Severe MH issues in teen. What sort of treatment would be appropriate

[Cheshiresquirrel]

I am coming to the end of my tether and just need some idea or draw on experiences from others as to what treatment would be the best as we are not making progress and MH is getting worse

Teen has suspected ASD (waiting list 5-6 years long) diagnosis of severe anxiety disorder and depression, suicidal, recent suicide attempt, selective mutism and anorexia. Hallucinations (auditory - a voice telling them to end their life) and seeing weird stuff.

We have the eating disorder service involved (medicated with ADs which have zero affect). Won't engage with talking therapy so nothing happening on that front. Social services got involved after the suicide attempt and instructed us to provide 24/7 care and supervision incl sleep in the same room to minimuse risks. Unable to attend school as not coping in a busy school (Ehcp has been applied for but our LA is shooting down most requests so I expect a no and the need to appeal. will be realistically 1-2 years if I factor in tribunal). I am just totally on my knees. MH not improving at all. No Camhs involvement as they say the root is the eating and ED service needs to help but they are completely out of their depth. In essence, we have regular weight checks and medication and nothing else. I am at breaking point. Been like that for a several months. Help. Anyone with a similar child. What support should we get ideally? We are in a position where SS put the onus to safeguard in us. School refuse to have DC as mental health is so poor (there were incidents of self harm in school which resulted in a&e attendance). Camhs say it's a job for the eating disorder service and ED service says the mental health issues are so severe that it's beyond their remit. Child is going downhill. Still planning to end their life's as they voices tell them.

Can't really advise but there is a children's mental health board with parents of other similar, plus a thread for parents on the main mental health board too.

that must be so exhausting for you emotionally and physically.

what medication is she on? Can you ask for a medication review? It sounds like she needs different medications or a dose increase. Email the prescribing consultant and make an appointment. Anti psychotics medication for the voices possibly? Keep reviewing the medication with the consultant until it’s effective.

It sounds like she needs input from both services - ED and CAHMS, can you push for this? Either way she needs involvement from the complex engagment team who are used to working with non cooperative kids.

Is she still on roll with the school? Speak to your local authority education department and ask for advice on what the school should be offering. It might be online education or hospital education or outreach tutors or alternative provision. The school are not providing the education they are being paid to provide. They can’t refuse her attendance while not offering alternatives. Finding an alternative might be the way forward.Do not take her off roll, remaining on role means you can access more services.

In your shoes I’d not worry about exams but think more about theraputic and nurturing activities which are centring . Horse riding, dog care, crafts, art and so on.

Take her to A&E immediately if she’s on the edge and suicidal. Ensure she sees a psychiatrist while there to properly assess. Sadly things have to be rock bottom to access real help.

we are on antipsychotic drugs and on ADs. We tried a couple of different ADs to no affect (currently on Fluoxetine, but were in sertraline for a long while). Psychiatrist wants to wait a few months more before onto something different to give it more time. school say it's a health and safety issue and they cannot keep her save (true) and she absolutely cannot cope in the mainstream environment. school suggested we apply for an Ehcp and we did so. but it's long process.

Bumping in hope more knowledgeable people can help. Sounds awful for you and your teen.

I only have experience of adult services, but I wonder what the social worker thinks of the buck passing between camhs and ED service? It sounds like a dual diagnosis issue. I'm wondering if you should be pushing for a multi-agency safeguarding review? You could also try raising a concern with PALs as well as seek advice from Mind?

I'd also try to get support from your own gp. It may well be that it will take you to "break" under all this in order for others to step in.

Really feeling for you

The school still need to coordinate an education for her wether that’s accessing alternative provision, home tutors, hospital tutors or online. Speak to your LA so you’re clear on what the school should be offering her in her circumstances. It’s a balance between engagement and overwhelm I guess.

Does she have any hobbies? Interests? Friends?

Has she had blood tests for deficiencies?

Keep your consultant updated via email, ask for a review date so that it’s in the calendar and you know when things can be reviewed

School needs to arrange some kind of tuition, likely through the medical needs tuition pathway.
It sounds as if CAMHS and the Eating Disorders teams are not communicating well, they need to work together to come up with a treatment plan.
Have you thought of requesting help from the early help and prevention team at your local council? School can advise you of how to do this or you can Google it for your local council. Essentially it pulls together all relevant professional services with you to put together an action plan that is reviewed regularly.
It sounds really tough. School cannot just exclude him from education without providing an alternative. This doesn't mean they have to send work home or pay for tuition out of the school budget but they do have to ensure they've made the correct referrals.

Sounds like what my DD was like. She was like this for 9 months. Very very small steps helped her such as being persuaded to sit in garden for a short while. Slowly worked up to a walk, a coffee etc. CBT (iapt) didn’t help at all she needed something specialised. We ended up paying for an autism assessment. I applied for EHCP myself as she hadn’t been in school for 18 months. Still needs a lot of support from me but not at any suicide risk