Posting on behalf of my Mum, I am scared of and for my sister.

[Claeseen]

We live in the UK, I'm 25, my 'little' sister (LS) that this post is about is almost 15 and 5'8, my younger brother (YB) is 13 and my youngest sister (YS) is 12. All three have the same Dad, my Step-Dad who divorced our Mum about 9 years ago.

When LS was about 10, she was diagnosed as having autism after years of campaigning by our Mum.

When she was younger her behaviour wasn't as excessive, she would pour drinks on our heads, push us, hit us, break our and her things, but Mum and my Step-Dad could handle her, she'd get things taken off her, grounded, but she never seemed to care.
Fast forward to when she was about 12 and her behaviour is escalating.
She's left many scars on our LB, she hits our YS for looking at her... But she's perfect at school. At home someone touches her coat so she has a melt down and tries to strangle my dog, but when other people are around she can control it, which is what I'm unsure about.
She ends up living with her Dad, but still comes to the house and terrorises us "it smells like wee in here" because we have pets, saying YS stinks, starts trashing the house, me and Mum get all the pets on the other two and lock ourselves on the conservatory so she can't hurt us, house get trashed, things we've made or expensive things we care about are trashed, she deliberately goes for these things.
She finally leaves, she walks off all the time and you can't restrain her. When she was younger she would run off whenever she was upset regardless of where we were and police had been called to make sure she was safe.
She has a fall out with Dad and runs away from his house and wants to come to Mum's, we say no as LB is terrified of her and is having a negative effect on his mental health.
She smashes the window on our front door and runs off.

Last year Step Dad gets in a bad road accident, luckily survived, but is now paralysed from his chest down, luckily he has use of his arms and hands and can breathe by himself, but still very sick and a lot of healing to do.
While he was in hospital LS lived with his parents and after a few months her behaviour picked up for them.
Now.
She's back living with Dad, but he has carers, so any conflict or violence in the house and he will lose his carers, which he needs to get out of bed, to change his catheter, to set his machines and to move him so help his pressure sores.
She's not been to school for over 20 days so we have the threat of court proceedings, a lot of social workers and attendance officers coming over, but she barricades herself in her room so they can't see/speak to her.
Mum went over about two weeks ago to try and speak to her to get her to go to school and LS pulls a knife on Mum.
Mum just leaves and let's LS calm down.

Last night LS decided she was too hot, despite wearing a dressing gown and being under blankets, so asks for central heating to be turned down, Step Dad is cold and needs the heat and so she is told no.
She goes upstairs and starts slamming and hitting the doors, trying to break the walls, etc.
So Step Dad phones his Dad, and LS pulls a knife on him then starts smashing up her room... While the other two were there spending the night.
Police are phoned and after about an hour they haven't shown up and she manages to run off.
Police are phoned again to say she's run off and they get to the house straight away, after about half an hour she's found and they follow her as she walks back onto the house, the second the police leave she runs off again, so police try to get her back into the house and she's completely ignoring them.
When she does go back into the house she barricades herself in her room and starts smashing more things.
After speaking to the door for a while police barge door down and she's very aggressive to the police to the point they have to phone their Sargent.
So she goes downstairs and starts threatening to turn of Step Dad's machines, threatening the other two, laughing at everything.
Step Dad doesn't feel safe and has asked her to not stay at his house, she refuses to go to Mum's or Grandparents, but social services can't be contacted until Monday.
The Sargent tries with her for about half an hour to talk to LS, but LS is being awful.
Unfortunately another incident comes in and as she's now in the house, they leave her.

Cahms won't work with her and have removed her from their books.
Team around the family want to help, but she won't accept it.
Social Services are now involved, but I'm scared if she's taken somewhere else she could seriously injure someone.
Mum is concerned LS, as well as having autistic traits and OCD, could be a socio/psychopath.

What can we do?
Mum is completely devastated, she's done everything she can and doesn't want to give her over to social services, but we're out of options.

There are no child mental health wards, police won't detain a 14 year old with mental health problems, she can't stay with her Dad anymore.

What on earth can we or anyone do?

What an awful situation for you all. Your poor mum, poor stepdad, poor siblings, poor you, and poor LS. No matter what the cause or what the problem is, what is happening now can’t continue. Your mum can’t take her in as it’s unsafe, and it’s no longer possible for her dad to have her at home as he needs care himself. I really think the only option ahead is for social services to step in and take on her care. I don’t have any experience of what form that would take, but I can’t see what else you can do.

This is just an awful and difficult circumstance, that isn’t anyone’s fault. It’s not failing to accept that the best care for her might not be with family. That’s choosing to do what is right with a poor set of options. I wish you all the best

If she could be diagnosed with a personality disorder would that qualify her for some sort of treatment?

Mum is completely devastated, she's done everything she can and doesn't want to give her over to social services, but we're out of options.

Your DM is being unreasonable here. She won't have your LS in her house, but she's happy with her living with your step-dad, a disabled man who is completely incapable of keeping an eye on her and whose safety and welfare is compromised by her presence, to say nothing of the stress of her behaviour. OP your DM needs to bite the bullet and tell SS that the family can no longer cope. Your LS sounds terrifying to me, your YB is terrified of her, you have to barricade yourselves into the conservatory when she comes round while she trashes the home, and now you're all worried that she's not only autistic but could be a psychopath! FGS what has to happen for your DM to face the fact that no one in the family can cope with your LS, keep her and everyone else safe? She's threatened members of the family with knives. Wake up the lot of you! She is a danger to your family and quite possibly those outside it. When she's waving a knife around what if she kills someone? These horror stories in the news about someone with a mental illness attacking and killing some poor stranger who was in the wrong place at the wrong time come are borne of situations like this one with your LS escalating and escalating over many months and years and the family begging for help. You've reached the end of the road - your DM has to hand her over for everyone's safety.

Why have camhs stopped working with her and what type of support did they offer? They should have a neurodevelopmental team who specialise in autism, ii would ask for a rereferral. Ultimately if your ls is refusing help but is a danger to others social care have to step in under safeguarding which it sounds like they are. Taking her away would be a last resort and they will try their best to support your family.

In the mean time I think calling the police is the correct thing to do if people feel in danger. So sorry you are going through this.

Completely agree, I advised DM to ask for help from SS about a year or more ago.
Step Dad until now has also said he didn't want her going with SS.
Unfortunately from what we'd been told, even if she went with SS, as she has mental issues they can't just detain her, but Foster families are just volunteers and I strongly believe they wouldn't be able to deal with her.
We've been told there are currently no spaces in foster, but there's no where else they'd put her.
I think Mum is more scared that other won't know what her triggers are and she'll be completely unmanageable and escalate her behaviour even faster.

Cahms stopped working with her because she's violent.
She's been in A&E before for threatening suicide and the nurse did file a complaint that Cahms was refusing to work with her.
Luckily after last night the police are filing an official report and have said that if Cahms wanted an escort they would be happy to provide one.
Thank you for your support.

Unfortunately from what we'd been told, even if she went with SS, as she has mental issues they can't just detain her

Can she not be sectioned under the Mental Health Act and assessed? If she's suicidal and all the other dangerous and violent things you've listed above I'd be utterly amazed if she could not be detained, both for her own good and those around her.

Definitely seek re referral and if that doesnt work complain via pals/camhs/etc. Make a noise, get gp to wrote supporting letter, she needs support.

It's all very well to not work with someone due to violence (and I absolutely support staff safety being priority) but it cant just be a case of "no, closed" ; there either needs to be a referral to a service that can cope with the issues or a solution found to enable work to take place with camhs. The problem (as you well know) doesnt just go away and its irresponsible of the service to leave you in the lurch so to speak. Is your ds at mainstream school? Does she have an echp?

As I said, social care will try to support her being at home but if they do place her someone else it will be down to them to risk assess any placement to ensure all involved are safe and competent to care for your dsis.

OP, please take on board @zafferana comments as what they say is important. Your LS appears to be a risk to herself and others. The child requires professional help in an appropriate and supportive environment. This should be arranged while she is still a child as things are much more difficulty arrange on her behalf once she becomes an adult.

Honestly your family need to refuse to have her home due to her risk to others and herself.

She may have PDA?

She will likely be housed in a secure residential unit tbh.

I've seen friends go through similar and it's the only way everyone has been kept safe.

You need to contact the emergency duty social work team for children's services in your area. It is clear that LS cannot stay with her dad as he cannot cope given his own care needs and the risk she poses to him. Your mum cannot care for her as she is a risk to your LB (I appreciate she is also a risk to you but you are an adult and not vulnerable). Therefore your mum needs to ask social services to step in and provide care be that foster care or residential. I am surprised that the police didn't contact the emergency duty team TBH. Dont be fobbed off with children's services dont open until tomorrow. There is always a worker on duty even on xmas day.

I do completely agree, I made this post to find what that is.
As I replied to Zafferana, I had advised to my Mum to get SS involved over a year ago.
I've been speaking further to my Step-Dad and SS is already involved with her, but they aren't doing anything as she's shutting herself in her room and refusing to speak to them.
I honestly don't know what that environment is.
There are no child mental health wards.
She's been on an adult mental health ward for a few days, but that had a negative impact on her.
As she's under 18 we've been told they can put her on a normal paediatric ward, but they can't restrain her.

Meow1989, she is in mainstream, originally when she went to high-school when she was more manageable she chose to go mainstream and the school does have a good special needs department, but with her escalating behaviour she's been on a wait list for our local special needs high school for more violent students for over a year. As with the nurse who filed a complaint against cahms, the SS worker that's been seeing LS lately has also been on the phone with cahms, but has also found their response to her to be unacceptable.
As I've said SS have said they'd take her into foster care, but there's currently no spaces and most Foster parents are volunteers who do not have the experience or knowledge to deal with an individual like LS.

In my previous career I dealt with a child that turned off the oxygen supply to their relative and nearly caused their death. They were unsympathetic and found it funny.

I don't want to raise alarm but these things should be taken very very seriously.

No matter her diagnosis or potential untreated problems- she is causing a danger to vulnerable people and needs more intensive input.

There are both secure children's homes and secure units for children with mental health issues. They may not be local to you but they do exist.

Sometimes being further away physically is easier for the child as it gives them distance and it can be better as well as absconding is less likely in an unknown area.

I work in Child Protection and your situation is not unfamiliar.
Time and again the one agency (CAMHS) who should be helping refuse, as it’s too difficult. Do they expect children with MH issues to behave in a calm and co-operative way?
Social services can do very little without CAMHS being on board.
Very frustrating. I have every sympathy for you all

That doesn't sound typical for "just" autism, tbh. Autistic people are not typically known to, for example, manipulate the police by pretending to go home but only when being followed. That requires excellent theory of mind and ability to step into another person's viewpoint which is not typically a well developed skill in autistic teens. Autism "challenging behaviour" is more typically distress based or sensory overwhelm based. Not cruel.

Who looks after her? When did this start? When is she calm and happy?

Thank you again everyone for all your input.
For us this is a very surreal situation and it's just reassuring to know that these things, unfortunately, do happen and I'm very much wanting to know and prepare for what is most likely or most recommended outside of our small town for children with this behaviour.
Because she's only threatened and not actually physically hurt anyone with the knife, the police say there's not much they can do.
Hecatah, thank you, it is reassuring to know there are facilities that will work with LS and keep her and the family safe.
Unfortunately with your comment regarding absconding, she literally does not care where she is. We've been on holiday in cities and other countries and she's run off.
She has no regard or no concept of consequences.
Thank you RandomMess for mentioning PDA, we were completely unaware of it, but seems to fit her to a T. Hopefully if we suggest PDA going forward that will put her in contact with the right services and people who can help.
PurpleFrames I'm so sorry to hear you've had to experience something like this, very luckily Step Dad is not on an oxygen machine, but she can be malicious in her actions towards him if she's told no etc.

OverByYer, it's just awful CAMHS is letting down so many of the children they are supposed to be supporting. Hopefully others in similar situations can find this thread and know that CAMHS is wrong for refusing help for vulnerable children.

She needs a residential setting with 24 hour support. It really is the only option and will be life changing for her in a positive way. Keeping her at home is actually selfish and doing her no favours at all.

@MbwaKidogo Myself and many members of the family agree, the way she can control certain aspects is not normal for Autism. It's part of why it took so long for her to get diagnosed until she had a melt down when she didn't witness my LB wash his hands after using the toilet. She doesn't like being touched and she showers three times a day. She also has to wash all her own laundry because if anyone else touches it it's dirty. She also Bleach cleaned the shower after YS used it because it was dirty.
PDA definitely seems to fit her better, but she is happy and calm when she is not around any other people, no other people have touched or seen her things and she can listen to her music.
Being around other people seems to be a constant struggle for her and she's identified that herself.

You will likely have to play hardball. Your Mum and Step-Dad both need to refuse to have her home as she is constantly threatening to kill etc.

Literally saying to SS that they are kicking her out and won't have her back.

I know it sounds an evil thing to do but it is probably the only way to get her in a specialist unit quickly before she does seriously hurt someone

That's where we're at now.
DM has said she won't let her live at her house, neither will her Grandparents or Aunty.
Step Dad said to police he doesn't want her in his house, but as he's unable to get out of bed he can't remove her himself and he was just told that there's no space in foster care and to wait until Monday, despite telling them repeatedly he does not want her on his house.

RandomMess that's what we had to.do.for my DD and it's the best thing we ever did for her. She's thriving. We all are tbh.

I'm afraid you've been misinformed by SS. Most foster carers are well trained and well paid in my experience in social care (it is of course a fantastic job that they do and they should be duly compensated but most are not volunteers at all). The issue you must be forced with the family simply refusing to house her. There are always emergency spaces. SS may not want to fund this but they will have to.

To defend CAMHS a little here, she has a diagnosis of autism and they are a mental health service. Their treatments are mostly not appropriate for children with ASD. CBT techniques are generally unsuccessful and these kids often struggle in therapy. Clearly there are questions over whether that is the right diagnosis for her and there is more going on than ASD. Other things can look very much like ASD such as attachment disorder and someone else has already mentioned PDA.

In that situation it's very difficult as children and young people will often fall between two services and be let down but this is not entirely CAMHS fault.

I'm sorry if I've missed this but is she on any medication and who is prescribing this?

As for the immediate situation, it's worrying that your very unwell stepfather has been told he has to wait until Monday. Maybe they've looked for emergency residential placements or foster carers and there just aren't any.

There are carers who are highly trained and have specialist skills to care for young people like your sister but I'd imagine there aren't that many of them geared up for this and it would almost certainly not be local to you.

What an awful situation, I'm so sorry.

Thank you, its honestly nice to know that they aren't just for children suffering with autism as I was under the wrong impression that they were, what you've explained makes a lot of sense and I do understand where they're coming from.
It's just difficult that there doesn't seem to be a service designed specifically for children with ASD or similar disorders which can cause them to present more aggressively.
She is not currently medicated, the only thing we've been told she would be prescribed would be seditives and I'm not fully aware of what happened with the meeting, but my Mum, Step-Dad and Doctor all agreed that would not be the best for LS.
Thank you also for info regarding carers, I'll pass this info along to DM and SD and I'm sure it will help them feel more certain with this choice.
It is just an unfortunate situation and if any number of things had been different things may have worked out.
I'm aware this is no single person or service's fault and everyone is trying their best for LS, but she does need more help than family can provide.
Unfortunately myself and my partner are renting somewhere in the middle of nowhere with unlit national speedlimit roads so I would not feel comfortable being able to keep her safe if she would agree to live with us (which she shouldn't as we have pets).
It's juts so difficult that we can tell her these things, but she doesn't fully understand and so she's saying she doesn't care.