Charles
Charles’ elder son became depressed and started self-harming aged 16. He is being treated by CAMHS and private psychologists. Charles finds his mood swings very worrying and difficult to deal with.
Charless son Henry [not his real name] became depressed before taking his GCSEs. He moved to a different school where he seemed happier, but then said he couldn’t face school anymore and tried to harm himself by tying ligatures round his neck. Their GP, without consulting Charles and his wife, referred him to the CAMHS (Child and Adolescent Mental Health Service) Crisis Team. They saw several different members of the Crisis team, who recommended that Henry should not return to school. Charles and his wife couldn’t understand what the problems with school were, and were anxious that Henry did not fall behind with his school work. Nevertheless, Charles took Henry away to their holiday home abroad for a week. He tried to talk to Henry about coping with depression but Henry became angry, cut himself with a knife and tied a belt round his neck, leaving the door open so that his father could find him. They returned to England and again saw a succession of different clinicians, including a psychiatrist who considered admitting Henry to an inpatient unit. Henry wanted to go with the family on holiday, so persuaded the clinician that he did not need hospitalisation. There was one incident on holiday when Henry put a dressing gown cord round his neck following an argument with his brother. Henry is now back at school part time and is seen weekly by a private clinical psychologist who uses CBT (cognitive behaviour therapy), and is also seen regularly by the main CAMHS service. He is taking antidepressants.
Charles finds it difficult to cope with Henry’s sudden rages and the worry that he might damage himself or other people in an argument. Charless two younger children have been deeply affected by their brother’s volatile behaviour. His daughter has to control her reactions to him to avoid causing an outburst of temper, and Charles thinks that she is more grumpy and bad tempered as a result of this stress. Charless other son is relieved to be at boarding school, away from the tension at home. Charles says that the strain for him and his wife is huge, like walking on glass. Their efforts to comfort Henry sometimes make things worse the clinicians have advised them to give him space’. They feel powerless and constantly dread triggering more violent behaviour. Charless wife thinks much of Henry’s behaviour is related to teenage hormones and the normal difficulties of adolescence. They sometimes suspect that Henry is manipulating them, using his illness as an excuse not to go to school and to get his own way.
Charles has lived abroad for much of his life and is not used to the National Health Service. He is very satisfied with the private practitioners he has used, especially with the convenience of making appointments and being included in treatment. The Crisis team made him feel disempowered: he says his views, feelings and perspective were completely ignored. He is confused about the relationship between the Crisis team and the main CAMHS service, but is much happier with the consultant NHS psychiatrist and case worker who are now looking after Henry. Charles thinks that he is more trusting of the professionals opinions than his wife, who feels ignored and excluded from Henry’s treatment. They would like the opportunity to discuss the situation with the clinicians without Henry present, and think family therapy would be beneficial, especially for their daughter so she could express her feelings, but there is a long NHS waiting list.
The school has been very supportive, but Charles worries about how long staff will put up with Henry’s poor attendance. He is anxious about the effect on Henry’s future if he misses too much of his school work. Charles used the internet to learn about teenage depression, and at one point thought Henry’s mood swings might be due to bipolar disorder, but was reassured by the private consultant that this was not the case.
There is no family history of mental health problems, though Charless great-uncle killed himself over a love affair after the First World War.
Charles describes Henry as a charming lovely boy for most of the time. He worries about Henry’s lack of confidence and low self-esteem, but hopes that the combination of medication and therapy will enable him to live a normal life. He would like to hear how other parents have coped with similar situations. His advice to clinicians is to involve the parents as much as possible, so they have a better understanding of what is going on and how best to help their child.