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Hi - I have been on this forum intermittently for about 7 years! My daughter is now 12.5yr and has severe OCD for 7 years and despite a lot of expert treatment (Maudsley OCD Clinic & long hospital admission) her condition remains just as severe (although it fluctuates in severity over the years).The main reason for this is that she will not engage in CBT sufficiently and refuses to take medication.  She has been out of hospital for 10months. She had been able to get to school for about 75% of the time but since January she has greatly deteriorated again and her OCD rituals are taking up so much time that she is unable to get to school at all most days.

So with this most recent deterioration the CAMHS psychiatrist feels if she doesn't agree to try medication willingly, then they might need to use the Mental Health Act to make her and the worst scenario (which I find very difficult to think about) is her been given it forcefully by injection.

Anyone have any knowledge about the use of the Mental Health Act on children? I'm finding I need to get as much information as possible before we end up going down this route.

Thanks

Kc

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I am going to refer this to Ashley, as you must be very worried about it.  I have to say, medication doesnt seem to have made much difference to my son, although of course I realise everyone is different.

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I'm sorry it's not an area I have had much experience in, I would have to make enquiries to find out rights.  But, there's no guarantee medication will work so forcing that on any patient (adult or child) seems a little OTT.

What may be helpful to try and understand is why she refuses to engage in CBT or medication?  If you can understand that it may help with a solution.

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Thank you Ashley. I actually sent an email to you via OCDsupport address with more information. This is a complex case. The reason my daughter is fearful & refuses medication is because she can't remember life without OCD and she fears what she will be without OCD - even though it has been explained that the aim would be a reduction in her OCD rather than it going completely. I also think she is in denial about how much the OCD is affecting her life. These areas have been explored but she usually becomes quite agitated and oppositional if it's pursued to much. Kc

 

 

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Hi kc,

I'm so sorry to hear of your daughter's (and your) situation. It's rare the Mental Health Act is invoked for OCD and even rarer that it is invoked for children with OCD, so this is an area where we need to all tread lightly, check our facts (and our rights) and take time to consider the choices from every angle.

There are two issues here as I see it.

1. Whether the intended medication is likely to significantly improve your daughter's condition without undue side-effects

2. Issues around consent and forced treatment.

On the first point, I have to say I'm wary. The only medication I can think of that's relevant in injectable form is an antipsychotic.

The evidence that antipsychotics help in OCD is limited. Some adults report a reduction in symptoms, others report no benefit at all. The mechanism by which they help some is poorly understood, but is basically aimed at reducing 'delusional-type thoughts'. How psychiatrists interpret whether a patient with OCD is experiencing such thoughts varies widely and is based on how much insight the patient seems to have that their thoughts may not be strict reality. Trickier still to decide that on behalf of a child who may have insight but not have the language capacity to easily express that they have it.

Use of antipsychotics in children (often outside of the drug company licences) is on the increase, so there are a number of studies available. They mostly emphasize the high prevalence of side effects from unpleasant weight gain to potentially serious heart problems. In short, as a parent, antipsychotic medication - however it's administered - is not an option you consider at all lightly for your child.

One aspect won't be listed under official medical side-effects but in my opinion is also worthy of careful consideration. TRUST. 

Your daughter is 12.5 years old. She doubtless has a strong will, as evidenced by her ability to endue endless rituals and to be oppositional when treatment avenues she doesn't want are raised. If you force her to submit to a treatment when she genuinely doesn't understand why you're acting that way those important bonds of trust between parent and child will be tested. She will want to to know why her mother is 'betraying' her. It won't be enough to say 'this is for your own good' and 'the doctor knows best'. You've got to have answers she can understand emotionally, not intellectually. You need to find a way to explain it to her that gets her on board.

 

The second point is issues around consent. There are two relevant laws which you may need to refer to.

1. Mental Health Act 2007 (which is intended for adults but has no lower age limit to it)

2. Children's Act 1989 (which is mainly about ensuring the child's interests always come first.) 

In the UK, most children are detained under the 'adult' MHA rather than the restraining or treatment sections of the children's act. The law is that the psychiatrist must seek parental consent in order to section a child whether for treatment or assessment.

If the parent refuses consent, the doctor can seek a court order BUT this would only be done if the child's life was in danger and would be unlikely to be granted in these circumstances. Bottom line - the buck stops with you on whether to consent or not.

Does your daughter get a say on treatment? Well yes and no.

First the situation as a voluntary patient: Under our strange British laws she has the right to consent without a parent's agreement as long as she understands what it is she is consenting to. However, it's a weird twist that while protecting her right to have her opinion taken into consideration, a child under 16 can't withhold consent if a parent gives consent on her behalf.

In practise this means it falls to the unfortunate parent to decide what is best and how much to respect their child's autonomy. 

An an involuntary patient (under section) : A child detained under the MHA cannot withhold her consent to whatever treatment is deemed necessary. 

You may find the sections on parental and child consent in this document worth reading, just so you've got the legal jargon at your fingertips. 

https://www.rcpsych.ac.uk/pdf/CAMHA-CAPS report for NIMHE.pdf  (scroll down to page 12/13) 

Ashley will, I'm sure support you any way he can, but another source to consider is the Young Minds Charity. The relevant section is on this page and the charity may be able to give more detailed advice by phone or email. 

http://www.youngminds.org.uk/for_children_young_people/unhappy_with_treatment/your_rights

 

A final word on what I appreciate is already a long reply. 

4 hours ago, kc73 said:

The reason my daughter is fearful & refuses medication is because she can't remember life without OCD and she fears what she will be without OCD - even though it has been explained that the aim would be a reduction in her OCD rather than it going completely. I also think she is in denial about how much the OCD is affecting her life. These areas have been explored but she usually becomes quite agitated and oppositional if it's pursued to much.

Been there, done that and got the t-shirt. :dry: 

As a child I couldn't remember a world before OCD so I'd no point of reference for what life unaffected by OCD might be like. Perhaps it's not denial of severity so much as not knowing any different, assuming life is that hard for everybody and 'better the devil you know... etc' 

I can only speak for myself, but for me OCD rituals were all about maintaining a sense of control in a chaotic, unpredictable world where I had no power. The idea of taking medication scared me because I interpreted that as the ultimate in 'handing over control of my brain and my life to others' -  the very thing all those painful and debilitating rituals were about preventing. Little wonder we 'oppositional types' get scared and dig our heels in. :a1_cheesygrin: 

CBT worked because it was presented to me as 'taking control'. Me deciding what was what, not the OCD, not doctors, not outsiders deciding they knew best. Perhaps you could persuade your daughter to engage with therapy as an alternative to medication (forced or otherwise) so she sees herself as the one making the rules, making the decisions. Not through defiantly digging her heels in, just standing up and taking charge. 

Whatever the next steps are, good luck to you both. 

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Snowbear - such a helpful, knowledgeable, detailed & supportive reply. Thank you so much for taking the time to write it.

A bit more background: Whilst she was in hospital, for the first few months they didn't prescribe medication as they knew how anti she was about taking it, plus they felt she was making some progress with CBT. Unfortunately a collection of events led to a big deterioration and the consultant then decided that she had to take medication, and as a motivator at this time, the consultant explained to her that she would not be allowed weekend leave home until she has started to take the medication regularly. We consented to all this. I spent each weekend at the hospital with her during this time (it was 85miles from home). 

However, despite a lot of psycho-education from the nurses and pharmacist, plus not able to go home at weekends, she still refused to take the med. The nurses were really good with her and I don't think they could have done any more to help her take it. So after 5 weeks the consultant asked Bruce Clark (lead of OCD Michael Rutter Clinic at Maudsley) to review her. He advised that the hosp stopped offering the medication as she was presenting as not ready to engage in treatment. He also advised the hosp team to change the focus to increasing her functionality rather than directly trying to help reduce her OCD symptoms. Our local CAMHS team however, felt uneasy about having her discharged to their care without her being on medication, citing that she sounded too unwell to be discharged & they discussed then about the MHA . However, the hospital consultant & team felt it not right to force meds using MHA, for every reason that you stated: anti-psychotic med may not be effective, trauma & loss of trust. We really wanted her to try medication but agreed with the hospital consultants decision.

So she came home in April, and fortunately she improved quite a bit during the first weeks home; she had become quite depressed during the last few months in hospital. However, her OCD was still very debilitating for her. As for CBT, she began seeing a clinical psychologist every few weeks at CAMHS (I would have liked her to have had more frequent appointments - at least fortnightly) and the initial aim was not to deliver CBT, but to allow my daughter to gain a trust & openness with the therapist, to help build up towards working on more active "therapy". However, just after a couple of months, the therapist questioned the point of continuing with her as she felt she wasn't delivering any "therapy" to my daughter. But she carried on and is still seeing her, although at every review meeting with have, CAMHS question if there any benefit continuing with sessions with my daughter, and they were going to stop. Until this big deterioration.

Sorry long post. 

I have heard a few times the believe that any child should be able to engage with CBT with the right therapist. But how do you get the right therapist, and it's never a guarantee that the therapist won't leave her position half way through treatment. I would love to hear more of a Clinical Psychologist opinion on delivering CBT for OCD & if for them as therapists, it can become apparent that the child is not ready to take part in treatment and that there isn't any gain from continuing - at that time? Aged 7 she received out-patient CBT at t he Michael Rutter & even the therapist there couldn't crack her!!

How do we and/or the therapists get our daughter to engage-in CBT?? That would be the optimum. The idea with the medication I guess was the hope she it would help her to engage, but I totally agree, the use of an anti-psychotic drug isn't the way to go. But having said that it feels we are running out of options. And maybe that's what our CAMHS consultant feels too. 

How long is a child left unable to function , go to school etc without doing something more radical. But maybe the better option is to just cope the best we can and hope she will improve on her own accord. It's just so draining & so worrying. How long did it take you to decide you would/could engage in CBT? We are discussing it with her regularly but ger resistance remains firm.

Thanks again

Kc 

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PS I have been to the Young Minds website and actually phoned their help line. It was useful to discuss the issues we face but most of the info they gave I already knew. I've been trawling the internet so much for information! But with your helpful info and advice, plus what I have read, I feel more ready to discuss with CAMHS alternatives. 

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How do you get the right therapist? Hm, the million dollar question! Luck of the draw, I think. You hope to find someone with deep empathy who can get inside her head and see things from her point of view, not 'empathise' from a non-OCD viewpoint while demanding she change her ways (which is what most adults do, however well-meaning.) 

'They' (the adults) never cracked me as a child. The harder they pushed and punished the more I depended on my OCD to provide the mental and emotional strength I needed to face the unendurable conditions imposed on me as 'treatment'. My OCD got worse and worse, but I grew stronger, learning to deal with it alone and to hide it.  However, that was back in the 1970s when psychiatrists condoned extreme, abusive parental punishments as a legitimate way to manage 'bad behaviour' (OCD).  Thankfully things have changed a lot! 

CBT wasn't offered to me until my 40s. (I'm in my 50s now.) As a child I did my own version of 'CBT', setting the rules on what OCD was allowed to interfere with and what was 'immune'. Luckily for me I choose school and later work as 'immune to OCD' and managed to function by containing the OCD to non-working hours. (Mostly) :blushing: 

I believe how CBT is presented is the key to helping children (and adults) engage. Autonomy and the right to choose are everything. Being constantly told 'you're abnormal, you're wrong, you have to change...' creates a defensive mindset. Being shown OCD is a choice, one to be chosen or abandoned of your own free will - this piques curiosity and extends the hand of hope. 

It may be the current therapist is simply not on the same wavelength as your daughter, or it may be she's fallen into a habitual way of treating patients and has temporarily sopped thinking outside the box and looking for imaginative solutions, creative ways to get the message across. Maybe you could do some imaginative thinking with your daughter in a non-threatening, exploratory, 'ok, let's have some fun with this' kind of way? And then share with the therapist whatever seems to catch your daughter's imagination as a way in. 

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Thank you for another very helpful reply Snowbear. I am sorry that the help wasn't there for you as a child; it must have been awful for you. At least there's more knowledge and openness about OCD & Mental health now (although still a long way to go). 

My daughters OCD is extremely entrenched and like you, I know she has developed some strategies. Her OCD rarely shows itself at school but we have been told this is fairly common with OCD sufferers to hide it at school. The positive of this, we have been told, is that it does show that she does have some control - and the OCD not totally controlling her. However, her main rituals have always been associated with "activities of daily living" - i.e. washing, dressing, going to the toilet etc. In fact her OCD symptoms first showed themselves following an episode of cystitis when she developed toilet rituals which she believed made the cystitis symptoms less. Her rituals became very elaborate very quickly, and within a fortnight she had decided it better not to eat any meals as she HAD to go to the toilet before eating a meal. She was only 5 at the time. 

Going back to CBT therapy, I like what you say about being shown OCD is a choice. My daughters current therapist, a clinical psychologist, has a lovely manner with her but when she wants to push her more into therapy I think she has said to her something like "seeing me is more than just having a chat " & we have been told by the therapist that our daughter gets very stressed when OCD directly discussed and one time she reported our daughter became very oppositional and that it had really shocked her!! (I was thinking, surely you have seen many stressed kids in CAMHS). This was all in the first couple of months post discharge from hospital, and is what triggered the therapist quite early on inferring that as she wasn't able to do proper therapy with our daughter, then maybe sessions should stop. They have continued but we parents are regularly informed that she is not providing therapy, that it is more problem solving about a particular worry or anxiety our daughter may have, and essentially that someone else less qualified could do that role.  I wonder is our daughter has received too much "negativity" , that she has an illness and has to change or she not going to be able to be successful with career etc in the future. I think us parents have been guilty of  this a little this past month since her education has been very very minimal. Only last week she blurted out "I know I won't have a career mummy; I know I won't get my GCSEs". Sometimes you hope being faced with the reality will help kick start her to engage in therapy but maybe it;s back fired. However, for most of her absence from school we don't make too big a deal of - but I'm sure she must know we would be concerned by her not attending school and naturally would be wanting to help her. 

 I shall try and take a different approach with her and see how I get on. We could get assigned a different therapist but I know it takes a very long time for our daughter to gain trust and for the therapist to get to know her.

As far as the forced medication route goes, following all my research and wonderful help from OCD UK & Youngminds, my husband and I agree forced medication is not the way to go - primarily because there is no evidence to suggest that the anti-psychotic meds will help. Frustratingly, I have only found out today that the psychiatrist never fed back to the the rest of team involved in our daughters care, after her visit to us - which was at 09.30 so in theory there could have been time to hand over to at least one other team member or write on the electronic notes - especially as she was then off for a whole week. I have felt in tormoil for a few days, wondering if this is the route we are going to need to go down and if it was the treatment option that everyone agreed with. I think (do you agree?) that it was pretty heavy information for the psychiatrist to share with us without having any opportunity  in the near future to discuss what we were told. She was with us about half hour and you don't have time to think and reflect at the time. I'm cross that the CAMHS team as by ignoring all my messages, my anxiety grew. But you, Ashely and other charity related folk were there and for that I am EXTREMELY grateful. I hope I can help others in the future.

Huge Thanks

Kc x

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What I meant to say in light of her rituals involving activities of daily living, this takes up so much of the day at the moment that she isnt able to get to school. But if she were able to get there for say, 3pm and have lessons at that time, I'm sure she would keep her OCD controlled for duration at school. Kc

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Hi kc,

I agree you were given an unnecessarily stressful burden in being left to decide the forced medication issue without support. However, I'm pleased you've decided not to go that route, and to learn the psychiatrist wasn't pushing for it, rather only CAMHS advocated it. Totally unreasonable for CAMHS to attempt to dictate that a patient of any age must be medicated to receive their services! That's beyond unacceptable, :mad: but hopefully won't be a future issue now your rights and the situation are clearer in your own mind. :) 

Returning to the idea of choice, the wording used to talk to your daughter is all important in getting her on board so it's worth making sure the whole team sings from the same hymn sheet.  For example, describing the suppression of symptoms for short periods as 'able to control it' perhaps unintentionally suggests there's an element of simply not wanting to control it other times. :unsure:  I'm doubtless over-sensitive to any implication of 'bad behaviour', but I think it's important you're aware that the ability to temporarily suppress symptoms may have several factors behind it.  

First - it's a postponement, not a switch off. There's typically pay-back to be done in extra rituals later which takes a huge emotional toll. 

Second - it's made easier by the absence of triggers in the 'OCD free zone'. As you say, she's not dressing or bathing at school, but bathroom visits could still be a difficult time within school hours where the rituals break through before being temporarily suppressed again - a potentially stressful, demoralizing and exhausting experience because it's in the self-designated 'free zone'. 

Third - there is an element of control, and choice, but it's a skill to be acquired through practise and repeated failures rather than an innate ability to decide on a whim. Also, when pushed into a defensive position the natural response is opposition, not co-operation. So control needs to always be clothed in the context of free choice and a positive skill to be acquired rather than 'choice' based on a judgement of wanted/expected behaviour. 

Fourth - interest/curiosity/useful occupation/distraction. This is another skill which can be harnessed to manage OCD, but again it takes practice and works best when presented as a mental treat rather than an expected chore. Find a topic she's passionate about and she'll want to disengage from the OCD in order to pursue her interest unfettered. There's no stronger motivator, no better aid to gaining control. :) 

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Hi Snowbear

So there has been so much going on last week and hospital admission is back on the cards. This is what has happened:

(to make it easier, P=psychiatrist, Y=psychologist & C=the case co-ordinator, whose background is mental health nursing. )

So as you know the P had been very blunt to us about what she believed the next treatment option needed to be.  This caused us huge stress but our research led us to believe anti-psychotics were not the way to go. In addition stress was compounded further by the very poor communication & by not having an opportunity to ask questions & to discuss the P treatment proposal in more detail. Then on Thursday evening the P called me (first contact since the previous Thurs) but I wasn't prepared with all my questions so it threw me a bit. However, in the short conversation we had, she said that she believed there were NO other options, and that CBT essentially been exhausted & that she has seen anti-psych drugs help. For good measure she explained that from this weekend she on leave for one month & also that the inpatient unit (IP) actually doesn't usually accept children until 13 yrs (dd is not 13 for another 4 months). I was left deeply upset after that phone call, feeling that not only was this perceived as the only treatment option, but that it wouldn't proceed for several months. This felt like torture - knowing what difficult treatment phase lay ahead but that have to wait a long time for it to start. After a lot of tears, hubby & I composed an email which pretty much demanded that we meet with someone face-to-face on the Friday.

The case co-ord said we could see him, and even better for us (and a miracle!!) both the Y & P were able to join us for some of the meeting. The outcomes were: 1) The Y & rest  of the team feel there no gain in pursuing CBT and that everything in that area has been tried ( but I'm still not so certain that they have really tried everything). 2) A referral to our local IP unit  is only an option - singular (however they are nor presenting any other options. I suppose they are saying it is an option and that we don't have to agree to it.) (but what support will we get if we don't agree to it???). But it won't be as drastic as the P presented it to us, in that there would be gradual links made with the IP unit before any sectioning done (but sectioning still sounds inevitable in the P eyes).

The team are very enthusiastic about this IP unit which is local to us as they say they have close links with the staff and quote the psychologist " they can plan a unique treatment package" for our dd.  This all sounds great - but in reality, would it ever be like that?? In addition, our long experience of IP stay for dd makes us a lot more sceptical about what IP units can offer & we won't be so easily convinced by what the prof stay. In addition my friends child went to this IP unit & says it mostly kids with eating disorders, which her child didn't have, but her child was very often treated like she had - so it didn't sound like the care that individualised. But in our favour we have the enthusiasm of the team about this IP and they know how sceptical we are  - so will this make them more committed to making it work??

As for the use of anti-psychotic drugs and the evidence I have found against their use for OCD: they said that they feel dd does not have pure OCD. Um. Not sure what they meant by that. The P believes these drugs could help. We kept addressing the fear that there high chance (going by evidence) that it won't be effective and  then there is all the trauma she and us have gone through with forced injections and god knows what long term consequences in to adult life. The P just took the angle that our dd is a complex unusual case of OCD & that she has seen these meds help kids with OCD & that essentially, we running out of options. We asked about the team contacting other specialists in the field of OCD, such at Micahel Rutter centre  - they listened but didn't commit to contacting the, to get another opinion. 

So at the end of this meeting, hubby & I felt a lot better just to have been able ask questions face to face and to be listened to. We actually ended up agreeing for a referral to be made to this IP unit. .  As far as waiting until she is 13 , the Y said did can go in aged 12 and told us not to worry about funding issues (although we know these things inevitably slow things down). There is no known time frame for admission. Last time we waited about 2 1/2 months. The rough plan would be for the hosp consultant to visit us at home first & we have chance to ask questions.  As far as how it might pan out as regards to a formal or informal admission, I still don't know.  I guess it depends how our dd is at the time. The P gave us the impression on her first visit that an ambulance would turn up, she would be sectioned and then taken to hosp. for the inevitable. It was wrong of her to give that impression and she actually did apologise for this.

Final outcome: we came away feeling much better than we had all week. However, very soon after the shock of it all starts to kick in again & more questions arise:  Shouldn't the P try prescribing SSRI's whilst in the community before admitting to hospital?  Why can't CBT be pursued?  And I have read around anti-psychotics again and the side -effects sound terrible. Maybe a IP admission is required - a different set of eyes etc, but I still feel extremely unhappy about her having anti-psy. 

Thoughts on what else we might be able to do & what questions to ask? Would Ashley be able to contact Michael Rutter on our behalf. I do have contact names and I know they will remember our dd following there review of her at the other IP unit in Dec 2015.

A quick summary on our dd condition: she has continued to deteriorate. No school, longer on rituals, esp toilet and at the end of last week she started to limit her fluid intake so she didn't have to go to the toilet so much. But this weekend she is brighter and she amazingly took herself out for a walk yesterday. 

Sorry this is so long.

Kc x

 

 

 

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7 hours ago, kc73 said:

We asked about the team contacting other specialists in the field of OCD, such at Micahel Rutter centre  - they listened but didn't commit to contacting the, to get another opinion.

Thoughts on what else we might be able to do & what questions to ask? Would Ashley be able to contact Michael Rutter on our behalf. I do have contact names and I know they will remember our dd following there review of her at the other IP unit in Dec 2015.

Hi kc, 

Well, sat least you got to see the team face to face, that's something. 

Questions to ask - 

1. Demand clarity on what they mean by 'complex and unusual case' and 'does not have purely OCD'.  (In my experience it often simply means 'not responded to the treatment on offer' making the professionals frustrated and stumped on what to do next.) 

2. Is there room to consider voluntary admission to the IP unit without going the route of sectioning, and a trial period of say 4 weeks where staff get to work their magic through behavioural management (as is done for eating disorders) without the use of drugs? 

I wouldn't be too concerned that the IP unit treats mostly eating disorders. The psychology behind anorexia and refractive OCD (not responded to initial attempts at CBT) is very similar indeed. 

I'll flag this thread up with Ashley to see what he thinks about the Michael Rutter suggestion. If that team know your daughter and are able to give a second opinion - particularly if it involves trying a different approach of CBT rather than drugs - then I'd say it's worth pushing for. 

I think it's worth saying CBT isn't one standard approach (or shouldn't be). It often needs to be slightly adapted to the individual. And thankfully there is no more adaptive therapy in the world! 

But I think a lot of those offering CBT become rigid in how they apply it and as a result they don't always connect with every patient. Sometimes too a person simply isn't at the stage where they are ready to face the challenges of CBT and feel unable to engage. In that case work needs to be done on bringing the person round to the point of wanting to engage before 'formal' CBT is tried again. This is the part that most professionals are hopeless at because it takes time, dedication and an ability to think outside the box. And I suspect it's what your daughter needs - that interim psychological work to help her get to a point where CBT has a chance to succeed. You can suggest this to the team if you like though I suspect they'll look at you blankly! 

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  • 1 month later...

Hi Snowbear, I just thought I would give you an update.

The hospital referral went ahead and an their assessment was two weeks ago and we are now waiting for a bed to become available.

Over the past few weeks I was able to talk to various professionals outside of CAMHS which has helped us gain some clarity. A lot of unknowns remain but we know - and now accept - that the next step is another hospital admission. Although the CAMHS Psychiatrist presented the main aim of this hospital admission, being to get dd onto medication, the hospital team have been more wishy washy with their aims for it. The hospital has a OCD programme (which I will be very interested to read) and I imagine they will go in initially to assess her before going forth with medication - willingly or otherwise. 

I was able to speak to one of the national OCD team at the Michael Rutter and I think they are going to liaise with the hospital team during admission which, if it happens, would be great.

As for the MHA: what I have gathered / learnt from speaking to the hospital team, is that as the children are older in this unit (12-18) than the unit dd was at last time (5-12) then they have to be much more careful that children admitted to their unit are consenting to be there. DD was an inpatient aged nearly 11 to nearly 12 & on numerous occasions we had to semi-forcefully help her into the car for the journey back to the hospital following weekend leave , and similarly at the other end when she refused to get out of the car. And on a couple of occasions, staff (after a long period of time encouraging her to get out of the car) had to get her out themselves (forcefully but using their trained techniques/holds etc). It was very distressing for us parents but we never thought what they did was wrong. However, it seems now she is 12, nearly 13, the staff at this unit will not be permitted to do any of the above without legal backing ie MHA. And given dd is so resistant about going into hospital (we couldn't get her to the unit for the assessment so they came to us) it is likely that the MHA will need to be used just to get her to hospital - let a lone receive any treatment! The consultants agree that she is still of the age for us to take her to hospital on the admission date under "zone of parental responsibility" but if we are unable to physically get her there - in the car etc (and we acknowledge now aged nearly 13 this will be v challenging) then (unfortunately) the MHA will be used. 

Between now and the admission (about 3-4 wks estimate) I am having regular chats with her about her OCD, exploring how we,how she might be able to challenge her obsessions etc and help her as much as possible understand the reasons behind the next treatment step. But what do you tell a child whose answer to inpatient treatment, is "it didn't help me last time; what will they do that's different" etc ??

Best wishes

Kc x

 

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Hi Kc,

Thanks for sharing the update and your insights on how 'force' can and can't be used in this age group - very useful to know. :) 

Hopefully quite a lot will be different this hospital stay with the hospital's own OCD programme and liaison with the national team during her stay. But if those don't convince her there is another variable you can add to the list - herself. She's different, she's older, maturing, more able to understand her own role in getting well. This aspect of her involvement as part of the process rather than a passive recipient of treatment can (and should) be explained to her. Whether she chooses to use that power for benefit to help herself or uses it to dig her heels in and stay stuck is up to her - let's just hope she's willing to put it to good use!

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