Getting a child medically signed off school. Am on the right track?

[ouryve]

Just had a call from school and DS1 is raging again. I can't keep sending him in. Almost every day since going back, there's been something big. He's so constantly distressed and angry. School, as it is, is harming him, mentally.

I'm going to call CAMHS for advice, but am I right in thinking that I need to get the GP so sign him off? I know there's people who have done this before.

Legally GPs can only issue Sick Certificates for employees and so there is no requirement for him to be signed off by the GP. Some NHS trusts send snotty letters to GP and say they should charge. But I took DS1 to the GPs to get him signed off to keep the school and the EWO on board. The GP used the form used for employees. This was not sufficient for EOTAS tutors rather than the school sending home work etc and the LA requested a letter from a consultant. Mine was a report from dev paed which was accepted.

There was no conflict with the school or EWO as DS1 had never attended the school and the senco was great was prepared to say that it would be counter-productive to force him. This was anxiety though manifest internally. Your DS1 may be feeling just as anxious but just displaying it differently. It all comes down to not meeting needs.

Claw will have more experience wrt to getting a letter (if you need/want one) from CAMHS.

I've tried to call CAMHS and the psychiatrist we see has back to back appointments all day. Have asked if he can give me a call, if he gets a chance. I'd rather talk to him first because most of our local GPs are clueless about his disabilities.

It's definitely anxiety. That's been a problem for years and school has never been plain sailing for him, even with lots of 1:1 support and various accommodations. We've been actively trying to get him out of mainstream for a while. Even have an offer of an Indy placement, now. The ball is in the court of the LA, there now. We have a tribunal date, but it's not until May.

When he's not raging, he's grumbling and so incredibly listless. He's never been into just sitting and watching TV, but he's been doing an awful lot of that. He's also developed tics, over the past few weeks. Something he's never had a real problem with, before. After Friday's to-do with refusing to walk home, I expected him to refuse to go in, this morning, and I would have gone with that, but he put his uniform on and everything without a single word of complaint, happily walked in and seemed relatively chipper. Then it got to break and something flipped.

Our GP refused to as he thought we needed to stay in the system to get help - this was before we had a diagnosis or statement. It was probably a year after this discussion that we did end up withdrawing ds2 from school without a GPs note and wrote to say what we were doing to every possible person we could think of schools, CAMHS, paediatrician, SEN team, exclusions officer, EWO. Despite my letter he did actually stay on the school roll and they did send some work home. We had no complaints from anybody to my surprise.

One thing we did find is that ds2 became even more depressed and withdrawn once he stopped going to school (hadn't thought it was possible as school was so dire for him by that stage) so recommend you to have a plan so that he is not doing nothing.

Following my relocation I'm officially educating otherwise than at school while the LA consider my request for SS/online/anything but yet another disastrous mainstream placement.

3 total failures tell me DS can't cope in mainstream, (or that mainstream staff can't/won't cope with him!) and I'm unwilling to waste yet another of his childhood, knowing it leaves him a mental wreck. Mainstream is a game I'm not playing anymore as the price for my child is just too high.

Deregistering but making it very, very clear than it is only temporary until a suitable placement is found is an option. I'm using it now, and used it for a term in reception too.

If things get really serious a trip to A& E means the child HAS to be seen by a shrink within 7 days. It's a way of bumping the waiting lists if you are in real crisis, but obviously should only be used as the final nuclear option when all the usual channels have failed.

Home ed has given me my child back. No signs of depression here, but lots of youthful mischief and enthusiasm .

OneInEight - he's been in the system, with help, for his entire school life. On EYA+ in nursery for 5 terms and then started in reception with a statement in place. We've lurched from one crisis to another, he finally started to pick up at the end of last year (fab class teacher really helped there, I think). We've been back to the usual headaches, since September and he's completely crashed, since Christmas. I'd say he's depressed. Where he is, with the help he's getting, is clearly not good for him.

Bochead De-registering isn't something I want to do at this point. School are supportive and DS2 is flourishing there in ways that DS1 never has. I have no idea if keeping him off is going to improve anything or will take me down with him, at this point. I'll be organising his day for him, from the start, though, otherwise he'll spend it looking at coins, reading about coins, searching for coins on the Internet and being bored of coins.

And you, know, I do wish DH would check his email and reply, even if it's just with a flipping grunt.

So, DS1 was extremely quiet on the way home. Hardly said a word apart from the odd mutter to himself - internal dialogue out loud. He's usually mithering all the way. Since he's been home, there's been lots of pacing, poking and griping. And no tolerance of DS2, at all.

I'm keeping him home, tomorrow. I warned school that I might, since he's plainly not well. Didn't hear back from CAMHS, today, so I'll try again, in the morning.

DH is forgiven re: the emails, this time. His phone was refusing to cooperate :o

And I'll be informing the EWO. Had them on my case, last year, when he was off several times a term with the migraines.

How is your application to the indie going & is it possible to hold out till then - probably not given the reluctance of LA's to accept these things.

I have just remembered we also kept ds1 off a week when he was very, very stressed. Not a great solution as he then refused to go into the school at all and the HT terminated his managed move - it did end well for him as he then got put into a BESD school where he is thriving.

Will your ds2 accept your ds1 being off school - that was another problem we had. Forcing one to go to school when the other wasn't was a nightmare.

Hi Ouryve, Local CAMHS are pretty useless when signing a child off from school and are very reluctant to do so in my experience. They would not recommend anything until they have assessed and even then it would probably be reduced hours. They are of the opinion than letting a child avoid something totally is counter productive.

CAMHS in A&E were much more helpful, probably as they can section people and are highly specialist, not like local CAMHS. They wrote in their A&E report if sending ds to school caused an increased his self harm and thoughts of suicide, then not to send him.

Our EWO was also extremely helpful, I contacted her. She paid us a home visit. I showed her a copy of A&E report, the pictures ds was drawing, pictures of him killing himself and she met ds and could see how distressed he was. She sat there and actually cried (not very helpful to me, but at least she had a heart!) and she told me to take ds to GP and get GP to sign him off to cover myself.

She told me that she would send a representative from medical needs team to the next meeting in school. Local CAMHS (who had not yet assessed ds) and social worker attended too. I couldn't attend, as I couldn't leave ds.

A plan of ds attending for one hour a day was made. I couldn't get ds to attend for one hour. CAMHS eventually signed ds off school, I have to say very reluctantly and with a lot of pressure from me and medical needs teams. Also social worker was pressuring them to make a decision (although she was hoping for the opposite) she still put pressure on them to decide one way or the other.

I would say a GP will not sign off indefinitely, without some sort of plan, they cant. My GP signed off until further CAMHS assessment and decision was made.

So Ouryve, I would suggest, depending on what you think your ds's level stress is and what your situation is at present.

a) next time school phone you telling you how distressed your ds is, you suggest picking him up and taking him for mental health assessment in A&E. Hopefully school will agree to this, if your ds is so distressed they have had to phone you daily? Local CAMHS are then suppose to follow up assessment in 7 days.

or

b) Take your ds to GP and ask if he/she feels an emergency mental health assessment is necessary.

Depending on your relationship with school/LA. In our case school/LA were already accusing me of exaggerating need as they had refused to SA. IF that is the case, it will help you, if you can get someone else to agree this is necessary, beside you. IF school are already backing you, then a) as above or c) as below.

c) get GP to sign him off until CAMHS assessment and ask GP to refer to local CAMHS as matter of urgency.

or

c) Suggest to school reduced hours to see if this helps. If it doesn't then as above.

OneInEight - he's been offered a place. it's all between us and the LA, now. We have an evidence deadline, next week, so we'll have to see what they submit to determine how dogged they're going to be.

claw sorry, I haven't got time for a long reply, for now, but that's all food for thought. DS1's regular CAMHS appointment isn't for a couple of months, so I definitely don't want to wait that long under the circumstances.

Spoke to HT, this morning, anyhow. I'm keeping him home and busy for a few days to see how he responds and if we can break the cycle. Already, with just me and him and no DS2 for him to focus on, he's more amenable to being directed to do stuff, even if he doesn't enjoy it. He's drunk without being told he has to and he's been to the toilet without arguing. I've got him doing some creative writing, at the moment, which he hates doing to the point of regular meltdown. We had a reasonable conversation, in which he indulged in word play on the way home from taking DS2 into school. He's still doing lots of tics. We'll have to see if they die down. And we'll have to see what happens when he's re-introduced. HT has him down as educated elsewhere. Most of his class are on a residential, this week, so he's not going to be missing anything important.

And everything will be in writing. For all the difficulties he's had at school, over the years, we have such an inconsistent paper trail.

Ourvye have the LA agreed the placement?

They haven't, no. We're awaiting tribunal because his current statement is so out of date it's laughable. They'll not be in a hurry to make things happen. They ignored their own EP when they refused to amend his statement.

Whatever they decide, we can't keep stumbling along like we have been doing. Everything we do as a family is currently dictated by DS1's stress levels. He's been telling us he's fed up of life. While, as parents, DH and I might be able to tough it out and firefight, DS1's almost constant anger is hardly pleasurable for him and he has a younger brother with his own needs to think of. Poor DS2 couldn't even hum a tune without being yelled at, last night, and when he's had enough of DS1's stress fuelled tyranny, his behaviour becomes incredibly difficult, too. The status quo is simply not sustainable.