Can I, as a FC block them giving my LAC anti-d's?

[Gymbob]

My 14 year old LAC, has been told by CAMHS she has 'a low mood'. She hasn't being diagnosed with depression. CAMHS are likely to prescribe my fd anti-d's this week. I have asked if we can try other avenues first, like CBT, or even a placebo if they must prescribe. I do not believe she is depressed, and I'm not on my own, school doesn't think so either. Trouble is, CAMHS have asked her if she would like to start on them, and she is delighted and looking forward to it.

I am not totally against the idea for the right reasons, but I don't feel that they should prescribe anti-d's without exploring elsewhere first.

As a fc, what powers do I have, does anyone know. I mean, do I have the power to prevent them doing this or will I just be overruled?

thanks in advance for any advice or opinions

[NanaNina]

Oh dear that's touched a nerve! Look OP I think discussing the matter on here isn't such a good idea, as you are getting a hard time and that can't be any help when you are distressed about your girl. Some posters seem to have very fixed opinions and I know this is usual and what MN is all about really, but I'm concerned that you are going to get more frustrated/distressed than is necessary.

Can you arrange a meeting between the social workers, CAMHS and yourself to discuss the whole matter and hopefully come to a sensible decision. I still think CAMHS would need to refer your girl to her GP as I am almost certain there is no one medically qualified as part of the CAHMS team. I can't imagine a GP being happy to prescribe ADs to a 14 year old - not at all, but then that's just my opinion.

Do hope this matter gets sorted out soon.

[NanaNina]

Kundry I beg to differ about your assertion that it is illegal to prescribe placebos in the UK. I know that in trials to test all sorts of drugs, one group is given a pharmaceutical drug and the other group are given placebos and no-one knows which they are taking. I know that as far as depression is concerned the trials have found that mild depression is as likely to respond to a placebo as to an AD and so it is not usual to prescribe an AD for mild depression, whereas they have been found to be effective for moderate to severe depression.

Given your 20 years of medical practice you must know far more about these trials than I do.

[LaurieFairyCake]

It's illegal to prescribe placebos unless people know they might be prescribed them and they give their consent like in medical trials

[Rhinosaurus]

Nice guidelines for depression in under 18s
www.nice.org.uk/nicemedia/live/10970/29858/29858.pdf

[NanaNina]

Oh dear - well that's told me.....I do actually know quite a lot about CAMHS as I was a social worker and middle manager for a LA Children's Services, and obviously came into contact with CAMHS - indeed the social workers attached to CAMHS shared the same open plan office. I also remember that CAHMS took over from the old "Child Guidance" organisation. My social work career spanned some 30 years. I am now retired.

I am also aware what a consultant psychiatrist is, so don't need your explanation, but the CAMHS in the area in which I worked was certainly not headed by a such a professional, and so there must be differences related to different areas. Of course I also know that a GP will defer to a psychiatrist. Indeed the CAMHS in the geographical area in which I worked did not have a particularly good reputation, but fortunately we had the services of an excellent clinical psychologist who was prepared to take on referrals that CAMHS had declined.

You see I am actually a service user of psychiatric services and am in secondary care, which of course you (with your comprehensive knowledge of such matters) will know that this entails oversight by a consultant psychiatrist and a CPN who I see on a regular basis. I have also been fortunate enough to see a therapist on the NHS as I was an IP in 2010 for 3 months, and had the dubious pleasure of having a weekly review "chaired" by a consultant psychiatrist, who had little idea of how to chair a meeting and so my reviews were a Q and A session between the conslt psych and myself. However I digress..........

I am also a member of the EforE panel (I expect you know that means Experts by Experience) and work with others to improve mental health services in the local MH Trust. Recently I was asked by the CQC to assist them in their inspection of the MH services in the Trust and I facilitated a patient's forum and took responsibility for obtaining feedback from patient's who did not feel able to do so themselves. All of this relates to "Older People" (of which I am one...) The CQC have been very appreciative of my input and have asked if I would be prepared to carry out the same function in other MH Trusts.

My comment about placebos was specifically related to trials and of course I am aware that they are not used in clinical practice and did not make this assertion. Contrary to what you believe I am not a "half wit" so I think you should come down from your high horse, and maybe strive not to be so rude in your posts.

[Gymbob]

Kundry, I keep trying to tell you she has not yet been assessed by a psychiatrist! Not at all!

Re the placebo, I strongly disagree with you. My mother was given a placebo several years ago by her gp. It was discussed with me and my father, and we agreed that it was the best course of action at the time. I have to say though that at no time did the gp say the word placebo. he said he was going to give her some sugar pills. my mother still doesn't know she didn't have the real deal.

I am obviously of the old school where medication was not given out like smarties just because a child says ' I want this and I want it now'. I am prepared to work with my fd and get the best outcome possible for her.

nana, I am sorry that you have been subjected to such rudeness on a thread that I started, I think it's time to leave it now.

[LaurieFairyCake]

If giving your mum sugar pills was discussed with you and your father does that mean that your mum wasn't competent and/or suffering from a mental health condition that meant you and your dad were best placed to make medical decisions?

I agree you should push for a psychiatrist or a GP to do a proper assessment about whether she needs pills.

[Gymbob]

it is not illegal! but it is against gmc guidance.

my mum does have mh issues although she does have capacity and she wanted real meds.

[LaurieFairyCake]

If it's against the guidance I'm guessing they will be even more careful seeing as she's in care.

If you're not happy when and if they get round to assessing her properly you might get a chance to talk to the psychiatrist alone, I managed to get a few minutes with her alone once before a fc saw her.

[Brittapieandchips]

I have a life long mental illness (bipolar disorder) - it is severe enough that I will never be off medication. On top of the mental illness itself I have to deal with the bad memories and consequences of the fact that I very clearly started to be ill in my early teens (with signs before even that), and my mum, with the best will and love in the world, refused to let me have medication and built it up as a terrible thing to me. I was left with cbt which was never going to work anyway but was made harder by the fact I had a chemical I balance in my brain and wasn't taking the medication to relieve the symptoms.

It took me being hospitalised for anyone to listen to me enough to give me medicine for the illness that was ruling my life. And I come from a fairly stable background, with mental health experts in my family who refused to accept that I was very ill.

I don't know this girls life, but I am guessing that she has had a lot to deal with. If the experts recommend it, why would you stop her getting respite from her brain chemical problem so she can deal with it. Most people are only on anti depressants short term and it could make a world of difference to her life.

[claraschu]

CAMHS is very seriously under funded. Everyone I know who has dealt with them has felt that they have not been given the best possible support.

I know adults who have been prescribed ADs by GPs after two short appointments (no consultation with a psychiatrist, no previous talking therapy). I don't think this is a great idea.

It is not news that the NHS is trying to save money. Putting people on ADs is sometimes a money saving tactic in situations such as the OP's. I agree with her that ADs should not be prescribed until other treatments have been tried in a case like this, where the depression is not severe.

[Shallishanti]

the NICE gidance seems clear enough, ads should not be given to yp with mikld depression in the first instance. Watchful waiting and other interventions, diet, sleep, exercise and talking therapies.
ADs are drugs, they have side effects.

[fasparent]

LA has parental right's with BP's , Is open too discussion and compromise, all round . Also have too check through. everything and I mean everything, have had children placed on medication grossly overprescribed giving children and baby's adult dosages , some resulting in organ damage , limiting their lifestyle living, have too look at secondary complications too drugs, as improvement too quality of life with drugs. LA's will be culpable of wrong decisions so important too discuss at length, taking into consideration child will be with FP's for most of the time , and they will know the child better than most.

[NanaNina]

Don't worry Gymbob about that rude post from eightyearson - it isn't your fault! I see she/he hasn't returned. I don't usually "out" myself as someone suffering from a mental health problem (depression and anxiety) on threads other than MH threads, where there is so much support and no rudeness at all. My depression is intermittent and between times I am fine.

I agree that I don't think there's anything to be gained by continuing to post Gymbob - I'm sure you've heard enough of others' opinions on the matter.

[MyLadyAnita]

Gymbob - My advice would be to put your objection in writing, give your reasons, and then BACK OFF. You will have done all you can by doing this and can do no more. Make a note of who you wrote to. Be factual and no opinions. Keep a copy.

If you go on a mission, even if with the best interest of your foster child at heart, you will end up bruised and hurt and this will be no use to your foster child.

She will survive this and so will you. Time will probably prove you right but you cannot fight the professionals.

[fasparent]

In addition be sure your LA provides you with a drugs record chart's (Official One) and record everything in diary children's log. Also speak school regards too their drug policy, and qualified staff if administration of drug's is required during school time.

[Gymbob]

UPDATE: Met with psychiatrist. The psych spoke to my fd alone for 10 to 15 minutes, so that constitutes 'a full assessment' before prescribing (NICE guidelines).

My fd is already receiving talking therapy from another source (NICE guidelines as first line treatment), so she qualifies for AD's. Further talking therapy may be too much as she is already engaging in one lot, so she qualifies for AD's.

Because she may not engage in CBT she qualifies for AD's.

Result: AD's if she wants them, it was so obviously a foregone conclusion. Fd also told psych she is anxious (news to me), so she recommended one particular drug. She also told psych that birth mum suffers from depression and short term memory loss (news to me). Rang CAMHS next day to tell them fd has decided on AD's, then rang (new) social worker to pass on the news. She said 'WHOA, hang on a minute, I need to see about this'. Rang birth mum, who said 'WHOA, hang on a minute, I need to see about this'.

So I have inadvertently lit the blue touch paper, and now I am standing well back .

[MerryInthechelseahotel]

I think if I thought it was going to be a foregone conclusion I would have spoken to the new sw and bm before the appointment tbh What is going to happen now?

[Gymbob]

They knew about the appointment in advance obviously, it was only my opinion it was a forgone conclusion...but they knew that too....