Can Scottish CAMHS discharge a child from ND assessment waiting list?

[Dischargedanddisheartened]

Does anyone know if CAHMS in Scotland can discharge you from the ND assessment waiting list because they know you could have access to a private assessment? Have been open about seeking private mental health care for my DS and was surprised to be discharged today.

Have you arranged the private assessment? It might be because it’s not really best practice to have two separate people treating for the same thing simultaneously.

No, we haven’t. We sought a private psychiatrist because this appeared as acute anxiety over the course of a few weeks and by Dec he was also depressed and saying he didn’t want to be alive. He’s on antidepressants now, which are helping, but we have no plan to access ND assessment privately.

have you asked them why your dc has been removed from with waiting list?

I don’t know but my dd age 13 had a physical injury and I was told if I got private physio for her it would be a problem to run it alongside NHS physio (NHS was offering a 6 month wait and then one physio session every four weeks; private physio was weekly and started immediately which is obviously better).

I would say it’s better if you can possibly afford it to do everything privately. I defo would not trust the NHS to offer the best care. My friend whose teen dc had an eating disorder and was self harming was discharged by Camhs because when they saw her on an urgent review, the child said no self harming and eating normally. They chose to believe this fiction which was ludicrous since it was actually the school that started off the referral and had observed the child passing out from being famished in several occasions. A year later, the child was in hospital on a drip. I would not trust camhs.

Thanks, I guess that’s the situation we’re in. And I’m grateful we do have options. But the responsibility of deciding what care he needs, finding appropriate care providers for him willing to take him on and anywhere near our home, and managing medication and day to day new / exacerbated symptoms without being able to access support through his GP is so so challenging. I’m not an expert on child mental health and can become informed but not to the extent I should be the only person with this responsibility for him.

They said they didn’t see adequate evidence of distress to put him on the MH waiting list, which left my son - whose anxiety is exhibiting partly in an extreme fear of talking to people - thinking he’d done something wrong by not talking enough about how scared and sad he is and why that makes him unable to go to school or spend time with friends. And they assume we will access a private ND assessment. I think it really is down to them knowing we have options and having to set the bar so high for when they can offer support. Which I understand partly - it’s a broken system and a lot of people need help. But if we’ve not made arrangements for the assessment privately I don’t see how they can refuse to put him on the list for assessment when they’ve told me he’s autistic. Surely if we wanted to remain under their care and wait for assessment we should have that option?

@Dischargedanddisheartened - a friend is in this exact situation (actually so similar I wonder if you are actually my friend). The thing is, the lists are years and years long so it's not like anything is likely to happen anyway. I have had two friends lately whose children have been discharged from CAHMS - one in precisely your situation and one whose child is actually attacking people and her other children are unsafe in the home. CAHMS said there was nothing they could do to help in either situation.

In a lot of ways as well, being diagnosed as autistic won't change very much of anything. Schools are meant to assist with the symptoms, not the diagnosis, there's no medication or anything for autism. If you have the ability to access support and therapy privately for the behaviours and challenges, then I'd throw everything you can at it now. CAHMS wouldn't do much after a diagnosis anyway to be honest.

My daughter is 13 and 3 years into the waitlist. We have no expectation of her getting a diagnosis before she ages out. The only reason we are staying on it is just in case she needs the piece of paper to access some sort of specific support at University. Everyone knows she's autistic, she knows she's autistic, the school is doing a wonderful job to support her, but I'm trying to future-proof the best I can for her.

@Dischargedanddisheartened
They said they didn’t see adequate evidence of distress to put him on the MH waiting list,
The MH list, or the ND list? ND assessments go through stages of triage, and it is usual to be discharged at points on the waiting list. If they said the MH list, DS might still be on the list for ND assessment. I say this mostly because 'distress' isn't part of the autism assessment.

@NobodysChildNow
My friend whose teen dc had an eating disorder and was self harming was discharged by Camhs because when they saw her on an urgent review, the child said no self harming

This is, of course, the right decision. In any other context, we would rail against the system if it tried to force a teenaged girl to do something against her will. She has not given consent to treatment and, unless she needs hospital treatment (they will have weighed her and calculated WFH) she can't be forced.

It was the ND list and the MH list, they assume we will go private rather than wait in the ND and he’s not sick enough for the MH - though he is currently unable to attend school and distressed throughout the day.

On the other case, I’m interested by your view of this. Obviously teenagers have the right to consent or not to treatment, but do we not have a duty of care to sick children who are not reporting their symptoms accurately. If she is self-harming, and parents know this, but tells healthcare staff that she isn’t as a way to avoid treatment, where does this leave the parent in their safeguarding role?

he’s not sick enough for the MH - though he is currently unable to attend school and distressed throughout the day.
I wonder if this is because of the private psychiatrist? It is usual practice to not get involved if there's already a medical professional involved (as someone mentioned above, so you don't have conflicting treatment plans) but a letter from the private psychiatrist requesting a transfer of care usually fixes this, and if there's medication involved, it often means prioritisation so you're not without the antidepressants.

Where does this leave the parent in their safeguarding role?

Same place as before. It's always primarily a parent's responsibility to safeguard their child. If the self-harm is serious or significant, then taking the child to hospital triggers appropriate treatment there, but that will likely be focused on the risk, because she isn't consenting to treatment for the eating disorder.