** WARNING - THIS IS A LENGTHY POST ** Apologies in advance, I tried to make it as succinct as possible.
My feelings after my son's residential stay in a CAMHS facility.
Prior to being admitted to the residential care unit, my son was in a severely depressed and non-functioning state. Every single part of his world had collapsed. He existed completely within the confines of his bedroom. The highlight of his day was to be on his computer. In this cyberspace existence he was able to feel “good” and stay somewhat connected with the outside world. Unfortunately, he became highly addicted to his computer and often spent in excess of 16 hours per day in front of his computer screen,at the expense of good quality sleep. He had no motivation to alter this situation and became paralysed in the grips of this self-perpetuating cycle of depression and addiction.
When my son was first admitted into residential care he improved and made some significant gains. I am of the opinion that he improved and performed well because his need for quality sleep was being met, he was in a structured environment that enforced healthy habits, and included a large variety of diversional and recreational activities that relieved boredom and loneliness. He also had access to regular therapy and connected with a person in a healthy therapeutic manner. Most importantly his improvement could also be largely attributed to the fact that he felt that he belonged somewhere, had purpose, and because he wanted to be helped, was optimistic and hopeful.
I believe that during the second half of his stay, after integration began, it was mistakingly believed that his declining mental state was directly related to his fear of leaving - and to a certain extent that may certainly have been a very valid factor. However, many things coincided with this including losing his main therapeutic alliance and having a period of absent “therapy” before the incoming registrar was able to engage with him. He enjoyed being in this facility as it was the only thing which gave his life a sense of purpose, meaning and direction. However, integration meant he had to spend more time at home. For every night & day that he spent at home, no-one realised that he was falling straight back into old habits of isolating and was unable to self-regulate his computer addiction. His outbursts of anger, increased irritability, drop in mood, failure to perform academically, and failure to meet the demands of the integration program were, in my opinion, viewed as being deliberate manipulations designed to lengthen his stay in the facility and defer his inevitable discharge. Although his impending discharge would undoubtedly have been a stressor and a large contributory factor, he was also met with inadequate support at this time, both inside the facility and externally.
The focus of care at this time appeared to shift from emotional to behavioural and he was treated with little sympathy and concern accordingly. Telling him that he needed to take responsibility for his own behaviour, and that it was now all up to him, was effectively like telling a drug addict to quit using and get on with their life in a responsible manner whilst simultaneously creating increased stress and dangling drugs in their face. It wasn’t going to happen, and like every addict he concealed what was going on whilst falling rapidly back into the clutches of his depression and associated computer addiction. I believe integration failed because of his increasing returns to home, and the associated lack of support, routine and supervision, rather than because of the fear of leaving the facility.
My son was (is) effectively dealing with the double demons of depression and an addiction. Unfortunately, throughout his stay in this facility, there was little (if any) therapy directed towards either, other than re-establishing healthy routines, re-engaging him with life, monitoring meds and enforcing healthy habits. In many respects this was simply putting on a bandaid, without attempting to heal the wound underneath. The core of his issues did not receive any direct or individualised treatment/counselling in accordance with well-established standards of care for depression/anxiety, and neither did he receive any therapy to address his addiction problems. A psychiatric registrar, mental health nurse and teacher are not trained psychotherapists and collectively were not able to deliver the much needed deeper work that he needed in conjunction with the above. It’s hard to imagine that a facility specifically dealing with adolescent mental health issues does not have a full-time psychologist employed to provide much needed therapy. The best that they could offer was either a mental health nurse, or a psychiatric registrar, both of which are not trained in psychotherapy.
I’m at a loss to understand why the treatment of depression/anxiety in 2016 fails to provide a holistic and integrative approach in line with the gold mark standards of evidence based care. His treatment appeared to skim over the surface of the real issues and failed to build up his resilience, or arm him with self-help tools and providing a network of viable supports.
I am sure the program works well for some, less complex cases. It probably works well for adolescents that have only missed 12 months of school, as opposed to years. It may work for those that have a school full of friends to return to, or that have a functional home/social setting that includes siblings and extended family, or a group of peers that they can reintegrate with, or for those that have someone that they can connect with. It may also work for those that have a clear pathway beyond the facility, and for those that have the internal strength to face adversity and suffer from simple, less complicated and responsive variants of depression/anxiety.
When dealing with an adolescent suffering with mental health issues one needs to look at the big picture. It’s not just about the individual, but what exists around that individual. In my son’s case he had nothing. If there was a checklist that needed to be ticked prior to discharge it would look something like this:
Has the adolescent’s mood shown consistent improvement and stabilised for a period whereby their mental health would now be deemed as stable?
Does the adolescent have a clear and well established pathway beyond discharge?
Does the adolescent have age-specific social support in place?
Has the adolescent shown that they have the skills and capacity to cope outside of this facility?
Does the adolescent and his family have appropriate support established to meet their needs?
Do you have confidence that the adolescent will be able to cope following discharge?
Has the adolescent followed and complied with the integration plan?
Do you believe that the adolescent is comfortably integrated into their new setting?
The answer to every one of these questions is “NO”.
So my question now is: Where is someone like my son supposed to get help from? If the “best” adolescent facility in the state has been unable to provide a lasting or sustainable improvement, is he now deemed as being “untreatable” and beyond help? Is it right for a mental health facility to discharge someone who has been unable to demonstrably display that they will cope on the “outside”, or to discharge someone without suitable age-specific and sustainable support? Has our mental health system become so focused on bed availability and protocol that discharge forges forward regardless of the well-being of a patient and somehow legally bypasses “duty-of-care”? I’m sorry, but I just don’t get it. Not one part of me see’s that my son’s discharge was ethical, warranted and in the name of patient care. His time was up, they needed the bed and they were not prepared to invest another millisecond of time towards him.
And in keeping with the general tone of the place, we have not received any communication or gesture of post-discharge support since he left. Eight months of association, and so-called care, has ended with not even so much as a phone call to check in on his well-being. Doesn’t that just say it all.
Having gone to this facility is not being viewed as a total waste of time and a failure. If anything it has been a valuable learning experience that has revealed exactly what does work and what doesn’t work for my son. It has provided me with greater insights which hopefully will bring him one step closer to getting better, and me one step closer to getting my son back.
I really needed to offload this. Sorry 😁
Janna ❤️
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13 YARN