Last week I phoned a Mum to ask if we could change their appointment as a meeting had suddenly been arranged. Very suddenly, it was Tuesday and the appointment was for Thursday. ‘Of course’ said the Mum ‘I was going to let you know that I couldn’t come anyway’. And when I asked, said something about a holiday. ‘Where are you going?’ I asked and she laughed at me ‘Oh, we’re here already, I just thought we needed a break’. It is always good to be reminded that I am not as important as I may think I am. Some parents, strangely enough, manage very well without us. But yesterday, a lady phoned to cancel because she had flu, and could I send her another appointment, and on Friday, one family just didn’t show, and another cancelled because they were unwell. So, in three working days, I had four empty appointments. And I know that at least three were genuine – the lady who didn’t bring her son, and didn’t let me know, has problems with a boy who has a powerful personality and is quite aggressive. I must point out that a] it is usually a treat to find myself with a cancelled appointment – I don’t usually have more than one a week, and b] I would hate people to come with nasty viruses that they might pass on, particularly to me. However, each appointment is given ninety minutes – non-attendance can be a problem [and of course there is always the issue of fitting the families in later. I usually have an intention to the time between appointments, and four weeks instead of two changes the dynamics considerably]. Anyway, last week we were sent round a document on policy regarding DNA – the title was PCTDNA – and I spent the first few minutes wondering how much ideas about genetic inheritance had to do with me, before I understood it meant ‘Did Not Attend’. It’s an interesting document covering a lot I hadn’t thought of. Obviously it is based on the time wasted in waiting for people who do not turn up and the cost to the organisation. But, in all fairness, it is more than that. It talks about the need to consider whether children are harmed by their non-attendance. There are children who have strabismus [a squint] who will both lose the sight of one eye and look strange if the problem is not corrected. Children with acute health problems need help, but is it critical if parents don’t follow-up on an appointment for verrucas? The relevant question is: Will the child be harmed by non-attending? In our situation, with Child and Adolescent Mental Health, how does one decide? I may think I am super-relevant and helpful – the parents may feel not. I may have a great connection with a child who I am helping to see a different picture, but will this help him or alienate the others? I may be able to advise the parents on how to manage the child, or encourage positive sibling relationships, or overcome bereavement, but if the parents don’t feel I am useful, they won’t take the advice. When we are talking about mental health, I can’t definitively say, usually, that harm will be caused by not coming, any more than I can be one hundred percent certain that I will do good. And if I could, parents who do not share my views can undo all I am trying to do in minutes. CAMHS is very little like the rest of the Health Service.