CAMHS report your thoughts please?

[claw4]

I will paraphrase rather than word for word.

'ds presented in A&E due to deterioration in self-harm. He had cut himself with scissors the previous day.

He reported that he deliberately self-harmed because of worries related to school and his brothers. He has two brother (16 and 19) he said that 19 year old sometimes hit him when he lived at home (i would add ds did not volunteer the brother info, i had to prompt ds to tell CAMHS what he had told SW and i told CAMHS that his brother hadnt lived at home for over a year)

He told us that he was bullied at school and this make him worried and not want to go to school. When asked about going back to school, he said he hated it and it would make him very sad and worried. He also said he worries about his eye problems and autism.

He has been self harming by scratching himself for approx 2 years. He described he sometimes has itches and he has to scratch himself. I wonder if there is hypersensivity to feeling on his skin, which evokes a need to scratch.

He decided to scratch himself with scissors because he was feeling sad, he wanst sure why he felt sad. He reported also punching himself and hitting himself with a hairbrush. He reported scratching does nothing to help his feelings. He said he is happy 1% of the time and unhappy 99% of the time.

I assessed his thoughts about wanting to die, these thoughts are connected to wanting to get away from his worries and his scratching rather than intent to die.

RISK He has a significant history of self harm which is triggered by his worries and sad feelings. Risk to others low. Risk to self low.

Safety plan was agreed with mum
Says about keeping all sharp objects and medication etc away from him and
I advised that mum will need to consider whether DS going to school would cause an increase in self harm and wanting to die. Ongoing liaison between CAMHS and school would be helpful to develop a joint understanding and way of managing his self harm

Yours thoughts please?

It's a bit woolly tbh.

It doesn't say WHAT will help him, or what kind of plan (unless it does somewhere and you haven't put it).

'Liaison' isn't intervention.

It doesn't really blame anyone for his anxieties, although it mentions school as a trigger. It does seem to suggest that ds' anxieties stem from him mostly, which is good enough to flag up the need for support imo.

I think its a bit wooly, because this was an 'emergency' assessment, this was the first time they had seen ds and it will be the last time, these particular psychologist see ds.

He will now be seen by a different psychologist in therapy and psychologist that saw him as an emergency case, has said (although they didnt put that in writing) that this Psychologist will then decide on a way forward. I have an appointment, without ds with the psychologist he had his previous therapy with.

CAMHS never blame! I found it was like getting blood for a stone, getting them to make any education recommendations last time. Even though they did tell school when asked directly "what is the cause of ds anxieties" they replied "school"

Im glad they have mentioned the sensory 'feelings', as hopefully this will mean he DOES need the OT help, which should be enough to get him a statement.

'I wonder if there is hypersensivity to feeling on his skin, which evokes a need to scratch.'

Yes. I would follow this and need for OT as far as you can get with it.

Does ideal school have onsite OT?

OT's have been making links to the self harming for years and provided recommendations, all of which were ignored.

Ind OT did a complete assessment of ds and highlighted lots and lots of difficulties, she recommended that ds needs direct input from sensory tranined OT, daily sensory programme in school, movement breaks, staff to be trained by OT, OT to set targets etc, etc. Again ignored, as only way to provide this help is via a statement.

Psy we saw in A&E was of the opinion that ds's self harming is a combination of worries and sensory, which i agree with completely. I would also say that his worries are also linked with his understanding, especially socially. He has great difficulty with unsupervised social situations, even at home.

Any interaction he has with his brother has to be supervised by me, to avoid a melt down, all his brother has to do is breathe the wrong way and it sets him off.

We also went to 2 birthday parties the other week, whole class invites (one i was even told ds was there to make up the numbers!, but never mind, ds didnt know that) Both time took his ear defenders, didnt help at all and he spent most of the party, sitting outside with me and we had leave after about half hour, both times.

Even in A&E children dept where we saw Psy, i had to take ds to another room as he was getting very irritiated by being around other children and keep taking him outside, so he could run up and down.

I am currently making a list of what to ask at the meeting i have with CAMHS.

Top of my list is what next.

What im undecided on is what i want from CAMHS, obviously ds needs a statement, which i am currently doing.

But do i want them to recommend home tutor for now? Inp school? although this wont be possible without a statement, i could push for emergency placement at inp school?

Yes, emergency placement at ind school could be something you ask for, but get legal advice, because you might not want to show your cards on that one this early.

And it WILL be fought.

Does the ind school you have in mind have on site sensory OT?

I don't think you should be asking them to 'recommend for now'. I think you should be trying to pin them down to what your ds needs long term, as this will be the most useful for you all and for the tribunal.

So, they can say that the ongoing unaddressed 2 years of mental suffering will require substantial and lengthy intervention beyond that that can be provided by the mainstream state school.

Yes indp school have onsite OT, SALT and Psychologist.

They are usually difficult to pin down with regards to education and dont like to go 'against' school ie im reporting he is unhappy with school, school are reporting he is happy. They prefer to say ds displays different behaviours at home and school. Which then adds fuel to schools 'its a home problem' fire.

Okay, - so you need to get them to suggest that his sensory needs appear to have escalated further and are causing him increasing distress. That there are most likely TOO many kids in the room he is in, and noise levels increase this anxiety (check how many children per class in indi) and that the ratio of staff to child is currently a cause for concern as he will need VERY close supervision and monitoring by someone trained to a HIGH level in SNs.

As close as something to that. Tell them you're not asking them to say this for the purpose of his education, but for his mental and emotional well-being.

Good idea Star, ind school has very small classes about 6/8 per class and high ratio of adults ie 2.

You need to be careful that they don't say (they probably won't anyway) that his distress is caused by the school not implementing previous suggestions and OT as that will be the LA's way of improving their offer and denying a statement i.e. okay, we'll tell the school to do what is recommended then, within their allocated budget.

You just have to be clear that his problems have worsened since last assessed iyswim, and blame his ASD by all means.

School would not be able to follow the recommendations without a statement. For example OT declined the referral made by school due to understaffing (well school sent me the form for the referral and i made it myself, so i got declined directly and had the letter) I already knew they would decline, as i spoke to OT on the phone.

So only way to get this help would be funding via a statement for priviate OT.

Same for SALT recommendations, school wouldnt be able to without a statement.

As for 'anxiety management' by school, they have tried and it was obviously not enough, as ds has regressed.

I was thinking of going very much with schools inability to understand and address his difficulties, this speaks for itself as i ask for support for ds, they report me to SS.

This is the 2nd MS school that have been incapable of understanding or addressing his difficulties, therefore he needs specialist school?

I will leaving in a second too, fingers crossed!

I think you know what you are doing really Claw. Just be careful to keep your eye on the ball and not get distracted by side issues.

Anyhow my plan is to keep quiet and see what they suggest first, only if what they are saying i dont agree with, will i have an opinion for now.

Im off, butterflies!

Good luck.

Oh well very wooly, basically all my what now, what next questions were answered with "has to be discussed at the team meeting"

So will be discussed at team meeting, ds will then be 'assessed' again, then a plan made.

I did make it clear that i wanted his medical needs assessed, so this would need to be done by a Psychiatrist and trainee Psychologist and again 'this will be discussed at the team meeting'.

They asked my opinion of what ds needed, i stated that ds returning to this school was not an option and that i had tried two ms school and failed and he needed a school which were qualified, experienced to deal with his difficulties etc.

So more waiting.

Should have read NOT a trainee psychologist

has the date and time been set for this 'Team Meeting' then? How quickly are they going to respond?

Not suggesting this negatively but could you gain the insight and support from an advocate/witness going forward?
more for reasons of witness, recording and keeping the meeting well focused so it's not in danger of getting off on tangents, etc and feeling you could lose out on the valuable meeting time allowance, etc...

Fingers crossed for you and your son. I think anyone reading a report which says that a child is 99% unhappy has to think seriously about the right placement. Given that he is on the second MS school, which I think makes you look really reasonable that you and yor son have tried the cheap option and it hasnt worked, they should realise that they have to look at non maintained provision.

Hope your son and you get some recovery time over half term.

Team meeting, is internal meeting at CAMHS, only CAMHS people present, happens once a week. I should hear end of next week, they will phone, then put it into writing.

Usually process is 'assessment' of ds for probably a few one hour sessions, then at the end of 'assessment' they either offer therapy or not.

I cant see them, not offering therapy. He previously had therapy for 18 months there, it has only recently stopped.

CAMHS are usually very 'cagey' about 'education' recommendations, so i think i really have to emphasis that his anxiety IS affecting his education.

This shouldnt be too hard, as he has hardly been in school since July due to this anxiety, all of which i have in writing.

I am not liking the emphasis being placed on me "I advised that mum will need to consider whether DS going to school would cause an increase in self harm and wanting to die" but until ds starts therapy, i suppose they cannot commit.

What she did say is that 'school cannot carry on like this' ie not supporting me and continuing to deny that there is a problem and that she will be speaking to SW regarding ds's comments to SW about his brothers 'beating him up' and his sensory issues and intolerance of others etc being a typical ASD thing.

Which prompted me to tell her that i did not consider ds returning to this school an option, but when asked if she felt this was an option, i just got "it will have to be discussed at team meeting"

What i would also add, is that although she said she not been in contact with SW. I could tell by her questions, that she was asking me to explain the allegation of 'brothers beating me up', so i am assuming that SW has told school what ds told her, as CAMHS have had 'a few phone calls from school'

oh right...sorry I didn't pick up on this...so it's their internal team meeting...I see now what you mean.

You'd think it was wiser to have kept DS on their lists CAMHS and reviewed regularly or something...it seems so awkward that you are back to assessment stage again, esp when the situation is at this crisis and needs interventions made now/asap

Just remember to do everything in writing/email and cc everyone even remotely involved...for clarity and to minimise buck passing and ignorance, etc

claw It looks from what you have written that you might have some unspoken support here.

Unwritten too so far. Let's hope they stick their neck out for once.

Be careful to stay as sensible as you can in their eyes, but without backingtracking or giving up.