Why are CAMHS so fucking shit?

[Minifingers]

Apologies for the length of this. Long history of posting here about my difficult dd, now 15 and in year 11.

DD was referred back to CAMHS recently (we had had a pointless 12 weeks of family therapy which achieved nothing a couple of years ago) after telling her counsellor/mentor at school at the end of last term that she was suicidal. School promptly banned her from the premises as they felt they couldn't safeguard her there. This means she couldn't attend any revision sessions over the Easter holidays or the revision residential for children at risk of failing maths and English.

I have been anticipating and predicting this deepening of her problems - I told DH six months ago that she would have a mental health crises as her exams approached, as she had to face up to the mess she's made of her education, and experience the horror of sitting lots of exams she's not studied for at all.

I know she's very unhappy. How could she not be, after 4 years of doggedly oppositional behaviour towards us and her teachers she's got used to adults being exasperated and pissed off with her, and her self-esteem is very low. She is massively cheesed off with having to get up and go to school when she doesn't feel like it. Sometimes she won't go. Sometimes she goes but then buggers off somewhere. Conversely she certainly seems to have a lot of laughs with her friends, is out happily socialising every day and has been most days since telling her counsellor she was incredibly unhappy, so I'm a bit confused about her mood.

She is out at friends' houses every evening after school pretty much and every weekend. When she's at home she is horizontal in bed on her lap-top, coming out of her room only to demand food or money, or both. We've recently told her we won't give her money. She also does no school work and won't lift a finger at home to help. We have offered to pay her to study. She has said 'no' firmly to this and instead threatened to shop lift or beg if we won't give her cash for doing nothing. She feels that we have an obligation to give her money because she needs to buy cigarettes, and feels we should give her the money for these because she's 'stressed'. I'm anxious about what she'll do if we carry on not giving her money as a few weeks ago she stole my bank card for the first time and went to get her nails done, because I wouldn't give her cash. I did get it back off her, but she hasn't returned the money, and I've now lost all trust in her. Incidentally, neither DH nor myself smoke and we are very unhappy about dd smoking, but recognise that other than not giving her money for cigarettes we can't stop her doing it when she's not at home.

The psychologist at CAMHS has said that she is experiencing a lot of anxiety in relation to school and GCSE's. My response: no shit sherlock - DD has spent the last 4 years being chucked out of lessons, disrupting lessons, in internal exclusion, not doing homework, truanting, doing her coursework at the very very very very last minute and handing it in late, if at all, it's inevitable that the chickens which are now coming home to roost are going to make her feel severely anxious as she faces up to the reality that she has to do these important exams and she's probably going to fail.

When I pointed out that anxiety might actually be an understandable and rational response to dd's situation, the psychologist implied that the anxiety goes back much further than what dd is talking about now. I'm at a loss with this as neither I, nor DH, nor any of dd's wider family (who she's close to) or her teachers (many of whom like her, despite her bad behaviour, because she's confident and amenable and bright when she's in a mood to be) would have described her as an anxious child. In fact, we all would have said the opposite - that she has always been an unusually confident and self-assured child, even in the last few years of bad behaviour, she's still not ever had any problem communicating her needs to adults, and has had good friendships.

CAMHS view seems to be that her behaviour is the result of anxiety and that it's also 'relational' - ie, that it's because we (me in particular) have a poor relationship with her. Pointing out to them that our relationship was absolutely fine until dd became hugely difficult and oppositional, and that it's deteriorated because of her behaviour, seems to be water off a duck's back. They just won't acknowledge that the very difficult behaviour preceded the conflict in family, and that the conflict in the family grew from it. I feel that unless they acknowledge this, and also acknowledge that her lifestyle (constantly eating junk food, no exercise, spending prolonged periods of time in bed but staying up half the night texting and using the computer, having no hobbies or any activities which don't involve staring at a screen) may also be hugely compounding her problems.

Anyway, since she's been back attending sessions at CAMHS her behaviour has deteriorated - she's going out more and more, spending less and less time at school, and doing less and less school work (well, nothing at all actually). They've put her on antidepressants. Bizarrely, after having made a really big issue about how important it was for us to take charge of her medication (to the point of the head psychologist phoning me at home telling me that I needed to take the week's worth of fluoxetine they'd given her on her first appoint) they then gave her a prescription for a month's worth of antidepressants at her appointment, and phoned me to tell me to get the tablets off her. I pointed out that I'd told them that she was profoundly oppositional - hadn't they taken that on board, and that it would be very difficult for me to get the tablets off her if she didn't want to hand them over. Predictably, neither DH nor myself has been able to persuade them to hand them over, therefore we now have a situation where a depressed 15 year old is walking around with enough medication in her handbag to properly overdose - given to her by CAMHS, despite their own concerns about the risk.

Anyway, sorry for the rant, but I'm so fecked off with CAMHS - what they're doing with dd is like pissing in the wind. I feel like we're in a chicken and egg stand off - they see dd's oppositional behaviour as growing out of anxiety and problematic family relationships, we see dd's oppositional behaviour as having come out of the blue in adolescence (she was an exceptionally happy, confident and easy child up to this point) and that all the other things - low self esteem, anxiety about school, unhappy relationships with us, as having grown out of her being so doggedly confrontational and uncooperative, particularly her refusal to behave reasonably at school. I want them to explore why dd is so oppositional and see what can be done to help her help herself, rather than just medicating her, and pathologising her totally understandable and normal anxiety, which any child would feel when facing sitting important exams they've done no work for.

Incidentally, please no one suggest we should have home schooled. I'm very pro home schooling. But we tried it for a term when we were in the process of changing dd's school, and it consisted of dd lying in bed with the duvet over her head every day telling me to fuck off because she wanted to watch tv.

I totally agree with your statement about camhs, and citt , they were absolutely terrible. They totally fucked up with treating, diagnosing and helping my dd with her anxiety, depression, self harming and suicidal thoughts and attempts, she was always seeing different so called councillors, drs etc, but they didn't help at all, and never got to the bottom of her problems, gave her so many different anti d's , which had awful effects on her, I could go on and on !!! She is 18 now has finally opened up to a psychiatrist and social worker (after seriously self harming herself yet again) about what is really going on in her head, and what happened to her !!!! (which is absolutely horrendous and something a parent should never hear has happened to their child) I am still in a living nightmare at the moment trying to deal with whats happened and I am not sure whats ahead, but hopefully now she will get the help she so really needs.
Try and speak to someone higher up the ladder in camhs, tell them your not happy with their treatment, lack of help etc, I so truly wish I had, and maybe my daughter could of got the help she truly needed a lot sooner. Best of luck to you and your family. X

You mention the laptop, Junk food etc. Have you ever tried restricting access to these in the past?

Peer influence is huge. Read the Nurture Assumption. It is controversial but really talks about group socialization after ten. There's also the similarly titled but very different Nurture Effect which talks about behavioural science vs psychology as a means to reducing coercive behaviour. One of the key recommendations is to limit harmful external influences like peers who are oppositional and access to material that promotes coercive behaviour.

My aunt was in a situation not unlike yours when my cousin was a young teen. She was lucky to be able to do a Fresh Prince on it and he was sent away to boarding school courtesy of her wealthy brother in law but removing the peers changed everything. Alternatively if you could access an actual behavioural analyst or therapist to do clinical behaviour analysis and come up with a plan, I'd really recommend it. Don't know if those are financially viable but I really don't think some mh service approaches are suitable for behavioural difficulties.

Thank you Ashtray.

You know we finished weeks of family therapy (which must have been hugely expensive as it sometimes involved three therapists at once) without DH or I ever getting an inch closer to understanding why dd is so oppositional or how we could improve the situation.

A senior psychologist asked me if I felt the sessions had been useful. I said 'they've been interesting. I quite enjoyed role playing how we would get on if we went to the cinema together in a few years time, but we're going to leave here now and the likelihood is that dd will refuse to get in the car so we can drive her to school, and then refuse to get up in the morning so she can get to her lessons on time, and we still don't know how to respond or cope with the feelings that this sort of behaviour arouses in us when these things are happening every day, year after year.'

They just ignore me.

Hence giving her a months worth of antidepressants and them phoning us up and telling us to take them off her. I think - have you any idea of what it's like to live our lives? They don't have a clue.

The same doctor phoned me after one of dd's sessions and said that she and dd had been discussing dd's anxiety about returning to school after the Easter holidays. She said that DD had asked her to phone me and say that I should drive dd to school, as this would help.

She seemed a bit put out when I pointed out that dd has engaged in an ongoing daily campaign of threats and demands to try to make me drive her to school for YEARS because it's easier for her, (she can spend an hour in bed texting, followed by an hour putting makeup on and fiddling with her hair, leave at 9am and only be half an hour late). Asked her if she had realised that the issue of lifts to school had been a flash point for years and that perhaps dd might have not been entirely honest with her about why she wanted to be taken to school... She didn't respond.

"You mention the laptop, Junk food etc. Have you ever tried restricting access to these in the past?"

The only way to stop her eating junk food is to stop all access to cash completely, and this has been very difficult to do.

We should have taken the lap top away, but she's so threatening and forceful that we allowed her to continue to use it, as all attempts to restrict it resulted in such spectacular nastiness that we felt overwhelmed. Ditto with her phone - attempts to take it ended up with the police being called. :-(

"Alternatively if you could access an actual behavioural analyst or therapist to do clinical behaviour analysis and come up with a plan"

Thanks - I'll look into this.

Is there any possibility that something happens en route to school, or in morning reg that makes your dd anxious? Like teasing or just too noisy or something? I appreciate I may be talking crap though but the delaying tactics could be displacement activities?

Hmm is she having unsuitable online/phone communications?

op every post resonates with my 13 year old niece. We have had the week from hell but looking back it's been rumbling on for the past 12 months. CAHMS are shite

She stole about £160 worth of stuff from my home the other day. Youngest of four kids which are all fine we are all struggling to deal with what she is doing. There is other 'stuff' which is which I don't want to divulge but I seen the signs about a year ago but her parents would not listen .

If you know the tablets are in her bag - get them. It doesnt matter if there is a fight.

I'm at my wits end as my SIL is really passive and doesn't want to cause a fuss but I seen this coming last year.

You absolutly can stop the Internet (which I did with my own kids) gave every body else the password.

Let the police be called. Who is parenting this child? My niece tried to through her mother out of a window the other day because she never responds appropriately. My niece is constantly posting on facebook about suiside yet when she visits me (3 times a week) she is very upbeat. I keep begging Sil for councilling but she won't do it.

I think somthing has happened that is making her this way.

Somthing is wrong for your dd to be acting this way

Too tired to read everything, but they've been pretty much squeezed until their eyes pop over the past few years. And that's resulted in some ridiculous policies, in some areas.

And now I've bmped to myself, I shall read properly tomorrow, if the boys let me.

A lot of this behaviour sounds familiar, my dd is 17 and went through the mill with CAMHS and they were utterly useless. They are stretched and I understand that but they also participated in so much parent-blaming that I could never recommend them to anyone - although jumping through their hoops was a necessary process to finally get some real help. I only started getting answers (PDA and ASD dx) when I finally became frustrated enough to see a psychiatrist privately though. She talked us through all the behaviours that dd had exhibited (oppositional behaviour, superficial social skills, anxiety) that CAMHS tried to attribute to poor parent and explained how they were classic PDA symptoms.

I think that it's extremely difficult to get any help through CAMHS and the only time I've seen it happen is when it's really been too late (when police have become involved, teen has self medicated using drink/drugs etc, suicide attempts). DD gets all her support now through school (private ASD school funded by LA, placement was only won because I had professional reports that I had to seek out and pay for as a single mum).

So the only advice I can give is seek out the professionals that will help, and it will probably cost a fair bit, but if you wait on CAMHS to help it might come too late.

"I understand that but they also participated in so much parent-blaming"

This ^^ really.

I know my reactions to dd's behaviour haven't improved things. She's angry with me for being angry with her and feels rejected because she knows we're disappointed in her, but I don't know how not to be angry and disappointed about her behaviour. Over the years I've learned to manage my emotions about it all a bit better and my relationship with dd is less volatile now (it's constant - she just utterly hates me but I'm fairly accepting and calm about that) , but that's no thanks to CAMHS - that's thanks to the advice I've had from this board.

"Who is parenting this child?"

My dd has been acting up for 4/5 years - we have gone through everything and come up with no answers to explain her behaviour. We have been in survival mode for a long time. Maybe your SIL is in survival mode too, where you stop trying to tackle problematic behaviour for fear of sparking something worse - running away, self-harming, violence. We just put our heads down and plough on, waiting for time to change dd (because in our case these problems started with adolescence, and we're hoping they end when adolescence ends - when ever that is).

That all sounds dreadfully hard for you

I dread this happening with my DDs. As a secondary teacher I've seen lots of teenagers lose the plot a bit and wondered what triggered it.

Minifingers. No advice to give just to say I totally empathise with you. This could have been my DD at that age. No contact with CAMHS though. We actually got an appointment offered 2 YEARS after referral. I don't know what the answer is but just hope it gets better for you all.

Minifingers I know this is a long shot as it was 3 yrs ago but did you ever get a diagnosis?how are things now?i couldn’t believe it reading your story as it could be mine.x

the EFFRA clinic in London (private through Maudsley NHS hosp) will assess your child for ADHD. I know two children 16 and 17 boy and girl who exactly match your description.

I don't want to generalise because I am not a clinician but sometimes in ADHD the desire for stimulants is a wiring issue, cigarettes and alcohol and computers are all ways of regulating brain, that's why children with ADHD crave computer games, cigarettes, alcohol, sugar,. Children /teens with ADHD can have no problems socialising, but possibly lots of highs and lows, and disturbed sleep (partly due to the socialising and stimulants) can make things worse. Anxiety can follow from ADHD because it is natural when everything is going wrong to feel anxious and a failure, however many times everyone tells you that you will be happier if you behave. 17 year old I know now has two jobs, both creative catering/people skills jobs and is brilliant. when he tried to do A levels it was a disaster because he couldn't concentrate. when he works at a task, which is physically challenging he can. Photography, Art, D & T, carpentry cooking drama music can all do what school work cannot. And school work makes the issues worse because they feel a failure. There are lots of level 2 courses that lead to level 3 in vocational subjects at colleges, up to 19 they are free. I would suggest you get her onto one rather than plugging away at school. They will do English and Maths inhouse.

family of 17 year old went through hell. Job has changed everything, like a light switched on in his sense of self worth and capability/reliability. the days when he doesn't work his mum says he starts getting anxious and rude/twitchy again. He didn't know that work was the answer till he was dropped from school.

I actually Agree with you they wasted 5 years of sessions I am about to leave My School And they have done nothing.
Unfortunely I Was Clinically depressed still am. And was at risk of suicide. They Left me and my family In the gutter.

I have very low expectations of CAMHS. We saw numerous people with our ds who has severe autism and LD. They were not just useless but actually didn't recognise it. They made things worse not better. I have not heard anyone say anything good about this service for a long time. It simply isn't fit for purpose.

Did you check for ADHD or ODD (oppositional defiant disorder)? ODD is typically found at kids with ADHD.

I was like this as a child to the point I put myself into care I changed during the 6 weeks holiday from being top 1% for sats to by the time I started secondary refusing to engage at all causing trouble on report and eventually school refusal do u know what my problem was ? I had started being sexually abused in the holidays before starting secondary school camhs where shit then social services , police and in all honesty my mums although tried her best camhs are right about one thing there is something wrong some where children don’t change that drasticley wether it be mental illness or some trauma you don’t know or haven’t realised has happened.

Agree with a couple of the posters - I immediately thought ADHD (we're currently exploring a diagnosis for my youngest who also has the oppositional reflex). I also agree though that it's worth exploring the potential abuse angle if things started very suddenly...

Great idea to consider looking for a job, or maybe some voluntary work for her? - something to break the cycle and introduce her to more positive influences/peer groups. I imagine though, you're thinking 'she'll just say no', and you're probably right if it's coming from her parents... a peer mentoring scheme might nudge her in the right direction?

It does sound like you've both been pretty much broken down by this - entirely understandably given the lack of support and real, practical advice/help. In the short term, I'd focus on building YOU back up - some solo counseling perhaps. You need your strong parenting juices to be refilled, so you feel like you're back in the driving seat.

The phone/laptop issue seems like a small concession given the onslaught, but really it's EVERYTHING. You need to have the strength of your conviction and follow through, even if she spins out as a consequence.

I hope this doesn't sound judgy btw - teenagers are a fucking nightmare at the best of times.