Suicidal ideation in a 6YO - what support should I expect and how do I get it?

[OddFodd]

My poor lovely DS has no DX as yet but has huge sensory issues, motor control problems and problems with concentration and an attention span of a goldfish.

He's also quite bright and is hugely aware of his lack of ability. At the start of year 1, he began saying he was stupid and an idiot and he hated himself. Over the course of that year, the school put in place a load of interventions, DS was getting support by a few outside agencies and the negative expression gradually tailed off.

But now he's in year 2, the academic pressure has ramped up a notch and he's being really down on himself. This week, he started saying that he wants to kill himself and has been punching himself in the head. The school called me in because he has been doing it there too and they are very worried about him.

I made an urgent appointment with my GP (who I hate) and he has suggested CAF which I'm not averse to - not least because there has been no co-ordinated intervention until this point and the paed/OT/STS haven't talked to each other at all.

But I understand the CAF can take a while and I think DS is massively vulnerable at the moment. His unhappiness is entirely school related - he says 'his mind' which keeps telling him he sucks and would be better off dead is not unkind during the school holidays.

I spoke to a friend last night who said she'd keep her DS off school for the rest of the term if she were me. I'm tempted to do that because I know he would be much much happier but is this going to get him/me into massive trouble?

What is the best way of getting him the support and help he needs?

I would seriously consider keeping him off school in those circumstances. The end of the winter term is full of sensory challenges; xmas plays, carol concerts, routines out of the window, the excitement of the other children etc etc.
I don't know enough about the legality of keeping him off (hopefully someone can advise soon) but I would think that you could argue that he was not fit to attend school and get GP to sign him off. Of course, not easy if your GP is not supportive, but in that case I would find a new GP asap.

Getting your son signed off school as medically unfit to attend is one way.

Another is to actually remove him from school altogether to home educate. You could do this either as a temporary arrangement or in the longer term. Parents in England and Wales can deregister their children from mainstream school to home educate upon demand without giving any notice or obtaining approval from anyone. If the school is oversubscribed then you may not get him back into the same school if someone else had taken up the place in the meantime.

If neither of the above is an option - if the GP refuses to sign your son off school and you don't feel home ed could be an option even as a temporary measure - I still think you should keep him away from school until things can somehow be improved for him. In this case you need to be prepared for the possibility that the LA could come down hard on you by trying to pressure you into forcing him to school. I doubt they would, but still... it would be wise to document your son's anxiety. Get something in writing from the school regarding their concerns and his behaviour - you could do this simply by writing to them with a summary of what they said to you in the meeting: "Thanks for our meeting. I understand his teacher has heard him saying he wishes he were dead and that you are very concerned for his welfare" etc.

Letting your imagination run wild, in an ideal world what sort of educational setting do you think would be best for your son?

Wow lots to think about. He's quite excited about the parties etc over the next couple of weeks so this might not be the right time to take him out in some ways. In theory while I could home ed for short periods, I can't do it longterm - I'm a single parent and self-employed.

What would my ideal school look like? What a wonderful question. It would be one where he had a lot more 1 to 1 because he doesn't do a lot without it and one that would teach him maths and english in a more creative way that fits with the way he best learns.

He is due to move school at the end of this year and it seems the new school offers more support to children with SEN.

I might ask him if he would like to stay home with me a couple of days but that may make it harder to go back. Hmm need to think/talk more

oh dear, poor him, poor you. my heart goes out to you both. I would consider keeping him of school. get him signed off by GP, or call the paediatrician he is followed by even if there hasn't been coordinated intervention.

My ds had similair issues last year, although they were only apparent only at home. I would keep him off school if you possibly can.

We didn't have a diagnosis at that stage but had seen a community paed who made an emergency referral to CAMHS. That was useful as she got itno school and made some very helpful suggestions. Would your GP make a referral for you? I know CAMHS are often no good with children with that profile but our practitioner had a lot of experience with asd children

Oddfodd, with that level of self-awareness he's probably not as unable as he thinks he is, more likely bright (as you say) but weaknesses are coming to the fore in school. I'd push for a tertiary level multidisciplinary assessment of all his needs. It sounds more like a specific neurodevelopmental problem and targeted help could make him very much more successful.

Sorry that my earlier reply was a bit terse - I'm rubbish at typing on the phone and DS had co-opted the PC!

I would love to get him referred back to CAMHS but the fuckwit GP (did I mention that I hate him?) wouldn't do that as he thought his referral would likely be rejected as it would be seen as inappropriate. So he's started the CAF process. I argued that CAMHS have already accepted that DS meets the criteria for assessment and would accept a referral for MH issues if he was deemed to need that but the GP wasn't going to budge. I do need to change GP but I want to wait for a couple of weeks until he's actually done the CAF referral as otherwise I think it will slow things down even more.

I should go back to the school and ask for a re-referral. It was the school which initially referred him to CAHMS - the GP (different one, same surgery) didn't want to know.

Half days is a really good idea - I hadn't thought of that. That would definitely work for me in terms of my work (I know that sounds awful but I can't afford to piss off my clients) and might really turn down the stress. I'm going to ask for a meeting with his teacher to find out how we can manage him and whether we should do mornings/afternoons or a mix. She is really freaked out by him articulating such dark thoughts. From what she/the GP/family liaison officer have said, it's quite unusual for children this age to say things like this.

Scatter - what is a tertiary level multidisciplinary assessment please and how would I go about getting that (who do I need to speak to/what do I need to say)? And yes, he totally underestimates his ability - he has a reading age and cognitive ability well beyond his years, but he doesn't rate those. All he sees is that he can't colour in without scribbling, can't sit still for more than 5 minutes, and can't follow a series of instructions. Basically, he can't do things that all his peers find very easy indeed. So I really understand why he feels like he's such a failure.

I really think MNers should write a book - So you think your child has SEN?

I'm so grateful for you being so generous with your time and input. I hope I can pass it on one day.

I really sympathise with the work/school dilemma. It is a challenge often faced by home educating parents who work. There are various approaches, none simple, but perhaps there is something that could be right for you. It's true that school provides free childcare, but it isn't the only form of childcare.

Although school combines the functions of education and childcare, it's quite possible to separate the two. Because one-to-one attention is so efficient in learning terms, educating a child outside of school takes far less time than doing it at school.

So you might, for example, send your son to a childminder or after-school club while you work, and then educate him when you aren't working. That's what I used to do. If you qualify for the childcare element of Tax Credits then that may reduce the actual cost by quite a lot.

It isn't easy though, that is for sure.

A tertiary level assessment is a level above CAMHS. It would involve an assessment of neurodevelopment rather than primarily mental health. I suggested this because there may be a problem with his memory, attention, self-organisation, processing etc that's affecting everything else. You can usually get a referral as a second opinion after CAMHS can't help but often CAMHS think they've helped by calling it something else. Such teams are usually in big teaching hospitals or others with good neuroscience centres. You usually need to be referred by your paediatrician but they sometimes accept GP referrals, depending on waiting lists.