All in all it was a very successful meeting and I'd say that it marked a kind of turning point in my relationship with CAMHS, or at least with the psychiatrist who, despite everything, I was actually starting to like and respect as a person. Her attitude towards me had changed, too - much more friendly and willing to listen.
Here's the 'agenda' I took along to that CAMHS meeting.
Ben’s weight loss / the future: What is your intervention action plan and what safety nets do you have in place? Early intervention makes sense.
Giving me back control is great on paper but (a) he refuses to cooperate and (b) he believes he can cut down on intake on school days because he’s “sitting around doing nothing”. How long can we give him a choice and how can we implement a stricter regime successfully given his hatred of the eating plan? Surely the time for “What does Ben want?” is over? But I can’t enforce this on my own.
He refuses to have X,XXX calories and finds it impossible to do this, despite promising he will. I am powerless and can do nothing except sit back and watch while he presses the self-destruct button and heads downhill.
Exercise – compulsion: He still does his usual sit-ups and weights. He insists on going for a run at least once a week and on doing PE at school. (For example he’s exhausted through lack of sleep and the only reason he insisted on going into school today was because it’s PE.) How long will you permit him to exercise? When does it get dangerous? What if he refuses? I can’t prevent him going for a run. He is addicted to exercise.
The in-patient unit: What is his current BMI? What is the BMI for IP admission? How much more does he have to decline before he is admitted? Some CAMHS offer early intervention at a higher BMI for 6/8 weeks; do you? Obviously the cost to the NHS is potentially far greater the longer he needs to be an in-patient.
If he doesn’t get that far, how can we turn things around as he refuses to cooperate and is rigidly trapped in his eating rules / calories / precision-weighing foods?
Me: I am getting to the stage where I am unable to cope or look after him properly on my own. He is bigger than me and very stubborn. I wouldn’t be able to prevent him running away or self-harming. And I can’t physically force him to eat or stop exercising. Under my care he risks deteriorating as I simply can’t get him to cooperate which leaves me demoralised, depressed, exhausted and very frightened.
School: Ben’s anxiety is resulting in sleep loss – he can’t sleep on school days and is exhausted. Yet he is forcing himself to persevere, exhausted and joyless – every morning / evening is a nightmare / miserable situation and it’s just not sustainable. We can’t go on like this.
School dinners: He is still cutting down. How will you intervene? Again, he refuses to cooperate. Action plans?
CBT [Cognitive behavioural therapy]: Because of the co-morbid nature of the condition [depression and eating disorder], will your sessions be focusing on depression AND food?