The term CAMHS has two meanings. In the past, it has been used as an umbrella term to describe all multi-agency activity designed to support children’s mental health, ranging from what is available to promote the wellbeing of all children through to what is provided for children with the very highest needs.But it is also commonly used to describe the activity of specialist child and adolescent mental health services and treatment; those services designed to meet the needs of around 2% of children in your local area (i.e. those with the most severe and/or complex mental health difficulties).
In this section of the site, we will use this term specifically to develop an understanding of the role of specialist CAMHS and of how to work effectively with these teams to meet the needs of your children and families. The broader landscape of community mental health support for children is outlined separately.
Who are Specialist CAMHS?
Specialist CAMHS are NHS mental health services that focus on the needs of children and young people. They are multidisciplinary teams including psychologists, psychiatrists, social workers, nurses, psychological therapists and mental health link workers. There are also often separate specialist CAMHS practitioners/teams supporting the mental health of children with learning disabilities and linking in with children in contact with youth offending teams.
Local specialist CAMHS services will have their own websites explaining what they do and what support they offer, together with information about access, referrals, etc. Check the NHS Choices directory of CAMHS for your local service’s details or the Youth Wellbeing Directory.
Making a successful referral to specialist CAMHS
What senior leaders can do
Establish a protocol with specialist CAMHS in your area to clarify referral and joint working procedures. This may include:
- Agreeing how you might access advice and consultation. Many specialist CAMHS teams are happy to offer school staff and other professionals advice about potential referrals, which can save time and simplify the process.
- Finding out and documenting who can refer to specialist CAMHS. Some areas have an ‘open’ system of referral (which means that family members, children and young people, teachers, counsellors, social workers etc. can refer). Others have a system where only certain professionals can make a referral (e.g. schools nurses, GPs etc.).
- Finding out and documenting how children are referred. Some specialist services have a single doorway (or point of access called a SPA) or an initial screen system (called triage) to determine whether a child’s needs are best met through a specialist CAMHS service. See for example, Solihull CCG’s Transformation Plan.
- Agreeing an information-sharing protocol so that schools and families can work together and complement any treatment a child or family might be receiving.
- Agreeing a clearly documented partnership approach for helping support a child to maintain progress and ‘step down’ from specialist help when it ends.
- Exploring opportunities for joint training with specialist CAMHS to develop partnership working and to problem-solve more effective support for local children.
A model of joint training between children and young people’s mental health services and schools
Anna Freud National Centre for Children and Families piloted a model of improving partnership working between children and young people’s mental health services and schools through encouraging a network of local school link workers and bringing them together with local services supporting children’s mental health.
The evaluation pointed to improvements in knowledge of child mental health, local support activity and partnership working. Find out more about the mental health services and schools link programme.
What school staff can do
- Document evidence of the symptoms or behaviour that are causing concern. Daily monitoring diaries, which include information about time, place and duration of symptoms are useful for this.
- When making a referral from a school (or supporting another professional with a referral), keep information relevant and focus on the things that specialist CAMHS teams need to know, including:
- How much a child’s difficulties are interfering with day-to-day life and progress.
- How long a child has been struggling with symptoms/difficulties. Use your daily monitoring diaries to describe how mental health needs and behaviours affect daily functioning and learning.
- How many other difficulties and risks a child and family is facing.
- How much a child’s safety may be compromised by their mental health difficulties.
- Whether any other school-based or community support has been tried. For example, for behaviour difficulties this will mean thinking about whether parents have been helped with strategies to support their children (usually delivered through programmes such as Triple P or Incredible Years).
- Carry out a Strengths and Difficulties questionnaire at an early stage. Both school staff and parents can complete one. Although not a diagnostic tool, it provides a useful way of working out the nature and severity of a child’s needs and what next steps to take. The results of this questionnaire should also be combined and considered together with parents/carers, the child’s own experience and school staff observations. Information gathered from this tool can also give school staff, parents/carers and mental health services a common language, understanding and reference point.
Find out more
MindEd is a free educational e-learning resource for professionals on children and young people’s mental health. Resources can be used for individual professional training as well as prompting wider staff discussion. The second half of this module has some useful information on how to make an effective referral to specialist CAMHS and includes information on avoiding delays.
What do specialist CAMHS do when they get a referral?
Whenever they receive a referral, specialist CAMHS will generally assess how urgent, complex and severe a child’s needs are. This process is often known as ‘triaging’ and it can operate in three ways.
- A referral would be considered an emergency if problems were severe and there was immediate and active risk (either to a child or to others). This could include severe depression, suicidal feelings accompanied by signs of planning, some loss of touch with reality (psychosis) etc. This type of referral would usually involve a child being taken into a place of safety such as a hospital or receiving intensive home-based support to prevent hospitalisation. It will often involve immediate or next day assessment; outside office hours there should be arrangements in place locally to manage children and families’ emergency mental health needs. However, these services have been historically lacking for children. If your area does not have 24/7 specialist CAMHS cover, contact your local duty social care team who will be able to provide advice about ‘out of hours’ response and/or ask your DSL (designated safeguarding lead) for advice.
- A referral for a child which is classified as urgent may also involve many of the risks above – but the level of risk will be assessed as slightly less immediate. In these instances, a child might be seen within five days.
- All other referrals will be evaluated as ‘routine’ referrals which means that an experienced clinician has assessed that there is much less immediate or imminent risk of harm to a child or to others. Children and families with this level of need will have a longer waiting period. However, under the NHS Constitution, no child should have to wait longer than 18 weeks from referral to start of treatment.
What happens if specialist CAMHS don’t accept a referral?
Specialist CAMHS are designed to meet the needs of around 2% of children in your local area (i.e. those with the most severe and/or complex mental health difficulties).
If they don’t accept a referral, they should provide a clear reason for their decision and give advice about what to do next, including:
- what other local services might best support a child, and
- the most effective things the school and family can do to support them.
See our section on the broader local landscape of support and services that support children and young people’s mental health and wellbeing.
What happens when a child’s referral is accepted?
There has been ongoing concern about children having to wait lengthy periods of time before they can get specialist mental health support as well as substantial differences in waiting times across the country. A government green paper is currently (2017) considering action to create a standard four-week waiting time for getting help from specialist CAMHS.
What happens while a child waits?
It can be very challenging for a child (and their family) to have to wait before they get the help they need. In the case of emotional difficulties some children may want, and be able to get, school counselling while they wait for specialist help. Or in the case of challenging behaviours, parents/carers can be helped with proven strategies to support children to settle their behaviour. [link to MH needs> challenging behavior] Sometimes children may make sufficient progress during this waiting time to avoid the need for specialist intervention.
Even when children don’t make progress, this type of less specialist help can help them, their parents/carers and staff to understand a little more about the nature and complexity of their difficulties and this may add weight to the specialist CAMHS referral. Indeed, for children with a non-complex or non-urgent mental health difficulty, specialist CAMHS will usually expect attempts to have been made to help children through the broader range of community services available, before they become involved.
We have also included a number of national helplines and resources across this site to help parents and children get advice and support and potentially develop some ‘holding’ strategies while they are waiting for a referral.
When a child is accepted by specialist CAMHS
Schools should maintain close links with parents and with specialist CAMHS when a child receives treatment or intervention. Both schools and parents can strengthen and complement treatment through providing a supportive school and home environment, helping children implement coping strategies routinely during the school day and, when treatment is completed, helping a child maintain progress.
Longstanding difficulties in the system
There have been well documented and persistent difficulties in the child mental health system which the government’s Future in Mind CAMHS review sought to address. Problems have included issues such as children and families facing lengthy waiting times to access specialist CAMHS, only around a quarter of children who are unwell getting NHS help, and the broader landscape of support being fragmented and confusing to navigate.
There have been efforts to increase NHS investment to improve children’s access to the help they need. Referrals to specialist CAMHS and to the wider landscape of support need to be understood in the context of these national and local pressures.
The 2017 green paper (Transforming children and young people’s mental health provision) lays out the government’s ambition that all children and young people have access to high-quality mental health and wellbeing support linked to their school or college – with a commitment that, when a need has been identified, young people should be assessed quickly, and referred to the most appropriate support. Specifically the green paper outlines plans to:
- Incentivise every school and college to identify a designated senior lead for mental health to oversee the approach to mental health and wellbeing.
- Fund new mental health support teams to provide extra capacity for early intervention for those with mild to moderate needs, jointly managed by schools and the NHS.
- Trial a four week waiting time for access to specialist CAMHS.
The government intends to roll out the new approach to at least a fifth to a quarter of England and Wales by the end of 2022/23 starting in a number of pilot areas.