9 months.

I knew of at least two young people who took their own lives whilst on the waiting list.

Just to challenge some other comments/common perception - there isn’t always long wait lists or no support offered when it’s required. In my county there isn’t a waiting list to access core CAMHS (but there is for accessing specific therapies eg. CBT, family therapy etc) but they are seen and “held” by CAMHS.

They may help her develop her own safety plan based on harm reduction principles, lots of resources out there

And what does being 'held' by CAMHS mean exactly?

Dont worry, I know the answer, it means they're listed on the child's file as being part of the network but actually contributing actually nothing to safety planning or care planning.

And its absolutely disgraceful that CAMHS, an NHS service, feels the need to stipulate that 'other services' should step in first if a child needs MH input. They ARE the MH provision, not schools, not parents, not youth clubs, not social workers, not police. Right person, right service.

If I went to the doctor with self harm or low mood, he wouldnt be saying he expects that I had accessed MH support via my employer as the first step.

Our experience was positive....eventually, they listened and worked with my dd for many months before discharge. At no point did they say to section her. The wait list was long, wd went through 2 practitioners and one complaint but got there eventually. Sadly though my dd wants to go through the system again and we have to be re referred, no quick steps to get back in. We also accessed at 14 due to self harm.

By held I mean seen and supported regularly. Not sat on a list not seen or supported. This does involve care planning and safety planning.

There are various situations where other services might be better placed - like children’s social care for example. I think it’s easy to focus all the support on the child but ignore the cause of their difficulties - are you just putting a sticking plaster on if you don’t change the cause of the issues?

Can I give an example of something we often see - child who has been exposed to domestic abuse (or still is), resulting in low mood or anxiety, might be self harming. Children’s services are needed first and foremost to reduce or remove the cause of the harm. Services like local domestic abuse services often offer specialist support for victims. This is likely to be the best initial plan for this child, not necessarily CAMHS intervention.

I can only speak from my area, I’m fully aware it might be awful in other areas. But sweeping statements aren’t helpful, some places are in a better position

My dd self harmed and was referred to CAMHS.

13 months later we got an appointment. No suppprt of any kind in that intervening time.

I don’t think CAMHS are capable of anything least of all sectioning someone.

And when we saw CAMHS she was told to get a nice bubble bath or treat herself to a nice hot chocolate as part of self care.

Uselesss.

I have worked in a lot of different areas and its pretty much the same (SE England, cant comment on other areas of the country)

Children cant always be removed, the court may not agree with that plan, you have to work with the child you have in front of you but CAMHS usually say they cant do that because the child is still there. Imagine if that were an adult suffering depression. Oh Mrs Smith you have a shitty husband and are living in poverty. Come back for some therapy or medication once that has changed.

If children are removed, they are still traumatised, they are still the same child, but possibly more dysregulated because theyve been taken away from what they know.

The problem is you can say its a sweeping statement, it is unfortunately the real experience of thousands of families and children up and down the country and the professionals around those children

Anyway my rant isnt helpful for OP.

Dont have direct experience of the services you have as not in the UK, but unfortunately SH is fairly common, or seems more so than it ever was. One of my daughters did it a little, one quite a lot. Got support for both in various ways, I am not sure it helped in honesty but both had ups and downs. One unfortunately did it this year which I think was due to the stress of moving house which she found difficult as she has mild autism. There is a common thread with autism/various ND issues and SH and it can be a coping mechanism.
I can't offer advice but wanted you to know other parents go through the same,.its hard to deal with when you see SH marks but be there for your child and take things a day at a time.

I think the best way to support SH is for it to be safely done. So cut only x by x amount, with a clean blade, agree on dressings or treatment, agree to try other strategies that can cause pain or harm but within certain measurements or parameters. Theres a lot of information about that online.

If our experience is anything to go by you will be 'signposted' to MH services in the community. Translation: completely overwhelmed local charities who do offer things like counselling but it will be another long wait. Schools/college often offer low intensity CBT

My DD made a serious attempt to take her own life last year and even then it took months of struggle (including writing to my MP) to get CAMHS to take her on, then months to wait for an assessment, and another wait to be allocated a worker, who promptly left the service. We are now waiting again. If you can afford it, seek out private support.

The chance of getting a bed for a child who is actively suicidal is remote never mind self harm ..

My Ds was under camhs from 10-18 and now under Cmht ..

my advice if you can afford it get a private psychotherapist get her the help she needs .

Its really sad to hear some of these experiences.

Firstly, reassure your daughter that it's great she was able to tell the Dr, and talk to you about it. Hopefully not keeping it secret will be a help in itself. And reassure her that camhs won't section her - they'll just ask questions and try to ensure her safety, but admission to hospital is a last resort for when young people are really ill. Often its the opposite problem that people want to be admitted and are turned away as there's scarce beds sadly.

Ask her what will help from you/ her dad ie can she tell you when she feels an urge, what does she need at these times eg tlc/ distraction/ to talk about it or not etc. Can you spot the triggers together and put steps in to prevent them? eg contact with certain friends etc.

Young Minds website might be helpful for you both, and has crisis numbers for if things escalate. If you're ever really worried you can take her to kids a and e to have an assessment.

Try to discuss with her access to means of self harm eg scissors, razors etc? If you can keep her away from these when she feels risky often the urge/ distress might pass.

Sending sympathy both your ways.

Yes, I second this, as someone who has both worked for CAMHS Core as a therapist and triaged CAMHS cases also in a CSC service.

Sometimes therapy isn’t the immediate answer, often systemic factors need to change. In my area and experience, you’ll often get upset families as they haven’t had what the think is needed which is some immediate solution.

Feeling suicidal and actively self harming aren’t things that can be quickly dealt with, children need time and family support to find alternate strategies.

I often see this derogatory comment about the crisis teams ‘they told me to have a bath/cuppa/do some self care’ that’s all about starting to change behavioural responses to internalised anger/self loathing/shame etc, rooted in DBT.

The one thing I will 100% agree on though is the waiting time in some areas, including mine. It’s sad and frustrating.

in my area OP, the usual process would be:
Referral made
Triaged (we have urgent vs routine, yours would be routine based on info as no emergency care needed, no intent or planning) urgent is response that day, routine can be couple weeks wait
Processing for either school support, MHST or Core (or depending on your info could be other teams) OR if more complex or unclear then Core Duty assessment
outcomes from this can range
our wait list for therapy is 9months atm
if a child is in active crisis then they will pick up immediately and support with visits x2/3 per week

It is upsetting to say, but often a parents idea of crisis and the clinical/criteria context are very different. We will often get parents ringing to ‘get my child sectioned’ or ‘expedite their child on the wait list’ , we get it, your child is your priority but we have huge wait lists and therapeutic and clinical work is very intense.

I have some wonderful therapeutic outcomes with yp, and often work with my yp for a minimum 20 sessions and fairly often up to 30, some for longer if needed due to complexity . Of course, getting that support right means waiting lists then start to stagnate but no funding for more staff!

this is such a summary it’s hard to really reflect the nuances in the triage process
I don’t just read and snap decide, I’ll look at loads of factors
and when I’m deciding if a child needs therapeutic support the process is thorough, no snap judgement, full exploration and discussed in MDT and if needed wider service meetings

To summarise though, reassure DD that sectioning is rare and an absolute last resort for VERY mentally unwell people. Self harm isn’t a reason to section someone unless the self harm is so severe their lives are at risk, and even then, very hard to section someone.
CAMHS may take some time to come back to her, or may not even come back to her if no prior history and no past support. They may signpost to online services, and school support to see if other semi therapeutic support is suitable rather than jumping straight to intense therapy.

Our experience was a telephone call about 6 months after the referral. A few questions and then dismissed as not meeting the threshold for help. Cuts so bad they need A&E treatment don't meet the threshold. It appears you pretty much need to be dangling off a bridge before someone at CAMHs might actually offer some help.

My daughter had mental health sessions through camhs and the first video call was the initial assessment and then she was offered 8 sessions via video link to help her with mental health issues, it helped her a lot.