Self-harming teen - GP referral or college counselling service? Advice please!

[Indecisive2018]

Advice please. My 16 year old boy has been struggling with depression for the past year (low self esteem, social anxiety and holds himself to high standards), and we recently found out he has been self harming since January (cutting around waist so he can hide it, and has done arms).

He won’t speak to anyone but me, and I have been trying my best to help him, but am feeling way out of my depth. He doesn’t want to speak to any counsellor or doctor, but earlier this week I found more bloodstains on his bath towel and in his room. I am scared this self harm is going to escalate. So I was more forceful in saying he really needs to speak to a professional now (was that wrong to do??).

Should I make a GP appointment (if he agrees) and see if they can refer him to a counsellor? (Will there be many months of waiting lists, so should we do this asap?). Alternatively he started at college three weeks ago and looking on their website I can see they have a mental health team with counsellor appointments available next week - would that be as good?

Which is the best option? Should he be on the NHS system asap as I’m aware waiting lists are probably very long and he might need CBT / more than a college counsellor can provide.
Equally I am frightened a GP will just stick him on antidepressants and I don’t think that’s the answer - he needs talking therapy and maybe CBT to reframe, as he has a exceptionally negative/untrue perception of himself. He has friends, hobbies, is a high achiever, a lovely personality and a great sense of humour but he can’t see any good qualities in himself.

I offered to support him at whatever level he wished, help arrange it, drop him off, be in the waiting room etc - although I assume as now he is 16, he has to want to go in on his own or there is nothing I can do?

(For background info, a family member has attempted suicide before - years ago & my son is unaware, but there are mental health issues in our family).

The college counsellor may well be part of the 'Mental health in schools team (MHST)' - do check with the college that's the case. If so, they're part of your local NHS trust, under CAMHS. The counsellor will have a basic training (they can offer CBT) and will be able to help in most non-complex cases, if your DSs problems/level of risk feel outside of their capacity or he still has difficulty after seeing them for however many weeks they offer, they can refer him into core CAMHS for more specialist intervention (that would be a long wait)

If the school counsellor is not under MHST, then yes I'd ask for a CAMHS referral (via college or GP) and expect a long wait.

Do you have any funds to see a private therapist?

If you can afford it go private and immediately. He also needs to get on with the person hes seeing so he can open up. NHS is hit and miss.

College, access can be virtually immediate. Potentially less intimidating for him too. Lots of colleges have a self referral system, or something similar, to make access easier. College counsellor should refer him on if they feel they can't help.
What does he want to try? What does he feel would be easiest way to start? Ideally he wd approach or email himself, or perhaps with a trusted friend, if he can. I'm sorry he is going through this. He may have immediate access through wisdom app at College, or similar. Try and help him to explore or ring college and ask for guidance for him anonymously.
Can he think of anyone at College he feels like he could talk to? Any adult there should be able to help ease the path to an expert for him.

Years ago my dd was in a similar situation and she approached the college for help. They also helped her to contact a local self-help group for self harming who supported her as well. It might be worth seeing if there is a specialist group in your area as well.

Thank you so much for explaining that @LavenderDisco that’s really helpful. I will find out if college service are MHST.
And thanks @Mysticguru
My husband has just found out we can get private health cover for our son through his work policy, but it won’t start until January next year. That felt like such a long time away - but I guess NHS waiting lists are very long anyway, so maybe we should sign him up - it’s not cheap but we could just about stretch to it. And hopefully the college service could give him some sessions in the meantime to help him.

@Rubberfrog
He isn’t keen to speak to anyone at all. Part of his struggle is he feels that he can’t talk to people/doesn’t have social skills, so the idea of exploring help options himself wouldn’t happen. So I will need to be super supportive and persuade him.
I fear he would let the self harm fully escalate to the worst case scenario before seeking help himself.
I suggested the college counsellor route or GP route and asked him to have a think about it, and that we will chat again soon. He is new to college, and takes a long time to get to know adults (he’s very quiet & reserved) so doesn’t have any trusted adults there, and feels too self conscious to tell his friends about his struggles.

I am thinking of emailing the college myself first (maybe anonymously), enquiring about if they are MHST, and describing my son’s situation and seeing what they suggest. Then trying my absolute hardest to persuade him to sign up to a session.

Thank you @Lallybroch - good to hear the college were helpful for your daughter.

He isn’t keen to speak to anyone at all. Part of his struggle is he feels that he can’t talk to people/doesn’t have social skills

There are many different types of mental health professionals, with different trainings which work in different ways.
For example a person offering CBT would say that a child who literally didn't talk or do the homework was not engaging with the work and would discharge them after a few sessions.

However an ACP registered phycotherapist can work with body language, non verbal sounds, face and eye movements in response to the therapists questions/interpretations. They can provide art/craft material and interpret what the young person creates. This sort of work can continue for a long time, or can provide a gateway for the young person to gain trust and start talking either in a indirect way (eg using themes contained in films, current events, music, etc as a metaphor for their difficulties which the therapist interprets) or directly and openly about how they feel.

What sort of professional do you have access to via your insurance?

Thanks for replying @LavenderDisco . I don’t know what’s covered under the private health insurance, I will try and find out.
Thank you - your knowledge has made me realise how clueless I am about these kind of things. Hopefully if I can get him to a college counsellor then we can see how he gets on and if he is able to open up.

He says it’s been hard and daunting opening up to me and telling me how he feels, and to be honest he has never done it off his own back, it’s because I have found blood stained sheets, tissues etc and approached the subject. I first found out in June and since then have focussed hugely on us spending quality time together one to one, making time for chats, telling him positive compliments, doing things to help mental health like walks in nature, and occasionally asking/checking in on the SH. He used to have the urges every day, they got less frequent in the holidays but are back daily and strong now.
He was using the calm app and delaying tactics. I have told my husband (who doesn’t know what to do) but I feel like I am carrying the weight of supporting my son on my own but constantly thinking about his SH and questioning if I am doing enough to help him.
Sorry for the long message!

Op I'm so sorry you are going through this and that your son is cutting himself, my 14yo daughter started cutting herself last month, it truly is heartbreaking.

I personally, made an appointment for the GP, also on the waiting list for CAHMs, I found a psychologist who she gets along with and she goes for 30 minutes a week, she does CBT, she's been going for around 2 months, sadly she's still cutting.

Have you checked what he is accessing online? I found out my daughter was being encouraged by strangers!

He is hurting himself so you must seek help and you know that of course. My son had really bad ocd and I was able to get him to write a letter to the surgery giving them permission to talk to me. I was then able to have a consultation with the GP on his behalf to discuss the best routes forward. Would your boy consent to this do you think? Ds was more willing to talk to someone once the GP had told us to if that makes sense. College counselling was quick and easy to access but he was a bit too complex for them. Initial nhs triage was quite quick but then the waiting list was really long for the actual therapy. We went private as not prepared to wait.

@narcASD Thank you.* *I am so sorry you are going through this too. It’s really helpful to hear how other people have got help. Can I ask did the GP give you details of psychologists or did you just look online for a local one?

And that’s a really good point about what he could be accessing online. Am wondering what the best approach would be to try and find out. Did your daughter let you see what she was looking at on TikTok etc? I don’t think my son would necessarily tell me if he was accessing that type of content. I have checked his phone without his knowledge before (when I was very worried he might be suicidal) but it was tricky.

@3teens2cats Thank you very much for replying. And that’s a good approach - I think my son might be ok with writing a letter giving the surgery permission to talk to me. Then I could at least find out the GPs suggested routes for him.
Do you mind me asking - what sort of length were the NHS waiting lists for therapy?
I hope your son is doing better now.

Around 6 months we were told which is awful.

And thank you, my ds is now almost 20 and doing well. 16 -18 was awful and it feels like he lost 2 years of his life to OCD. I wish your ds a successful recovery too.

Do both. NHS waiting lists can be a long time. The doctor won't just stick him on antidepressants, that's usually a last resort for under 18s (not sure if things have changed, but I had to have several sessions with camhs before they'd consider antidepressants. This was over 10 years ago).

If you can pay for private, I'd really recommend it. Camhs stopped supporting me as soon as I turned 18, and I had to switch counsellor halfway through because my original one left.

When my mental health is bad, I like to write in my journal. Helps get all the bad thoughts out. See if there's something that could help him at home. Journalling, drawing, reading etc. can be helpful.

So sorry you are going through this OP, I am also going through self-harming and suicide ideation (ASD, ADHD and OCD) with my DD12. It is horrible, so I can sympathise.

I would suggest doing both pathways if possible - go to the GP for a CAHMS referral, and go private at the same time for a psychiatrist and counselling if you can. The CAHMS referral for us is taking a very long time (we have been waiting since April, even with repeated requests to see someone sooner). In our case, the private CBT counsellor that we were given refused to help because my DD needed extra support, and she said only CAMHS would suffice. So we are still waiting with no help.

It is worth trying everything. Good luck.

@Indecisive2018 thank you, it's awful situation to be in isn't it.

I actually found out from someone else, which was devastating, my daughter had confided in a school friend, the friend told her mum (thank god), the mum then informed me. I went through her phone and laptop without her knowing, my daughter would not willingly let me do this, she'd been chatting to a boy who was encouraging her to do it. I contacted the police, I didn't implicate who told me, although I'm sure my daughter worked it out.

i found the psychologist from a recommendation from a friend. My daughter has started sessions with the psychologist prior to me finding out!
Then I found out she'd cut again and she was telling me she doesn't want to live anymore, I called the GP who saw us the same day.

I know your son is 16, so slightly older, but in the eyes of the law his still a child until 18, so I would go through his phone / laptop. I'd also contact the GP with or without his consent.

My daughter is autistic, very intelligent, kind, articulate and gentle, but also has no self esteem, didn't show any signs of self harm, it's really important to seek help as soon as you can.
Sorry for the very long reply, but I'm right in the middle of it and I know how scary and upsetting it is.

Its also reassuring that your son has confided in you.

Thank you for your replies @WishfulThinkingToday and @narcASD - am so sorry you are both going through this too. I think I will go both pathways to try and get him help, and also check his internet history to see what sites he is visiting etc.

I had another heart-to-heart with him last night and I think he is finally starting to come round to the idea of getting professional help. He kept saying to me "but I haven't cut since last weekend and I'm going to stop now, so I don't need to speak to anyone" but I framed it as 'imagine a big pint glass, its full of all your worries and stresses, there could be multiple different worries in there, but when it reaches full and the glass starts overflowing - that's when you end up cutting. And I know you feel better today, but today that glass is only half full, and one day in the future that glass will reach full and overflow again, and we need to find a different coping strategy for then - instead of cutting."
He's asked if we can wait until the end of the week to contact the GP/college counsellor, and when I checked his phone secretly this morning, I saw he has told his best mate he has been depressed & how I want him to see a counsellor, and his best mate said a counsellor is a good idea and encouraged him to get help. So I think we are getting there.

Sorry for everyone who is in middle of this right now - it is so upsetting to watch a child do this to themselves. I have realised its been all-consuming and all I have thought about everyday for weeks - and I don't think this is going to solved very easily or quickly so I need to start looking after my own mental health to make sure I am strong for him. Its been a rollercoaster of emotions.

@3teens2cats Thank you, it's so good to hear that your son is doing well now. I am really glad he is okay.

And thank you for your reply @daisydreamies - we will do both routes nhs/college and see how we get on. We have the option of going private in January. I suggested journalling to him as I do that and it helps me when stressed but he refuses unfortunately. He isn't into art but he does love music, he is playing that more and more which is helping.

I’m going through this with my 17yr old DS, it’s heart breaking. Can I ask what helped your ds?

So sorry to hear of your son’s troubles- and everyone with teens in similar positions. I was a self-harming teen and finally was referred for DBT on the nhs in my 20s. DBT is a clinically proven intense therapy programme for people who self harm. I don’t know if it’s still available on the nhs (and if it is, waiting list probably impractical). It’s definitely available privately and there are providers who work with adolescents.
It is a hugely transformative and effective form of therapy and aims to help people regulate their emotions, tolerate distress better, develop mindfulness and improve interpersonal communication. It also aims to help people make a “life worth living” which it certainly did for me.

We paid for a private psychologist. He had a session every 2 weeks. It was a slow process. He had to gently challenge his intrusive thoughts and compulsions. He couldn't be pushed too quickly or it would actually make him worse. He really wanted to go on a football tour abroad with college and this was something for him to work towards. College were great and made lots of accommodations but he was barely able to leave the house so it was going to be tough. He did it and it gave him the confidence to keep going and be well enough to get a part time job. Having a goal to work with has helped.

@Indecisive2018 that is a positive step, the fact he has confided in his friend is huge, the first steps to being open towards help.
You framed it perfectly to him, you sound like a lovely, caring mum and definitely need to look after yourself too.