advice about 17 year old's rights please

[RipeningApples]

I'll try to make this short. DD started self harming a year ago and took a couple of tiny overdoses. CAMHS assessed and refused any helpful intervention but offered inaccessible group therapy and said take it or leave it, nothing else.

I had dd referred to a consultant psychiatrist who recommended CBT which dd didn't connect with. Started fluoxetine December and well until the last few weeks. This is exam related as it was last year. She had a bit of a melt down on Wednesday but seemed fine Thursday. Evidently she took some cough medicine and anti-histamine Thursday lunchtime, seemed as right as rain on Thursday evening. She rang a helpline on Friday and they advised her to get checked out.

She presents to a&e adults who referred her to paeds who phoned me 3.5 hours later. Her bloods were fine. They called ss and said she'd be admitted overnight with a 1:1 nurse and CAMHS would do an emergency assessment the next morning.

I said if she needs an assessment it needed doing urgently tonight and she wanted to go home. She affirmed she wanted to go home. I noted that camhs hadn't given a toss previously and she had her own psychiatrist and we would be leaving. Then they could manage to get mh involved then and I gave them an hour. MH nurse turns up after 45 mins and spoke to dd and to me. I asked when we cd fo. Then she had to call CAMHS and I said fine providing I cd speak to them too. She said fine. 45 mins passed still no info. She was then on phone to CAMHS and I was told I couldn't speak to them. Lies and poor communication.

Told sister we would be leaving in ten minutes and was told we couldn't and I was interfering with my daughter's well being and creating a safeguarding issue and if we left they would call the police. They'd had three hours to raise that sort of comment and I'd asked several times what prevented us from leaving and didn't get an answer. The original Dr said they'd call ss if we left and I asked on what basis and didn't get an answer. I asked on what basis police would be called and was ignored. They all had another conflab and dd was allowed to leave about an hour later. Original Dr said if there was a way to get her assessed and home that was best for her and the NHS. But he didn't know he could sort an emergency assessment until I insisted and said it was a good thing.

She is not psychotic, wanted to leave and is loved and well cared for. She went to hosp thinking she'd get checks for the pills she took and be home by teatime.

On leaving the sister said you appreciate she was asked if she'd be willing to stay overnight and she said yes. I asked if she had been given the opportunity to say she didn't want to and there was awkward foot shifting amongst the three staff with us and dd affirmed it hadn't been out like that.

If there was no money to help her a year ago why is there money now for an unnecessary overnight stay, limited information, was told it was protocol and policy so I asked for the protocol and policy and was ignores.

DD was competent, there was no talk of the MH Act, she wanted to come home. So why the lack of clarity and por communication. What were/are her rights?

I'm waiting a call from CAMHS, will make an apt with her own psych and speak to GP this week. The response felt disproportionate and disrespectful and poorly communicated.

What exactly are one's rights in those circumstances. DD is obviously my priority and if this was a cry for help she'll get it but how staying overnight would have helped because CAMHS only work9-5 I fail to comprehend. She was not a suicide risk.

Becoming an inpatient triggers much more than just a camhs assessment. A discharge plan and after care has to be arranged.
Money is very short in camhs, they only help the most needy. Becoming an impatient puts you on the most needy list. It makes the difference between not getting any assistance and getting five visits a week, DBT or whatever else a thorough assessment deems necessary.
Nobody wants their child to be a MH inpatient., but it makes the difference between life and death for some. If you are ever in this position again (hopefully not) thank the nurses and agree to admission.

PreAdvent is spot on!

Pre-Advent speaks sense. The nurses were a bit thrown I imagine because your DD had agreed to stay in and most people would want the extra help of being an inpatient, particularly when getting any help for MH issues is such an uphill battle.

Agree with preadvent. Railing against her care is not helping her.

Why should being an inpatient for one night with the sole purpose of getting on a fast list provide more care and help via a care plan than through the same assessment as an outpatient which considers the same facts.

As far as I am aware dd, I have been told, dd will be having a CAMHS assessment next week. It smacks of abusing resources to access required care via an unnecessary admission. It is wrong.

My DD will get care regardless of CAMHS via her consultant psychiatrist who she is seeing on Tuesday. Confirmed this am. If her own psych recommends a care pls it will be put in place via The Priory if necessary.

I remain unclear about dd's rights in relation to the NHS. It seems to me she has no right to MH care via CAMHS if she isn't admitted to hospital a la last summer/autumn and no right to leave a hospital she voluntarily attends to get herself checked over.

I've spoken to her this morning. She says they said it would be a good idea for her to be admitted and would she agree. She said yes because she though she could change her mind and when I arrived four or so hours later she had changed her mind. I think they should have set out clear options for her about care patterns so she could have made an informs decision. This did not happen - it seems she was coerced and then they didn't want to unpick it. I should not have had to make a fuss there should have been a clear plan with options discussed by all parties and agreed by all parties on the basis of all the facts.

There weren't any known facts, other than that your DD had taken a small overdose and was physically ok. Everything else was still being assessed.

How was your daughter coerced?

By being told it was a good idea and not being told it might commit her to staying if she changed her mind. Also when I said we wants to go and they kept saying no without giving a reason. When I said if they didn't sort it within the hour they starts sorting it. After 2.5 hours I said if they didn't sort it I ten minutes we would be leaving and the nurse said I was preventing my DD from receiving care and if we left she would call the police. They all had agreed at this point that subject to a conflab, which wasn't happening, dd could go. What I want to know is whether she could have called the police in those circumstances and without a court order or section or other legal sanction. If not then I think it was a threat and very unpleasant. I do not trust people who do not provide clarity to look after my animals. They certainly won't look after dd. If they had said it was essential she was an Inpatient I'd have called the Priory and had her transferred. This,was not discussed so I do not understand the threat to call the police.

Oh, and talk of me preventing care was absurd. They had had eight hours by then to sort out care, we weren't staying by default so it needed sorting.

Maybe they were concerned that your DD had agreed that an overnight stay was a good idea then changed her mind when you arrived because she was going along with what you wanted?

And you then throwing your weight around saying you wanted this and that within certain time frames made you appear to be an overpowering personality and this increased concern about your DD changing her mind when you arrived.

Dd's first words were "oh mummy you're here". I asked do you want to stay or go home. "I want to go home".

If clarity had been provided at the outset I wouldn't have had to be robust. They were given initially an you to sort out her discharge and this stretched to four. DD stated clearly in my presence and privately to them that she wants to come home. They said they follows a protocol and policy but could not give me a copy or provide clarity about its steps.

Undoubtedly had we stayed we'd have been awake all night and still waiting for CAMHS. Her private psych has been in touch. No word from CAMHS.

I don't feel dd or I were treated with a great deal of respect.

I guess this is one of this threads where h ps are always right and patients always wrong.

Thanks guys. I'm obviously a terrible parent.

Ripening I so hope you were right in refusing medical recommendations.

I didn't refuse medical recommendations. They recommended a CAMHS assessment after she had a MH assessment which said she was good to go. That is what the CAMHS assessment was to do. CAMHS are still to assess and suggest a plan. I will pass that across her consultant psych.

Who walks into a hospital where their child is and says 'do you want to stay or go home?'. mylove is bang on.

Honestly having dealt with a similarly difficult looking for an appropriate term service I really doubt you are being unreasonable in your actions. Dealing with these services, I have learned that, you are best off figuring out what exact outcome you want from the particular engagement and being extremely clear from the get go. 'I feel DD needs an immediate evaluation but an admission at this point is not in her best interest' repeated ad naueseum might get you there.

The notion that you are not well placed to help with your daughters mental health issues and that mental health professionals have the time and proper resources to make them more competent in decision making around your daughter's care is naive in my experience. Family and services need to work together.

I am not a mental health professional but I do have enough experience to understand how mental health care is delivered in the NHS, to a rough approximation at least. If there are any professionals on the board and any of the below is untrue, then I can only apologise.

Based on what you have described, you are not a terrible parent. You are a parent. Parenting is difficult. Resources are finite.

It smacks of abusing resources to access required care via an unnecessary admission.

For all that resources are scarce, maybe the admission was necessary. When a decision is made to admit a patient, it is not made lightly.

In terms of rights, in your daughter's case, I am not sure if it would have been her self-discharging against medical advice or you discharging her against medical advice, but doing either of these can make it more difficult to access care in the future.

The hospital's suggestion that the police would be called is not a threat although it might feel like one. It is the staff at A&E following their obligations. The thinking roughly goes that if they did not call the police they would be at risk of being accused of being negligent if your DD was harmed after she left hospital.

Sometimes a patient has the right to certain assessment and care within certain timeframes on the NHS, in accordance with the NICE guidelines and local policies, but local NHS trusts do not always have enough resources for these assessments and treatments to be delivered to all patients who have the right to them. Patients or carers have few options beyond trusting that the nurses in A&E know how to triage, or accessing care privately if the means are available. Private medical care in this country typically does not handle emergency care of the type delivered by A&E and indeed private mental health services in the UK refer to NHS A&E in life-threatening emergencies.

I am not sure if any of this gives you comfort, and I hope that your DD is safe and well. You are caring for someone who is in mental distress, which is a difficult job at the best of times. One suggestion is that, now or in the future, you seek support for yourself, for example via your own GP, as well as looking after your DD.

I think the point you are missing in all of this is that she was admitted as an emergency case. If the AE or Paeds Drs treating her wanted to or felt comfortable sending her home, they would have, but they didn't, they recommended keeping her in overnight.
This isn't a service you take or leave as you choose, it is a channel or way of keeping someone safe who is considered to be an emergency. Staying in overnight offers several benefits...it provides a safe place for the distressed person , it allows review by the appropriate professional the following day ( sometimes camhs sometimes other MH team members) in their own time (Overnight they have to prioritise and only see certain cases), and it allows a period of observation and general assessment to be done ( was she settled in the night, did she self harm, was she crying or distressed) with. 1:1 MH nurse on the Paeds ward.
By telling all of the health professionals that you basically wanted special treatment ...summon that camhs nurse NOWand to think you can to choose to tailor your daughters care in her behalf.. Is what both worried and inconvenienced staff. It seems a very hostile and negative approach.

As you said, they said they could call police if you left and the decision had been made that she was a danger to herself..or that the MH professional you demanded to attend straight away was not available to assess her for safe discharge..and that is true, the Police would have brought her back in that instance.
I understand you are worried but she took an overdose, she asked for help..encourage her to engage with that help.

sellingyezyerdaysnews. You put that very well. What a pity they couldn't.

Please read my posts. She was assessed by an M H specialist before she left. Can you go back and look at the facts I have posted. For example the paed consultant thought it a very good idea to get her assessed by adult MH if that was a possibility it was.

She was discharged on the understanding CAMHS would call me today to arrange a mutually convenient assessment. Guess what .......?

She is on good form and has had a great day. Her consultant psych has phoned me and we have spoken at length. A mutually convenient appointment has been arranged.

I'm just going to say that I was told the reason for keeping her overnight was because CAMHS had finished and the protocol was that she needed to be assessed by CAMHS. The consultant paed did not think she was high risk. The consultant paed agreed that if a MH assessment could take place she could go home. My view was that in that case that MH assessment should have been arranged as soon as the bloods came back clear. The left arm didn't seem to know what the right arm was doing. Having messed about, it remains my view that the hospital should have been much more clear about guidelines and protocols. If they felt it was essential for dd to stay overnight then they should have said so in the first place instead of agreeing to an MH assessment.

Anyway more will become clear tomorrow when I can start getting to the bottom of this.

If I have to contact my MP I shall, likewise also very happy to get my solicitor to set out the law for me so that if there I a repeat I will be informed as clearly one cannot expect transparency from hcps.

I will ensure my daughter gets the very best care I can. I think it I highly unlikely it will come from the NHS.

Camhs as such only work daytime. There is an out of hours equivalent service which only does certain things like give phone advice. There is an out of hours adult psych service but they only see overnight those acutely psychotic pts etc and look after psych HDU. So there is no routine service for seeing pts after an OD out of hours . It is not a provided OOH service and is done the following morning.
If someone insists on going home, senior nurses, on call paeds, etc all probably have to be contacted and a senior decision made or camhs spoken to by phone and then some sort of decision about the patient going home before formal psych assessment can be made.
I am not saying that it is good to have no service like this overnight.. But it's the way it is and there are some good things about staying open overnight as I said above. It may be Drs may feel the discharge is not safe in which case the pt would have to be sectioned after liaison with psych team( Drs) or it may be juniors cannot make the decision for discharge and other people need to be called to make it. It is done for the sake of th,e pts safety. I think I can see you felt she was low risk..I'm just explaining that others may not be confident she was safe until seen by the psych team . It's always a difficult thing as is pts taking their own discharge..out of hours there are limited staff available and those that are working are covering AE admission, emergencies etc as well so have to prioritise starting with the most urgent emergencies can't always attend straight away by any means.

EI'm providing a little update here. Am exhausted btw. DD has had three really good days (I think).

First thing today I made a GP apt. 2nd thing I explained everything to dd's housemistress (fab response) 3rd thing a confirmed apt. with dd's onsultant psychiatrist. CAMHS eventually called me after 4pm. (it was v urgent according to a&e - so urgent they wanted her kept in for a CAMHS assessment). I chased them via their central number (the central no was helpful actually). The local unit was as flippant as usual. After chasing they said they'd only known for an hour - what did I expect. Was able to confirm that central booking had confirmed they had been notified more than two hours previously. Inktially they offered an assessment with an agency nurse mid week. I asserted that was totally unacceptable. Whilst I would prefer dd to be assessed by a doctor they have now offered (after 4pm) an apt with a specialist nurse which I accepted with reservations. Sadly the earliest apt is at 9.30 even thought it is supposedly a 9-5 service. Extraordinary isn't it that even a restricted hours service can't roll itself out for the full advertised hours.

Have seen GP this pm who has advised I did exactly the right thing, that the response was disproportionate but because they didn't know us as a family and in her opinion dd was better off coming home. He affirmed dd needs help and should have been provided with help last year.

GP also confirms I was right to hold out for an assessment by a permanent member ov staff and has confirms the person dd is seeing is one of the best CAMHS have. It's a bloody shame I had to make four phone calls to secure an assessment with someone halfway decent.

I remain unimpressed with the modus operandi of the hospital on Friday. I remain spectacularly unimpressed with the organisation, competence and conduct of CAMHS last year. They can have another chance to deliver a service. I will see how they perform. DD is entitled to a service from them.

I think you would be better off persuing private therapy/ assessments / help. Camhs and mental health services are stretched services and there is not much provision.

Well, in that case the a&e dept shouldn't have pushed money to dd being kept overnight for a CAMHS assessment should they?

My DD requires a service, therefore the NHS is obliges to provide it regardless of means. Therefore I shall see what they will offer. If it is acceptable and she connects it's another option. If it isn't acceptable because we have options I'll kick up a stink, hopefully to try to approve things.

It must be remembered of course that I'm a terrible parent according to this thread. If only hcps were as bad at their roles as me eh? Fortunately the GP thinks I did the right thing.

Best of luck Ripening it is an incredibly stressful situation, it is clear you are a great advocate for your DD. I hope you finally get the resources she needs.

OP in my opinion you were well within your rights to take your daughter home in the interest of her well being. Unless staff were going to invoke the MHA it would be a breach of her human rights to try and keep her in hospital. Unfortunately I know first hand how psychiatric wards in this country are not only unsafe and frightening but have resulted in more trauma than the events that brought me to the service in the first place. I cant understand how people think taking children away from their homes and families and locking them up with lots of very distressed people is going to make them safe. I have never been more terrified in my life. The reality is we live in a risk averse culture where clinicians are terrified of ending up on the front page of the daily mail and this influences decision making. I imagine no one wanted to make the decision to let your daughter home without an assesment with zero consideration of the potential iatrogenic harms for her. It seems you have her very best interests at heart and are willing to fight for them. I hope you both get the support you need to move through this difficult time. I would suggest you make it a priority that your daughter has someone who she feels will listen to and validate her feelings and experiences and who she can trust will not break confidentiality. Im not suggesting anything at all with this statement as I have no idea what is causing your daughter distress but I know from my work with service users that this is what we are always asking services for and dont always get.

Yep Howcan that pretty much sums it up.