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.

I don't understand the money part.

When it's an overdose emergency situation it's protocol that patients are kept in until discharged by a mental health professional . Simple as that. If the mental health professional can't come it means starting to weigh up the risk and there may be no one qualified to do so overnight. When criticising the people who were caring for your daughter it might be worth remembering that she did intentionally harm herself and ask for help, which was then offered to her.

In the longer term , non emergency situation, there are community services but they are fairly sparse . Your dd will be coming under adult services now in most of the UK.

All the best to your daughter.

Community nurses (CPNs )make up the community MH teams.

My DD requires a service, therefore the NHS is obliges to provide it.

This is true to an extent. However, my understanding is that the NHS - and the public sector more broadly - do not have the means to deliver the services that they are statutorily obliged to provide. This problem does not affect only your DD, nor only CAMHS patients, but many groups of people and many vulnerable people.

Your obligation is to your DD, and it is true that the squeaky wheel gets the grease. Once you have an understanding of the system and the constraints you may choose to access care for your DD privately. Your GP can refer you. The private route and the NHS route both have their strengths and their weaknesses, and a good private psychiatrist or other mental health professional will be transparent about all of this and take the time to explain pros and cons of various treatment options to you and leave you as the parent to make the decisions.

I suggest that, rather than kicking up a stink, you work to support your DD and yourself first. Later on, once you and your DD are safe and well, you could try to understand where the limiting factors lie in terms of NHS resources. A child psychiatrist with experience in both the NHS and private sectors and/or a solicitor with expertise in mental health and the law would be able to help you to understand this. With this information, you could use the support of a solicitor and your MP to make a case for increased NHS resources for child mental health in general. However, these big and idealistic efforts are something that you may choose not to do, as is your right, and in any case I suggest that you leave this type of thing until your DD has the support that she needs.

I will reiterate that on this thread you have repeatedly described yourself as a terrible parent. No-one else on this thread has described you as such. This makes me think that you would be wise to seek support for yourself, by going to your GP on your own behalf and not that of your DD, explaining the situation and how you are feeling, and asking what options are available to support you. You could print this thread and ask your GP to read it, if you find the situation difficult to explain by speaking out loud.

You are not a terrible parent. You are a caring parent in a difficult situation doing the best that you can for your DD.

You seem kindly and sensible erinaceous.

I understand about scarce resources. I also understand that when they are sparse they need to be used effectively and wisely.

CAMHS refused an accessible and acceptable intervention last summer. What they offered would not have been in dd's best interests at all. When I declined it I was specifically told the case was closed because the mother was seeking private treatment. I couldn't seek private treatment because neither my gp nor CAMHS were prepared to help with a recommendation. There are 400BACP registered counsellors in a 20 mile radius of our home. For this dd waited 16 weeks for an u suitable recommendation after an urgent referral.

At that time I was told to find a therapist off the internet by both the GP and CAMHS because they did not recommend due to lack of knowledge about outcomes. I as a lay person am expected to exercise that knowledge?

I secured a recommendation to a consultant psychiatrist because there was no other help offered. DD had some CBT with which she didn't engage. She has seen the psych three or four times. She started on fluoxetine in December and was doing extremely well.

Now in my opinion when resources are scarce prevention is better than cure. But CAMHS don't help prevent which would be cheaper. So I the absence of NHS help the NHS was willing to spend money on a 1:1 nurse and block a bed overnight pending a CAMHS assessment which my GP has now advised wouldn't have been a full assessment anyway. This was to follow the under 16 protocol. DD is 17 and according to the protocol there was another option which avoided this. DD was not suicidal. I insisted on the other option.

Common sense tells me it would have been cheaper and more appropriate to provide some care in the first place. The CAMHS website says decisions are taken in collaboration with families. The decision to offer my DD a suitable intervention and refuse to offer an alternative was taken unilaterally.

In relation to care for me, if my DD had received care it wouldn't be necessary.

I think I know quite a lot about managing scarce resources and this sort of unjoined up thinking is both wasteful and unhelpful.

I will move heaven and earth to provide my DD with all the care she needs. It's a great shame the NHS can't do the same. Ha, ha, perhaps they could provide me with some talking therapies/sleeping pills instead - how does that help my DD when I am competent.

I have said I'm a terrible parent in response to some highly critical posts about my parenting. I know I'm not a terrible parent. I have been caring my daughter when the NHS has failed to do so.

The main criticism was regarding you insisting on taking dd home. Instead of having a big argument about her care it would have been better to just accept you would have to wait for the assessment.
By going home she missed the next days assessment.
We can't change what choices you made , we are just giving opinions on a forum , but alienating hcps isn't going to be helpful to her at all. You can't always have special treatment sometimes you have to wait your turn for things. Would it really have been that big a deal to wait until the next morning? Was it worth a big row? I can't imagine that is helpful at all.

sellingyesyerdaysnews. Every hcp she has seen since has agreed it was right to take her home. She has had a CAMHS assessment now. She has an apt with her psychiatrist tomorrow. She had a MH assessment before left hospital.

I do think it was worth taking her home. Far better she and I slept that night.

Had the hospital been straightforward and honest there wouldn't have been a row and I don't in the slightest regret it. Perhaps next time they will deal more transparently with issues and now they know that a 17 year old doesn't have to wait for a CAMHS assessment; a MH assessment can be arranged instead to allow someone who isn't at risk to go home.

It wasn't a,question of having special treatment. It was a question of having the right treatment at the right time. There was no point blocking a bed or spending money on a nurse for her. I was prepared to bring her back the following day for the CAMHS assessment but a CAMHS assessment wasn't essential due to her age and that should have been presented as an option. I think it is always right to ensure the right action is carried out. As for waiting for a CAMHS assessment we waited 16 weeks last year and they then offered her diddlysquat. What I saw was not impressive and certainly not worth spending a night in hospital waiting for and it might not have
the next morning I'm now told.

I think it was rather more about hcps alienating me rather than vice versa. They did nothing whatsoever to engage my trust. But thank you for your comments; they have crystallized my view that a formal complaint is required.

In borderline cases like these, the best course of action is difficult to determine.

Of course it's easy to say now that it was fine to take her home..retrospectively.
However, making a big fuss to mobilise lots of staff because you weren't prepared to follow the plan just meant you took people unnecessarily from their other work because you didn't want to be inconvenienced.

Well she was referred to paeds so that was the paeds protocol. In fact in adult medicine it's usually the same..seen the next morning. I don't know why that is so hard to understand. They weren't lying, that is the actual way it works. you didn't want to wait. Simple as that.

You are being ridiculous.

I really hope with your level of empathy that you aren't an hcp. They were the ones wasting money and should have liaised with full options before doing so. But hey the NHS is almost bankrupt and I'm only a mother and a taxpayer.

I wish someone had made a fuss and stopped me ending up in a psych ward. I echo ripening, I really hope you arent a hcp.

It wasn't a psych ward , it was a paediatric ward with a camhs bed.

It was a paediatric ward with a CAMHS bed that wasn't required. No options were presented.

Entitled, yes of course. DD and every other member of my family is entitled to clarity and the care they need to receive in accordance with shared and holistic protocols.

I'm not entirely sure what you problem is. DD has had a really positive few days and has learnt a life lesson it seems. I am her mother and will ensure she has the best possible care the NHS and money can provide.

In the absence of transparent information, I call the tune until evidence otherwise is provided. I'm awfully sorry if you have a problem with that.

< gives up >

Good.

I hope your complaint brings you some sort of satisfaction.

What it might do is to encourage some reflection about openness, clarity, providing holistic care tailored to the patient.

If I had though for a heartbeat that my DD would have benefitted from staying overnight, she'd have stayed overnight. If they had genuinely thought she was such a serious risk adults should have involved paeds at 2pm rather than 5pm.

I hope your complaint brings about much needed change. Mental health is not the same as physical health and as long as MH professionals hold the stance that they know best and do not acknowledge and respect the expertise an individual and their family have in their own life, people will not recover. MH care needs to collaberative, coproduced with decisions that are shared. Your experience shows clearly how that is not happening.

She was in a safe place. The concern was over safety to go home. That's not your decision to make, only input.

Unless they were going to detain it is absolutely the decision of an individual. Why wouldnt it be.

No, but I can't input if I'm not called for three hours. Further if a decision is required about safety to leave then that decision needs to be facilitated asap, not after hanging around for 8 hours and then overnight. If concerns are so great they thought they could invoke the MH Act then the level of those concerns should have been expressed and explained to both my daughter and to me. They were not explained.

I will ensure my family get the care they need. There was not a court order ir a section and no mention of one. If that was a possibility then it should have been discussed when I asked what would happen if I just took her home, no?

It rather sounds to me as though you might be arguing this because you were there. If so let me reassure you that she is from a very loving and caring family who will move heaven and earth to ensure she is well and safe.

CAMHS initially offered an agency nurse to assess her. She has been assessed by one of their most experienced staff as extremely low risk. Our GP thought the hospital had been disproportionate and she was better off at home. Her psychiatrist thinks communication could have and should have been better and that the hospital should have referred straight to paeds on arrival.

Well a little update sellingyesterdaysnews. DD was diagnosed as having ADHD, ADD variant by her psychiatrist a few days later. This was the root of the problem.

CAMHS failed to provide anything useful for three months.

Complaint to CCG resulted in change.
Complaint to CAMHS eventually resulted in apology.
Complaint to hospital had resulted in significant changes including hire of specialist CAMHS nurses and MH training for all nursing staff as this was considered inadequate.
Shortly after this the CQC evaluated children's serviced and a&e as requiring improvement (significant) re MH. They also evaluated the Trust responsible for CAMHS as inadequate and they are awaiting prosecution re a serious issue that took place on the hospital's premises.
The hospital has apologised in part albeit inadequately.
CAMHS thought dd's care so unimportant nothing was delivered for three months - and then it wasn't great.

DD by the way due to the care her family have provided is much better and generally on an upward trajectory. The NHS has done bugger all to support her. Her family have moved mountains and paid privately in spades. Love has been at the root of it.

Oh yes, CAMHS eventually rolled out some counselling three months later. Closed her case within a week of it starting. Couldn't even be bothered to monitor if it helped.

Anything else you' like to comment on as you felt you knew best. Not great is it. Perhaps parents really do know best much of the time.

As you were.