And It's All Too Familiar

Julie's younger brother Duncan is depressed. I hesitate to admit to this because frankly it makes me feel like a fool.  To have one child seeking psychiatric help is a misfortune, but to have two children... well at best it seems careless.  At worst it leaves me open to accusations of raising my children badly, which of course I don't think are true, but I feel too tired to even argue over.

In many ways Duncan's problems are very different from Julie's.  He feels depressed, he recognizes it as depression, and he has sought help.  There are no reports of hearing voices, no sudden dramatic decline, and no dangerous impulsive behaviour.  Although he is a teenager, and teenage depression is notoriously difficult to diagnose, his depression looks very like adult depression.

Unlike an adult though he will have to wait a long time for treatment.  A GP will try to treat someone over sixteen, providing some first-line of treatment (usually pills) while waiting for specialist treatment, but they cannot treat under-sixteens and all they can offer is a referral.  It is not difficult to get that initial referral through to specialist services for adolescents, but it is a referral to services that are frankly overwhelmed, and are currently in the process of a chaotic reorganization (and budget cuts).

The result is that the caseload has to be heavily prioritised.  We waited months for an initial assessment only to be turned away at first.  It took us two referrals to get them just to agree that Duncan was, as he said, depressed.  On our first attempt we were turned away, not only without a diagnosis, but without treatment, support or alternatives.  On the second attempt, backed up with evidence from his school, it was established that he was depressed.  This generated a letter, and put him on two waiting lists, one for pills from a psychiatrist (which was supposed to happen soon), and one for talking therapy.  Four months later he is still on both those waiting lists, with no sign of receiving any treatment.  He has now waited with great patience and dignity for a total of eight months from the time that he first asked for help.  He has not received so much as a single counselling session in that time.

Depression is emminently treatable; it makes no sense to ration access to treatment so heavily for depression in teenagers.  Teenagers are no better able than adults to bear the pain and suffering of depression.

We know these services all too well from our experience with Julie.  This is the same service that initially dignosed Julie as having mild depression and suggested that buying a dog for the family would help.  I was glad when we said goodbye to these services recently as she graduated to adult services; I am not keen to see them again, and I find them in a worse state than when I last saw them.  We know that any treatment Duncan does receive is not guaranteed to be the most effective, that it will be dogged by lack of training, resources and flexibility; there will be no choice of therapy, therapist or location.

What choice do we have but to look privately?  Our son is suffering, we have the money (just), his case seems straightforward.  It is hard to imagine that private care could have made a difference to Julie (would anyone have even taken her on when she needed inpatient care?), but it can probably offer something for Duncan. Private therapy can be no worse than public, and may be better.  Crucially, we can walk away and find another therapist if we are unhappy, something that we never managed to achieve on the NHS. 

I have always  believed strongly in the principle of the NHS, but in this case CAMHS is not fit for purpose.