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Self-harm: Parents' experiences

Mental health services - involvement of families

Difficulty in relationships within families may sometimes contribute to self-harm. However, in general, families are seen as a very important part of trying to help the young person. Services will usually try to involve parents and other family members within treatment. 

Some parents were pleased to be included by their child’s clinical team. Sharon went to a Child and Adolescent Mental Health Service (CAMHS) parents forum. She could phone at any time to talk to the team and they updated her regularly. Anna described good communications between herself, a psychologist, a psychiatrist and her daughter’s school: ‘Everybody communicated with me and nobody ever treated me like I was some half-wit.’ She and her daughter had both been bereaved by the death of her husband, so she accepted the CAMHS offer of support for the whole family.
 

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Other parents felt they had been excluded. Ruth wished she could have been involved more. She found it frustrating that she couldn’t discuss a lot of things with CAMHS, although she understood the need for patient confidentiality. Jo’s daughter was over eighteen when she was seen by the community mental health team. ‘It was made very clear to me that I was not welcome in the consultation,’ Jo told us. Pat was surprised that CAMHS didn’t include him, though he said he was sure that they would tell him if they were worried. Jane Z said, ‘The confidentiality thing is a huge issue because I have absolutely no idea what’s been said to her’.
 

Fiona said the child psychology service wouldn’t let her attend her son’s treatment sessions and didn’t discuss anything with her.

Fiona said the child psychology service wouldn’t let her attend her son’s treatment sessions and didn’t discuss anything with her.

Age at interview: 57
Sex: Female
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We were going, we went to child psychology in [town] and he went to sessions there. I had to drop him off. They wouldn’t let me go in on them and very unhelpfully, they would not tell me anything about it. I know I know about all the confidentiality and I used to say to them, “I’m not asking you to disclose. I’m asking for advice. Is there anything that’s been disclosed in there that I need to change because if I’m part of the perpetuating problem.” And it was just like, “No, we’re not getting anywhere and we’re not going to discuss anything.” And so that didn’t work because he soon stopped going to that. 
 

Pat was worried when he ‘didn’t get anything back’ from CAMHS.

Pat was worried when he ‘didn’t get anything back’ from CAMHS.

Age at interview: 43
Sex: Male
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I haven’t seen anything out there for parents really. CAMHS are ill-equipped I think, I don’t, but it’s not their remit I don’t I don’t think. Yeah, I don’t get anything back from them at all ever, which is a bit of a worry.

Yes, so you just take her there and you wait and then you take her away.

It’s very near to her school so she can make her own way. I’ve always picked her up and I think I’ve always taken her so far but, basically, I go there, drop her off, either sit outside or go and have a coffee and then come back and pick her up and I just go, “How was it?” Because you sort of want to know but I don’t want to pry.

And then I find out whatever she wants to tell me. Yesterday she had a lot to say but yeah, I haven’t, no, I haven’t heard from them at all. I did speak to them the other day when we had to move an appointment and I did, I do remember saying, you know, “Let me know if you want me to come along.” And I’m fairly sure they sort of sniggered [laughs].

But I’m fairly sure I’m quite tightly wound [laughs] at the minute, to be honest. I think my paranoia is kicking in. But I mean I don’t want to know what they’re talking to her about particularly. I just want her to be okay but it would be nice, I guess, all I’ve really heard is that they don’t think that she’s got a mental illness and they’ll keep seeing her and they did come to a meeting at the school where they expressed their deep unhappiness at the school.
 

Nicky thinks carers should be included as ‘part of the solution’.

Nicky thinks carers should be included as ‘part of the solution’.

Age at interview: 48
Sex: Female
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Do you have any messages for other parents and carers and for clinicians?

Oh for clinicians, please talk to carers. Don’t exclude us. We’re part of the solution. We may be part of the problem. I think often clinicians’ perception, certainly in my experience, can be that you’re part of the problem. Well, I maybe but actually, if you help me out I can maybe be part of the solution too and that the National Health Service has more and more that it’s being asked to do and to deal with and to support and not to use the people who really want to be used to help deal with this, to help support people who are going through it, seems like a really short-sighted and wasteful thing to be doing, so engage with carers. Find out what carers want. Wherever possible, if it’s if it’s helpful, and I know it isn’t always, but if it’s going to be helpful to get the the the patient to agree to let the carer know about what’s going on, do that, that made the biggest difference for me.

Was having [my daughter] give her, was having my daughter give her consent, that made the biggest difference because that meant that me and her CPN could talk about how she was and he, you know, he he never divulged anything huge but he would say, I would say things like, “Oh she’s been doing blah blah blah and I’ve been behaving x, y, z and it’s caused these kind of problems.” And he’d say things to me like, “Yes, she did mention that she’d been behaving like that and she did say, you know, and yes, I know that that, your response is really winding her up but, actually, that’s okay.” You know and it was it was just being able to have that frankness. He never divulged anything hugely detailed and, if he wanted to share something specific with me that she told him, he would ask her and if she said, no, that was an end of it. But there were a couple of occasions where he’d say to me, “She said something, she said x to me and I asked her if I could share that with you and she said that was okay.” And I found that really, really helpful.

Because, when you’re really worried, when you don’t understand and you’re really worried, you need that reassurance. You need to know that you’re doing the right thing or some gentle guidance if you’re not doing the right thing as to what the right thing is. 
Family therapy
Several parents were offered family therapy. Some decided not to participate – Sandra had other sources of support and thought it might be awkward as she worked in the same professional area. Isobel didn’t want to attend sessions with her ex-husband. Debbie chose not to be involved when she thought her family were being ‘targeted’. Joanne took part, though she thought family therapy was ‘there to help my daughter, but my ex, her dad, goes along to it and it’s basically my daughter having a go at him… but it doesn’t help.’ Ann found the process disturbing and wouldn’t recommend it, but Liz’s family thought it was useful. Anna was pleased that CAMHS offered support to the family unit (see clip above).
 

Liz found family therapy very valuable as it provided a safe place to express anger.

Liz found family therapy very valuable as it provided a safe place to express anger.

Age at interview: 52
Sex: Female
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I think, when she was very ill, I think it was very helpful to have a situation where we could see the family therapist without her and we actually, probably could have done with more of that. We saw them with her as well but certainly my husband found those sessions very, very valuable because he was he was angry and I was making him sit on that anger because I didn’t want him reflecting it back to her. So I was containing it very much and he needed somewhere where he could express that anger safely and I think that that was very, very useful to him that that environment.

And also her younger sister, similarly, she, it was particularly useful with the anger because the anger, I was terrified always of it being reflected back to my daughter and affecting her adversely so I was very, I felt like I was spent my whole time containing this anger from both of them and there was somewhere they could let it out there, which was very useful.
 

Debbie chose not to be involved when she thought counsellors were too intrusive.

Debbie chose not to be involved when she thought counsellors were too intrusive.

Age at interview: 37
Sex: Female
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And so were you involved by those counsellors at all?

No, but that, actually that was my choice not to be involved at that point because I found them very, they were kind of targeting us as I felt like as a family, they was, was their problems, they were trying to say to my daughter like, “Is there problems between you and your mum’s relationship? What’s your dad’s relationship like? How do your mum and dad get on?” Very inquisitive and it was as if they were putting words into her mouth and then I was worried that they were thinking so I was like, “Well I’m just standing back and she can do what she needs to do.” So my dad took her to them sessions for the six weeks but he just stayed outside. She went in on her own.
 

Although it might have helped her daughter, Ann was upset by family therapy.

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Although it might have helped her daughter, Ann was upset by family therapy.

Age at interview: 47
Sex: Female
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So yeah, family therapy, I wouldn’t recommend it. Made me ask questions, where I hadn’t asked questions before. Made me doubt things I’d never doubted before…. and I’d, I would come away from there in tears, inconsolable sometimes. 

That doesn’t sound very therapeutic does it?

No, it wasn’t and again, you know, it’s… I don’t know, it’s aftercare. You’d go in for this quite heavy session, it’d only be an hour but rather it was an hour and it was only when, you’d talk, you know, they ask the questions and you give the answers and all this talk happens and actually, it’s not until you come away and hubby is there driving, as he does, and I’m the one that’s sat there thinking and quite often I’ll just end up in tears, “It’s my fault. It’s all my fault.” Nobody has ever actually told me any different [laughs]. So that’s the other side of it, once they’re adults, you don’t get told anything. So, yeah, so I just do what I can do now, probably over compensate.

What does your husband say about the family therapy?

He got picked on a bit really for not showing his emotions, whereas I would get cross and angry and challenge things and he would just sit there, “Yeah, well, whatever.” But they would accuse him of not showing his emotions and that’s harmful to everybody. That’s just the way he is. He’s so laid back, he’s horizontal. You know when he’s cross. You don’t want to see him when he’s cross. He doesn’t get like it often. 

But, yeah, I don’t think it was ever much fun for anybody really, for me or him. When the when the other kids were there it wasn’t so heavy but I think they were definitely looking at the family dynamics and how we all interacted with one another.

So all three kids were there when you had those sessions?

Yeah, yeah. But I know, in the past, when I’ve had counselling the common thing at the end of that is, “And how do you feel now? Are you going to go away from here and be okay? How are you going to get through the rest of the day and, you know, it’s fine.” But there was none of that there. You were just sent on your way. Off you go [laughs] until the next time. 
So but I think my daughter found it quite beneficial.

Last reviewed December 2017.
 

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