In crisis care for a young person, the parent or carer might be hard to place. The carer carries the risk around the clock, yet often stands outside the formal care the young person receives, and is sometimes treated as part of the problem. Professor Pooja Saini, speaking at a conference on brief interventions for young people and families, described crisis care from two sides at once: families on the edge, and the staff meeting them while close to breaking point. One question stayed afterward: what it would take to keep the carer inside the room instead of at its edge.
The carer as first responder
For most young people who reach a crisis service, a carer brought them there. The carer is usually the first responder, the one managing risk long before a service is involved. That risk can move within minutes, and the watching rarely lets up. Carers describe checking on a young person again and again, feeling they have to prove how bad things are before anyone acts, and going over the same account many times. For families who have lived with this for years, the exhaustion builds in ways a single appointment can miss.
The carer cast as part of the problem
Then there is the harder part. The same carer who carried the risk can arrive hoping to advocate for their young person and find themselves treated as part of what went wrong. Some described being made to feel blamed, in writing or in person, something both carers and young people tend to pick up on. This seems to come in part from how services have long been set up to look at parenting when a young person struggles. Wherever it comes from, it can carry a cost. A young person who feels they are being set against the person who cares for them may step back from treatment, and the help meant for them can stall before it begins.
A different shape of care
There may be an alternative version that might be worth picturing. When staff manage to slow down and read a person’s history, including earlier adverse experiences, the care can take a different shape. One account from the talk stayed with me: a patient on a rehabilitation ward who became distressed, and at times aggressive, whenever staff came close, until someone read her file, understood a history of abuse, and the team adjusted who provided her care and how. What seems to have made it possible was time and attention: someone had the room to read her history and act on what they found. A carer often holds that same kind of knowledge already, and can carry the work on at home. It seems plausible that when carers are included this way, the young person is more likely to stay engaged. The reverse matters too. A young person in acute distress can push a carer toward their own breaking point, and a service that keeps the family at the door may find the carer in difficulty too.
Small things that still help
None of this sits outside real constraints. It is not hard to imagine the position staff are in, aware of the care they would like to give and short of the time to give it. Holding the family in the middle asks for time that pressured services rarely have. Some of what helps, though, is small: resources designed with carers, communication that names a carer’s experience, peer support for carers, a relational gesture that takes under a minute. Some community services go further and train carers directly, so that a young person’s disclosure of self-harm meets a steadier, more prepared response at home.
Closing
The carer’s position stays unresolved. The carer is central to the young person and, in the way a service is organised, left to one side, and no existing role quite holds them. Services built around an individual patient leave no obvious place for the person carrying the risk at home. That leaves questions open for anyone who designs or delivers crisis care. Who is the carer to this service: a resource, a risk, or a partner? What would it take to make room for them before a crisis forces it? And what is owed to a carer whose own distress has been building, unmeasured, for years?
Where next
Upcoming Webinars
Adversity, Protection, and Prevention: Rethinking Childhood Experiences Through New Evidence
Explore how adversity, protection, and prevention shape child and adolescent mental health at this ACAMH expert conference on Adverse Childhood Experiences (ACEs). Learn evidence-based strategies to reduce risk and build resilience in children and families.
Dr. Emma Morris leads webinar workshop helping clinicians use a mentalizing and systemic approach to assess, formulate, and treat complex trauma in children, young people, and families.
Safeguarding & Suicide Risk in CAMHS: Assessing and Managing Risk in Children and Young People
This set of talks explores updated best practice in suicide prevention within CAMHS, highlighting a shift toward personalised, collaborative safety assessment, formulation, and management following new 2025 national guidance. It also examines suicidality in autism, multiagency learning from recent cases, and broader safeguarding approaches including child exploitation and forensic CAMHS perspectives.
Maltreatment, Trauma-Related Disorders, and Their Interplay with Neurodivergence
Prof Helen Minnis leads a session about the trauma and stressor related disorders of childhood, known as Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED). These are disorders thought to be ‘caused’ by maltreatment (abuse and neglect). We aim to raise your awareness about RAD & DSED and to enable you with the skills to recognise associated behaviours in children and young people who you work.