"He needs to go in somewhere."

[QuickGuide]

This is from my mother regarding my 19yo son, who has barely functioned since his father died 2 years ago.

He hasn't harmed himself, doesn't do drugs or alcohol, but is very isolated and would spend 24 hr a day in his room. He's living in halls, supposed to be attending university but I strongly suspect he isn't. He hasn't engaged with university life, has no friends at uni and hasn't kept un touch with school friends.

He's currently completely out of contact, although the Uni welfare team have been able to confirm he's physically safe.

He had medication which I don't think he's taken since he had to sort the prescriptions out himself whilst away. He's been offered counselling from various sources which he refuses.

I think I need to get him home, but I've no idea how to help him thereafter.

My mother says he needs some residential care, I think she's offering to pay, but surely even privately that would be extreme for this kind of MH illness?

I would bring him home and at least get him to a private psychiatrist. The psychiatrist will then assess whether care at home or in a residential setting would be best for him. I will say residential care is much better & nicer (far less traumatising) than inpatient care on a secure MH unit.

You can also help him defer his degree course at Uni so he can go back when better.

Thank you. How would I go about finding a decent private psychiatrist?

Well, I used Ramsay Healthcare myself and am happy with them. But you can also try other private healthcare groups like Bupa and such.
https://www.ramsayhealth.co.uk/specialists

https://www.bupa.co.uk/

Almost all of them have pay as you go, so you don’t need to pay for private health insurance to book as a private pay patient through them.

Whoever you are recommended and are considering as a psychiatrist check the register to be sure they are qualified and licensed:
https://www.gmc-uk.org/registration-and-licensing/the-medical-register#searchTheRegister

Ah OK, I didn't realise it would be through a company as such, I thought it would be Google, like counsellors!

Both a friend of mine and my niece went into the Priory. We are in the North West of England (Lancashire). I don't know if they have them elsewhere but I know they worked wonders for my friend and my niece.

Would you go straight to psychiatrist rather than GP? Does the psychiatrist prescribe any medication, for example? And can that be an NHS prescription? I assume the drug cost is more than the standard prescription charge?

I've just put Priory Group into Google and it's brought up centres all over the country. There's lots of information on there, give them a ring and explain his situation and see what they say. Obviously, it will cost money but if your mother is willing to pay then I'd try and get him the help he needs as soon as possible.

Thank you. Yes I just looked at The Priory too. I had no idea this kind of care was available for people who "only" suffer from depression.

Typically how long would someone stay in such a facility?

The GP should absolutely be able to do an assessment and probably prescribe too. They can refer to an NHS mental health team if needed but sadly the services do tend to be very busy.

A private assessment would be done quickly which is nice. Prescriptions would be more expensive than NHS, maybe a lot more.

How much money does your mum have going spare? Paying out of pocket for treatment in an inpatient psychiatric unit would be costly - I’ve seen £1000 a night quoted for the Priory group. Most people would need at least a couple of months, if they‘re going to get full benefit. It could really add up.

For me the most concerning thought is - will he accept help? Have you asked him to go with you to the GP, is he even taking calls from you? How do you plan to proceed to support him to get help, wherever that comes from?

No that's exactly it. He's not taking calls, I'm not even sure he'd agree to come home. He did come to GP with me originally but he's always refused offers of couselling.

GP said medication would help him get to a place where he could engage with other treatments, but he stopped taking it when he had to arrange it himself (whilst telling me he had done it).

It's hard not to be cross with him for not helping himself but I do think he's got to a place where he can't help himself.

My friend went into the Priory for 2 weeks. My niece just attended on a regular basis as an outpatient for therapy sessions. My dh is under the NHS for mental health issues and is with the local community mental health team, but he is seriously mentally ill and it was even touch and go whether they would accept him. We would have gone private if we could have afforded it.

@QuickGuide I also wondered if he'd accept help from what you've said about him. My heart goes out to you both.

Yes you can go straight to a private psychiatrist and yes psychiatrists prescribe medication. In fact they are far better qualified and trained to tailor medication to each patient than any GP. Yes, it can be NHS prescription. The psychiatrist writes a clinic letter to your GP and requests the GP prescribe x, y, and z. They do this for me as I have a prepayment certificate that covers all my prescriptions. If the GP agrees to issue the prescription (and they should), it is the standard NHS cost of £9 or so. As I said I have a NHS prepayment certificate (PPC) that anyone can get and you pay £10.30 per month for ten months by direct debit and you have unlimited number of prescriptions for that. I’m on six monthly medications not including my asthma inhalers. Even if you only have one monthly prescription you save money with a PPC.

If he’s not engaging with you, how likely would he engage with mental health services? If he doesn’t, the only option is detaining him under the MHA, and obviously as this involves removing him of some of his rights, the threshold for this is very high.

I don't know but presumably if I can get him to a psychiatrist they would try to help with that?

He might actually quite like the idea of residential care - away from home where his dad died. Whether he'd engage once there is another thing.

As a mother of a similar aged son who has suffered with depression, I'd urge you to bring him home as soon as you can. Just so you can keep an eye on him and keep him safe. Then, as PPs have suggested, you can look into getting him help. Does he open up/talk to you about how he's feeling?

If you can get him there, yes.

For what it’s worth, an on-the-ball GP could try to help with that too.

I think you’re asking the wrong question here. It doesn’t really matter whether he sees an NHS GP, a psychiatrist, private or not, or has a bed paid for in a psychiatric ward. The question is, will he go to an appointment and let someone assess him? If no professional sees him there is very little they can offer.

I feel for you, it’s a horrible position to be in with someone you love.

It maybe difficult to get him to a psychiatrist if he’s that difficult to engage him. And even if he does, if he doesn’t agree with medication and/or therapy, there’s little can be done realistically without the MHA, if it’s ascertained he has the capacity to make that decision….. and unless he’s having a psychotic breakdown (ie hallucinated/deluded) I would imagine he does.

I have empathy for both of you by the bucket load. He sounds like he’s really suffering, which as his mother is difficult to watch. I’m not a mother but an experienced mental health nurse and i do understand it is difficult to get help in your situation.

Good luck to both of you, I hope you manage to get the help you need xxx

A GP may be able to do a home visit with or without the local mental health team. If Mohammed won’t move to the mountain, the mountain may have to move to him.

I would be very hesitant to go straight for residential at The Priory. They have had some awful reviews and incidents. If he can get good assessment and care while at home and build up a bit of a routine that will hopefully be a better route.

Do the university have a GP? Maybe they could see him to start with.

There are some great resources on grief (case you haven't seen them) which might help you help him?

refugeingrief.com/

There is also Cruse Bereavement charity that offers a support helpline and such https://www.cruse.org.uk/

I'm sure your mum has absolutely the best intentions, but ime it's overly optimistic to think there is some residential haven that will be the answer. I looked into this quite recently and it seems like a minefield. And extremely expensive.

There's a few things you could read to give you a bit more background:

www.mind.org.uk/information-support/types-of-mental-health-problems/depression/for-friends-and-family/

www.mind.org.uk/information-support/types-of-mental-health-problems/depression/causes/

This is good advice on finding a private therapist for any reason: refugeingrief.com/2020/01/07/how-to-find-a-grief-therapist/

I know you said he isn't self-harming, but worth reading this short summary just to be aware: www.papyrus-uk.org/wp-content/uploads/2020/08/Supporting-Your-Child-A-Guide-for-Parents.pdf

Does he have any siblings? And any interests/hobbies?