CAMHS referral – do we really need it?


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The school (or doctor) think we need CAMHS – I can’t get my head around it
There’s a 12 month waiting list!

I hear you. You’re struggling a bit, but teenagers are meant to be challenging, right?
In fairness wanting to question boundaries and question things generally can be a reflection of intelligence and motivation.

It’s more than that though isn’t it? You know it deep down but don’t want to believe it. Your child or teenager is normal, just struggling a bit. Child mental health is for other families to worry about….Professionally the biggest problems seem to be a gulf between medical services and psychological services. Medical services have short waiting lists (few weeks) but psychological services can have a 12 month waiting list. What happens in that chasm of time? Confusion, frustration, desperation and waiting, and more waiting, and more waiting.

This isn’t because of any problems with the individual psychological teams but from a general reluctance to acknowledge (and more importantly, adequately resource) psychological services. We don’t give these approaches the importance or respect they deserve. We also don’t integrate them enough into the classical ‘medical model’ – ‘what’s the problem?’

What is CAMHS?

Stands for Child and Family Mental Health Service. It is an all-encompassing term for a service which helps children with autism or anger to those who are suicidal or psychotic, and everything in between. It is not for ‘mental problems’ as such. It looks after all child mental health services, but has ‘tiers’ where 1 is for anxiety classes and similar levels and 3 is for families needing ongoing help and supervision. Depression in children often leads to tier 3 referral. 4 I think represents those who need in hospital treatment.
It’s not child psychiatry but acts as an adjunct to it and a referral route into it.

What else is there?

Emphasis is changing generally in healthcare to empower patients and help them manage their long-term conditions. Focusing on what they want out of life and what works for them in achieving it greatly improves outcomes – so could this (solution-focused) approach work for children with psychological issues – and what exactly are they anyway? The answer is a resounding yes.
A private Paediatrician may be able to help as mental health in children becomes much more integrated into General Paediatric practice and child health clinics.

Psychological issues

This seems like some sort of stigma or label. We know that 1 in 4 people have some sort of mental illness, but that’s the other 3 out of 4 – not us.
Generally these issues include children with medical symptoms as an expression of anxiety or distress. These can be headaches / tummy pains / diarrhoea / panic attacks / eating disorders and in some cases cutting or hurting themselves. Some of these are about the child or teen getting some personal control, and some are just how the body subconsciously expresses its distress. It’s normal, it’s common and it actually makes sense!

Example

Imagine if you are really anxious about exams for example. Most of us are or were. You don’t want your friends or classmates to know, your body needs a way of ‘releasing’ this that’s not embarrassing, so you get headaches or tummy pains. They’re common anyway, so nobody suspects you’re so distressed (perhaps even yourself).

How can you distinguish ‘real’ medical symptoms from psychological ones?

By ruling out the medical causes, but using ‘solution-focused approaches’ alongside. By accepting that not only are psychological issues a valid cause, but that we can treat it quickly and effectively, we can treat these symptoms much more effectively. It makes no difference to the person suffering the symptom whether they have a medical or psychological cause – the symptom is the same to the patient either way.

OK, I accept that we need to consider and then treat these psychological causes – how exactly?

Next time I’ll go further into the process.
But I’ve got you interested, huh?

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