'Tell them everything and I mean everything' – new CAMHS centre plan for children in crisis

03.10.2024

A young woman with complex mental health issues is urging children and young people to use a planned community crisis hub.

Aaliyah Ramessur has autism and has battled mental health issues, including suicidal thoughts throughout her childhood and beyond. She bravely spoke about her own experiences and how Emergency Departments felt like the wrong place to be, as a child undergoing mental health crises.

She and her mum Fay are supporting a new initiative by the Health Board’s child and adolescent mental health service (CAMHS). Called Alternative to Admission (A2A), it will provide a seven-day-a-week crisis centre for young people aged 12-18 in Conwy and Denbighshire, or who present at Glan Clwyd Hospital.

The plans, recently given the green light after confirmation of Welsh Government funding, will see a dedicated venue developed for the service, open between 9am and midnight. It aims to reduce both the number of mental health crisis related admissions to hospital and Section 136 orders for children and young people.

Staffed by the Central Unscheduled Care Team, the goal is a more appropriate space for those young people who would otherwise end up in busy emergency departments (EDs) and possibly end up in a hospital bed. As well as benefiting young people in crisis, it is hoped it will reduce pressure on overworked ED staff.

Aaliyah explained her experiences of visiting EDs as a young person, while in the midst of a mental health crisis. She said: “It was scary, because as a child, you don't really want to be going in there. The main thing for me was that they didn't really understand what was happening with me.

“They're trained to do a certain role and when they're doing a role of someone else, it's difficult for them - and it's difficult for me because, obviously you just want the proper support and care.

“I felt like I needed someone to listen to me, whereas they just have a procedure that they need to follow. They don't know what to say to you because it's not their field of expertise.”

Those experiences often ended up with Aaliyah being kept in overnight in order to see a clinician the next day. Sometimes she could wait for longer.

“By that point I would be getting frustrated,” she explained. “I just wanted to leave. I'd get really anxious and it would make my thoughts and things worse. It would be like all my negative feelings would get worse, feeling like I’m not being listened to and nobody understands.”

Fay Ramessur echoed her daughter’s view that EDs were not always appropriate destinations for children in the grip of a mental health crisis. She believes they can be daunting and scary for people going through poor mental health episodes – especially so when they are children.

“Being in ED would send her absolutely on the ceiling,” revealed Fay. “Aaliyah’s anxiety would be so heightened. She would just fight. She'd feel worse about herself because she didn’t want to be there, but didn’t know what else to do.”

Fay explained how, after years fighting to get an eventual diagnosis of autism for Aaliyah, her daughter then developed problems with her mental health. When she first caught Aaliyah preparing to end her life, she realised the family needed help.

She revealed how it often felt like there was nowhere she could turn to and no one genuinely understood what it was like to constantly second-guess or keep her daughter safe from harming herself.

She said: “I'm thinking, I need to be her mum and not her therapist. Somebody else needs to do this because she’s not listening to me – and she’s not going to hear it the same way from me.”

The family made multiple trips to ED during Aaliyah’s crises. There was self-harm, suicidal thoughts and Aaliyah would be admitted, a plan put in place and the cycle repeated. Fay wondered how much longer it could go on, until eventually Aaliyah found a therapist who she could relate to.

Now under the care of adult mental health services, it is still a day-to-day struggle for the 20-year-old and her mum. However, Aaliyah wanted to tell her own story and support the idea of a CAMHS community crisis hub.

She said: “In these crisis centres, I feel like people will be educated about childhood mental health a lot more - what to say, how to handle it. You've got the specialist people who can help you.

“I think in the day, you're not left with your own thoughts and feelings. You're busy, you're doing things. At night, that’s when it creeps up on you. So it’s good it will be open later.”

Aaliyah is urging young people and their parents to make use of the new service and speak out if they are having difficulties.

“I would definitely say talk to them,” she said. “As much as it's scary and you don't want to trust anyone, because it's hard to trust people. It’s like you’re on your own and you don't want to open up, but tell them everything - and I mean everything.

“Otherwise, if you don't tell them the whole story, they can't help you in the right way. I wouldn't tell them the whole story. I would tell bits of it and I wouldn't get the proper support that I needed at times.”

Mum Fay said having somewhere calm to go where Aaliyah could have collected her thoughts, rather than a busy ED, would have been a “Godsend”.

She added: “If you've got a space where she can just try and relax, some sensory stuff, it's a different environment that she associates with coming down, rather than going up a level of emotion. That would have been amazing.”

Cindy Courtney is the regional CAMHS crisis care lead. Speaking on behalf of herself and CAMHS programme project manager Becky Rowlands, she said: “It is really clear from Aaliyah and her mum Fay’s stories, and from the work we do with children, young people and their families, environment matters.

“We agree wholeheartedly that children and young people need a warm, welcoming and comfortable space when they’re experiencing a mental health crisis.

“We are so excited by this A2A project because we know it will provide compassionate care from our experienced unscheduled care team in a suitable space.

“It’s a shared vision developed alongside young people and their parents and carers and it is fantastic to see it coming to life, so it can make a positive difference to young lives.”

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