Some people who self-harm may need to be supported by their local Child and Adolescent Mental Health Service (CAMHS). CAMHS is a service for young people up to the age of 18 with mental health problems. CAMHS professionals will meet the young person and family to assess the problems and then decide with them what help is needed. Sometimes, if the problems are less severe, a young person may be referred to a mental health service providing short term treatment. The family members of young people who had been in contact with mental health services told us about their experiences.
Child and Adolescent Mental Health Services (CAMHS)
Several parents talked about positive contact with the CAMHS team. Susan Y was pleased with the help her daughter received: ‘She’s got the number for CAMHS. They’ve left it for her to be able to ring. She’s got lots of information where she can get help. They’ve given her booklets. …They’ve given strategies, talking and writing it down, everything has been really brilliant.’ Sandra had heard negative reports from other parents, but said the team were really supportive of her daughter. They offered Sandra extra help, including family therapy, but Sandra decided to rely on her own resources. Joanne talked about a CAMHS community mental health nurse ‘who has been absolutely brilliant. We’ve known her for two years, and I’m sure she does way beyond what she should be doing.’ Anna said CAMHS had been ‘fantastic in terms of supporting the family’.
The Child and Adolescent Mental Health Service worked with Erica and her daughter. Erica felt very looked after.
The Child and Adolescent Mental Health Service worked with Erica and her daughter. Erica felt very looked after.
And then she was discharged from the general hospital and she was by then, taken into care by CAMHS.
Our local CAMHS and they saw her every couple of days. So she had somebody working with her and I had somebody working with me, which was brilliant [sighs]. Sorry, it goes on and on. What happened, she went back to school, which I thought was amazing.
They were trying to take her life back to normal, while seeing her very regularly and she was under the care of a psychologist as well. Yeah, they came to see her when she was in hospital and they agreed on a plan. So I felt very held by these professionals.
Very looked after.
Sharon thought the staff in the Child and Adolescent Mental Health Service were ‘brilliant’
Sharon thought the staff in the Child and Adolescent Mental Health Service were ‘brilliant’
The CAMHS [Child and Adolescent Mental Health Service] team were very nice that came out and spoke to us. Then the psychiatrist from the unit came out and interviewed her and he was very good. She didn’t take to him straight away but I did. I thought he was ideal and, and the staff at the unit have been absolutely fantastic, absolutely fantastic because she’s had some foul moods. She’s had some really foul swings but they, they’re a brilliant team. They really are a brilliant team and she is very supported, regardless of what she says, depending on what mood she’s in, she does get an awful lot of support there. They are very good and they make me feel very, very supported. So we have the parent forum every week, where we can just sit back and have a coffee and a natter or ask something but the team is always there. I can phone any time to talk to any of them and they phone with regular updates or concerns or, or good news. So yeah, they’re, they’re really, really good.
Alexis thought the CAMHS team were ‘very kind and helpful’ but they didn’t stop her daughter self-harming. Although they provided somewhere to talk, made suggestions and gave her workbooks to try to bring her feelings out, her daughter found it hard to find someone she could relate to. Nicky said one good thing which came out of the CAMHS was that ‘it provided me and my husband with a space for us to talk about how her behaviour affected us and affected the family, which meant that we were able to talk about coping strategies and ways of dealing with it, which probably kept my marriage together.’ However, Nicky thought the CAMHS counsellor’s refusal to talk to her daughter about a possible diagnosis of bipolar disorder was a problem.
Nicky thinks the Child and Adolescent Mental Health Service (CAMHS) team’s refusal to discuss a possible diagnosis of bipolar disorder made her daughter’s behaviour more extreme.
Nicky thinks the Child and Adolescent Mental Health Service (CAMHS) team’s refusal to discuss a possible diagnosis of bipolar disorder made her daughter’s behaviour more extreme.
So she carried on self-harming. Things didn’t get any better. Things got progressively worse. Her behaviour got worse. She started indulging in behaviours, I’m not sure, I think if you look at self-harm as a broader topic, you probably would consider them to be self-harm, although at the time I never did, but part of her, she was diagnosed with borderline personality disorder just short of her eighteenth birthday. They’re very reluctant to diagnose mental, to give mental health diagnoses prior to eighteen, particularly BPD but I think, but she she’d researched it when she was about fourteen or fifteen and decided that that was probably what was wrong with her and she found it very unhelpful that CAMHS [Child and Adolescent Mental Health Service], that the person she was seeing at CAMHS, because we had family counselling at CAMHS and she had individual counselling at CAMHS, she found it very unhelpful that the person she saw individually at CAMHS wouldn’t engage with her in a discussion that this was a possible diagnosis. It’s one of the things, when we’ve talked about the things that made life difficult for her when she was a teen, is the fact that the person involved wouldn’t even have a conversation going, “I can understand why you feel like that, [daughter’s name], we can certainly talk about it but you must understand, we don’t diagnose until eighteen.” She would have been quite happy with that.
But instead, what she felt she got was a, “I’m not discussing it period.” And I think that what that did was it prevented her from engaging fully with CAMHS and I think, as a result of that, the destructive behaviours that we witnessed might, in some ways, have been more extreme because I think she felt she had a point to make by then.
Other parents were unhappy with the treatment they received. Joanna said the CAMHS service was ‘very unhelpful.’ Her daughter ‘ended up telling a woman what she thought she wanted to hear. There was no relationship with a counsellor there.’ Gwendoline and Jo-Ann would have like more continuity with the therapists who were often away. Jane Z was not satisfied with her daughter’s CAMHS treatment. In order to decide whether someone has a mental health problem clinicians have to ask about different symptoms. Sometimes, as Jane Z told us, this can appear like a ‘check-list to cover their backs’. Jane also thought her daughter might be upset by being asked questions about hearing voices, implying that if she was self-harming she must be mentally ill.
Liz thought ‘the root of the problem had not come out’ when her daughter was discharged after six sessions with a mental health team providing short term treatment.
Liz thought ‘the root of the problem had not come out’ when her daughter was discharged after six sessions with a mental health team providing short term treatment.
When she first was seen by PCAMHS [Primary care Child and Adolescent Mental Health Service], she was referred to them by the GP. There was a little delay. I remember being incredibly anxious during the time when I knew she was cutting herself and before she was seeing anyone. It was it was a time for me when it was it was a very anxious time because we weren’t talking about anything.
We weren’t talking about her behaviour at all but I knew that she was doing it and she was seen by PCAMHS. They have an assessment session and then six sessions and she, during the time that she was being seen by PCAMHS, she cut herself, to our knowledge, two or three times but then in the last three the last three weeks, therefore, the last three sessions, she didn’t cut herself at all. So when it came to time for her review from PCAMHS they said, you know, “We think this behaviour has stopped. We’ve managed to talk about it and stop this behaviour.” And I felt very unhappy about it because I knew that [my daughter] was still very unhappy. I keep saying that.
Yes, say, “My daughter.”
Yeah, I knew she was very unhappy and I felt that all that had, it was a sticking plaster on on what was going on. It was it was not.
The root of the problem had not come out. But they seemed happy and they said, “If you have any more problems go back to your GP.”
Isobel wasn’t happy with the CAMHS approach and stopped going to therapy sessions.
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Isobel wasn’t happy with the CAMHS approach and stopped going to therapy sessions.
And what is it about CAMHS that you don’t like or you haven’t found satisfactory?
I found them not to be impartial and, in fact, it’s in a meeting and my daughter painstakingly explained something that her father had had done, which was to my mind horrible and unforgiveable and just showing his controlling nature, making her stand out in the cold weather waiting for a bus. It might not sound much but it’s, you’d have to know him, and it was a horrible example of how he can have power over his daughter. So I think I made a comment like, oh, I sighed or something and the psychiatrist said, “Oh, it sounds to me like it was a mistake, a misunderstanding.” And that made me very angry because I didn’t think they were taking the content of what [my daughter] was saying seriously so I got quite upset and then I think something else happened later on in the meeting. I think they’d asked me to help, no, my child had asked me to help to talk for her, so I started saying a few things that I thought it might have been, the reason why she took the second overdose and again, the psychiatrist busted in and said, “It’s not helpful having these lists and just giving lists to [my daughter]. She needs to talk about it.” And I got very upset.
Yes.
I have to say, and I walked out of the meeting, and I haven’t been back since, but I would say that this is, sort of backs up with my experience of CAMHS as, in in my job and myself and my colleagues do often get very frustrated with, they seem to deal with minutia of life without looking, [sighs] well, I suppose we’re coming at it from two different ways. Because I’m a social worker, I would look at problem solving, I would look at how to make this family exist better and that might be that they need a washing machine. It might not always be terribly sort of small insignificant thing that happened when they were three or. I just find CAMHS labour a point too much but I was prepared to go along with their, the way that they work because of my daughter and I’m just hands off now.
Yes.
I certainly would never stop her going but I just don’t get involved.
So do they try and communicate with you or that’s?
They send me the meetings, the care plan.
Right. Yes.
But other than that, her father takes her, he, if needed he’ll go into meetings with her but I’m nothing to do with it anymore and I’m glad.
Jane Z thought the CAMHS process made her daughter’s situation worse.
Jane Z thought the CAMHS process made her daughter’s situation worse.
So we then found ourselves in a position where we were, telling [our daughter] she had to do what CAMHS were telling us, you know, we have no choice, and this is just going to sound. I mean it sounds ludicrous to me now that we, we went along with any of this but we did. And so we were told we had to take that route. We had this first meeting, very well meaning, you know, nice lady but just completely ineffectual and we came away from it thinking, “Well, we’ve come, we, we’ve got to persist with this because it’s, obviously, going to be a slowly, slowly approach and it’s going to take time. We’re not going to get a magic wand out, and it’s all going to suddenly be better, so we’ve just got to go along with it.” Daughter of course, came out of it thinking, “Well, that was no help whatsoever. I felt patronised.” Bear in mind, she actually wasn’t talking to us at all at the moment, at this sort of particular stage, but, we can see now, that this was how she was feeling. All the questioning, well, there were two kinds of questions, in that first meeting. The first style of questioning was, “How do you feel about what’s happened?” Okay, now, when, one of the first things this doctor said to my husband, when he talked about it was, “It is pointless asking how somebody feels. Because they don’t know how they feel, and they don’t know why things have happened, how they got here, there is no point, because all you’re doing is telling them how useless they are, and you’re putting them under more pressure.”
So, the first line of questioning was completely stupid, as it turned out, and, so all of the questions were, you know, “What did you do? What’s happened to you? How, where have you, why have you got to this stage? You know, tell us how you feel about your grandparents? Tell how you feel about various things that have happened to you over the summer, and how do you feel about the self-harming?” And, of course, all that do, was doing was making it worse, because she was sitting there thinking she was being bombarded and interrogated by all these questions, of which she had absolutely no way of answering.
I ended up answering most of the questions in this particular thing, and I mean I, I just found myself saying all the things as, as an adult, you learn to deal with situations and you go into game-play mode. So, you know what the social situation requires of you, and so you do what is required of you, and that’s what we did. We sat there and we answered the questions. We tried to get at what we thought our daughter might have been feeling, and so, of course, she’s sitting there thinking, “Oh okay, so that’s how they’d worked that out.” And so you’ve then got to go outside and say, “Look I’ve got absolutely no idea, but we’ve to play the game. We’ve got to.”
So, she’s not saying anything at all to this doctor, because the questioning is just so ludicrous, and then the second line of questioning, was, was just, check-list and, when I came away and told my husband about it, he just said, “They’re just covering their backs.” It was classic, back covering, questioning. So it was, “Are you still self-harming?” And, all I could say was, “Yes, I think so.” “Do you still have thoughts about taking, ending your life?” As bluntly as that, to a child, who’s just come out of hospital and is in that sort of state.
“Do you still think that you might kill yourself?” And just a succession of these sorts of questions, and it was, it was tick-box stuff. So daughter, obviously, to the question, “Are you still thinking of killing yourself?” Sits there and shakes her head, so the box gets ticked, and they say, “Well, that’s fine. I can let you back out into the community, because you’re not an immediate risk to yourself.”
And it was just so pointless, and, and then a list of small print stuff, “You do understand, don’t you, that we are only here during office hours. So, if you if you need any help we’re here between nine and five.” “I don’t work on Fridays so it’s nine to five Monday to Tuesday. I can be contacted by e-mail but, obviously, I’m a very busy person, so don’t expect me to reply straight away. Can’t always be accessed by phone. If you do need any help outside those hours, go to A and E.”
So, now we’re in a position where the CAMHS process is making the whole situation, not twice as bad, a hundred times as bad as it was. And actually all she needed to do was feel safe at home, and relax a little bit, and sleep, and eat, and try to become physically a little bit stronger, and then emotionally a little bit stronger. But, actually, what we’re being told is we’ve got to get her out of the house, and drag her three quarters of an hour across the town, to get her to this appointment. Anyway, we were then told that unless she attended the following appointment, they would have to be thinking that the situation was clearly an awful lot more serious than they thought it had been initially, and that they should be looking at ‘next steps’, without talking about what ‘next steps’ were.
So, now it’s all beginning to get quite intimidating, quite threatening, and we, eventually, got my daughter back across there for another appointment. The same doctor is there, who, same approach, same questions and then the psychiatrist, who is in charge of her care, comes in, and this makes me very, very angry. We actually had two meetings with this lady, she came in part the way through the meeting, and I don’t actually even know how to describe what she did. She walked in. She greeted the doctor by her Christian name, and that was fine, this was the other thing, they always sat on the opposite side of the room to us, absolute basics, but she came in.
She sat down. She just stared at my daughter. She just stared at her for a moment or two and just said, introduced herself, “I’m the psychiatrist in charge of your care. Tell me what’s happened to you.” And just, no kind of attempt to try and get any kind of background, or anything of that sort, and just went through the check-list of questions again, and my daughter just wouldn’t speak to her. She wasn’t speaking to either of them, at this point, just completely clammed in, petrified, absolutely petrified. …So, we had a point where, because my daughter wouldn’t speak to them, it was, obviously, more serious than they thought. And I thought, ‘think about why she’s not talking to you’. So, then all of a sudden, we’re talking, with her there, almost as if she didn’t exist, “Well, we should be looking at hospital admissions”. And this is two weeks before Christmas. “We should be looking at hospital admissions”, and so I said “well, talk me through and all the rest of it”.
And suddenly, we’re talking about making sure that we’re not dealing with bipolar disorders, that we’re not dealing with this, that and the other, and I said, “Well, what do you mean inpatient admission to deal with this? What does that involve?” She said, “Well, it means that she’ll be taken into a unit” and they were quite blunt. No family contact. It could be the other end of the country, because we don’t know what places are available here, and it’s likely to be for a minimum of three months.” So, suddenly, I’ve got this woman sitting in front of me, telling me they’re going to take my daughter away.
While many young people were treated relatively quickly, some parents were concerned about long waiting lists. Debbie’s daughter saw a mental health nurse in connection with her eating disorder but no psychological treatment was available for eighteen months. Susan Z said her daughter waited over a year to be offered counselling. Charles was told there was a long waiting list for family therapy. Sometimes parents had to push hard in order to get treatment. Joanne contacted her MP; Ann threatened to go to the local press.
Adult mental health services and the child and adolescent team disputed who should be responsible for Ann’s daughter.
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Adult mental health services and the child and adolescent team disputed who should be responsible for Ann’s daughter.
So I took her to the GP eventually, who referred her for counselling.
So another couple of weeks went by and we’d heard nothing from the counsellor but we then got a letter through the post saying that she was too young for counselling at the age of sixteen. So back to the GP we went with increasing cutting, low mood, withdrawal. They referred her to CAMHS, the Children Adolescent Mental Health Services. New scenario for me, hadn’t had anything to do with CAMHS before but a friend of mine, whose husband worked there, said, you know, “It’s the last thing you want is to get her involved in the system.” But at that point, I didn’t really care. I just wanted help for my daughter.
Nothing was forthcoming from there so I rang them and asked them what was going on with the referral and to be told at the age of sixteen she was too old for CAMHS and they’d referred it to the adult mental health services and at another hospital. So I then rang that hospital and said what did they do with the referral and they said that she was too young for adult services so and they’d referred it back to CAMHS. So I phoned CAMHS again and they said, “Well, she is too old.” And I said, “So what are we all doing here? While you’re batting referrals back and forth, I’ve got a child who is cutting herself, becoming more isolated and withdrawn and is obviously, in some sort of emotional distress that I don’t understand and who’s going to help us with that? Does it actually take for her to try and kill herself?” And they said, “Well, we don’t really know what to suggest.”
And my response to that was, “Well, my next telephone call is actually going to be to the local newspaper if somebody doesn’t help us because as healthcare professionals you can’t just bat somebody from one to the other and nobody take responsibility.” And when I used the unfortunate word of press, that’s when I got told that the duty worker would be in touch and she’d actually get an appointment with a psychiatrist within a week at CAMHS.
But things didn’t really improve. The first thing that they did was put her on quite a lot of antidepressants, which had their own side effects. She didn’t develop a good therapeutic relationship with the psychiatrist and self-harming continued.
Crisis Team
In some areas there is a CAMHS Crisis Team to help people in the community. Crisis teams are able to respond quickly to an emergency and can visit young people in their homes or schools. They may also be available overnight to provide telephone support. Alexis was delighted with the service provided. Jo-Ann was concerned that her daughter saw different people every time: ‘Each day you get a different person speaking to you. Sometimes people are very caring and empathic, sometimes they’re not so, sometimes they’re quite brusque and that’s very difficult then because then she doesn’t feel cared about and she feels that they’re just trying to fob her off.’ This wasn’t a problem for Alexis, who said that ‘you might see somebody different every day, but the handovers they did were amazing. So if something had been said on the Tuesday and someone else came on a Wednesday, they knew.’ Charles saw ‘a succession of different people, which we didn’t particularly like’.
The Crisis Team ‘turned our lives around’, Alexis says.
The Crisis Team ‘turned our lives around’, Alexis says.
But then the magic words, “the crisis team”, were said. I didn’t know what the crisis team was. She didn’t. She was very angry. She was so angry at the psychiatrist. You know, she was swearing at the psychiatrist and saying, you know, “So you’re not going to help me.” Well, you know, and [sighs] but he said, “We want the crisis team to come and see you.”
And so we were we were sent home and so I was sent home with this incredibly distraught young woman, who still five years on wasn’t sleeping, who would about twice a year have terrible episodes of depression and in between would self-harm and you’re sent home and you’re thinking, “So here we are and is life ever going to get, be normal? Is this going to be how it always is?” And the next day, the first psychiatric nurse came from the crisis team and I can hand on heart say, that team turned our lives around. They visited my daughter every day for a month but also what they were able to do, they were, it was it was all so joined up, and I know my daughter was really, really worried that she was going to see, yes, she was going to see different CPNs every day but their ability to feed back to each other was amazing. They were incredible people. They would come at whatever time was suitable to us. They would come in the morning. They would come in the evening. Sometimes, they came twice a day and they were able to talk to her about her medication because again, here we have someone who’s on medication but they’re still getting ill. I know people on medication get ill but it’s kind of like you start questioning it.
And she was able to see people at the hospital. She was able to be supported. I was supported. For the first time probably ever someone said, “And how are you doing?” And you sort of think, “Please don’t ask me that because I’m going to cry and, actually, I’m doing crap and I, I’m doing really badly but I haven’t got time for that because I’ve got to care and love and look after and keep my daughter alive.” And her medication was changed and suddenly, she was put on a medication that enabled her to sleep for the first time probably in about six or seven years. She was put on an anti-depressant that also has a sedative affect.
Jo-Ann’s daughter was referred to the Crisis Team by her Community Psychiatric Nurse.
Jo-Ann’s daughter was referred to the Crisis Team by her Community Psychiatric Nurse.
Yeah, They, the crisis team, her, [my daughter’s], her CPN came on Thursday. [My daughter] requested her to come. She normally comes once a fortnight. She came last week because she was pretty distressed and, while she was here, she said, “I will refer you to the crisis team.” The crisis team are there, they put in place, I don’t know if they exist in the rest of the country, but they’re put in place here to stop you being admitted to hospital. They’re a barrier because they don’t want you to go to hospital. It’s not and it, it isn’t the right thing. There have been many times when I’ve felt that it would be the right thing but that might be selfish reasons on my part actually. So they come they come to the house every evening if you need them. So they’ll phone you each day and they’ll ask you if you need them to come and if, if they thought you needed admitting, they would admit you. If they thought you were at risk or at risk of hurting somebody else they would, you know, put things in place. They have they have, you then have access to them. You can phone them if you’re in distress and there’s no nowhere else for you to go.
So they have also arranged psychiatric assessment with the consultant for Thursday, so [my daughter] has got a feedback for a different assessment on Wednesday but they’ve made this appointment, and it’s not with her psychiatrist. It’s with the, the consultant, who works with them. So I don’t really know what that’s about but they can also administer drugs so they can prescribe you or bring with them diazepam, temazepam, which is what they’ve done with her to help her calm and help her sleep. So yeah, that’s basically what they do.
Charles would have liked the Crisis Team to help get his son back to school.
Charles would have liked the Crisis Team to help get his son back to school.
Since we came back from France, we managed to get out of the grip of the crisis centre. I can see their role seemed to be to do anything to keep this boy calm. They had no obvious consideration about getting him back to school or the bigger picture or treatment for that matter. It was purely a sort of, “We’re on the end of a telephone. We’ll come and see you. How are things?” You know, “Come on, [son], cheer up.” Just taking an interest and so on. I mean that seemed to be, what to us, that seemed to be what the crisis people were concerned about. Subsequently, he was discharged by them when we left for three or four weeks holiday overseas because, obviously, they can have no role, and since coming back things have settled into a much better routine.
