Child and Adolescent Mental Health Service – CAMHS

All children and young people have a range of emotional experiences that can sometimes include things such as stress, worry, anger, sadness or relationship issues that they successfully overcome with support from those around them and by drawing on and building their own resilience.

Children and young people can also experience difficulties that would be considered as a mental health need. This can show as things like; persistent worries or anxiety, low mood or depression, self harm, a big reduction in wanting to do the things they usually enjoy, poor sleep, panic, phobias, obsessive thoughts, compulsive behaviours and many other things that could be thought of as symptoms.

Every child and young person is different and we don’t use a ‘tick list’ to describe mental health difficulties, it is the experience and meaning to the individual and their family that is considered.

Referrers can help us by:

• Aiming to send the referral to the service that seems the best match, the service will then recommend elsewhere if they feel that is appropriate. Sending referrals to more than one service at a time doesn’t help a child or young person get seen more quickly and can lead to delays and duplication that add to waiting times growing.
• Use referral forms and give as much information as possible to help services understand the child or young person’s needs

There are 2 stages to the referral process in most services. A screening where skilled staff look at the information you send, followed by allocation for an assessment or intervention if they consider themselves to be the best service to help.

To match a child or young person’s needs to the right support we will consider:

• Reaction – does this feel very different from what you expect for a child of this age and stage of development?
• Disruption – how much is it getting in the way of daily life?
• Impact – how long has it been going on far?
• Support – have they had any support previously and did it make a positive change?

Universal support may be given if the reaction is expected for the child’s age and development stage, it is causing minimal disruption, the impact is short term and usual support systems can help. This might mean support from the school, GP, talking to friends and family, self help guides, and family support. Find details at www.onyourmindglos.nhs.uk.

Additional support might be needed if the reaction is beyond what you would expect, it’s causing quite a lot of disruption, it’s upsetting the young person and/or causing concern to family, carers or professionals and support might need a targeted intervention or therapeutic approach. This might lead to counselling, school nursing, Young Minds Matter, Cognitive Behavioural Therapy, youth work or mentoring, targeted intervention such as grief support or support for sexual assaults and education support.

Specialist support might be required if the young person is experiencing a lot of distress and difficulty in most situations and they are unable to do their usual activities, there has been a sudden, severe or unexplained decline in their mental health including risky self harm, suicide plans and loss of contact with reality. It may also be if they have tried previous support and need further help to recover. In these cases a professional who knows the young person such as a teacher, social worker or GP should consider a referral to CAMHS.

We provide a service up to a young person’s 18th birthday. For young people aged 17 and over at the time of referral alongside the usual screening and assessment consideration is given to the length of time available to engage in a course of treatment successfully and what services are available to them post 18. We have transition arrangements with a range of services to handover care.

Children and young people who are neuro-diverse are included within every area of CAMHS and where a child with neuro diversity has an emotional/ mental health need that meets the remit of our specialist mental health service we have staff with expertise to assess and treat this with adjustment made to the child’s individual needs.

There is a separate dedicated children’s autism and ADHD team who offer assessment for Autism and ADHD and have their own access guidance.

If we receive referrals where undiagnosed neuro-diverse needs are identified alongside mental health needs we will liaise with the appropriate assessment team colleagues to understand the best next steps. If we receive a referral purely for assessment of ADHD or Autism, we will return this to the referrer signposting them to the relevant website: SCAAS > Gloucestershire Health & Care NHS Foundation Trust (ghc.nhs.uk) This is because referrals requesting assessment for ADHD and/or Autism require specific information to be provided by both parents and educational setting, which the team will then review to consider if there is sufficient evidence to indicate further assessment for Autism or ADHD.

We usually support children and young people with a Gloucestershire GP. There are a number of families who live on our county borders however and a case by case decision is reached with neighbouring county providers when for example a child is living and goes to school in Gloucestershire but has a GP across a border. The needs of CYP who attend boarding school or college in Gloucestershire and who are only resident for part of the year are also considered individually. If there were urgent needs we would assess and treat those and come to agreement about any need for further care with other areas when it was safe to do so.

Referrals for Children in Care are transferred to our specialist integrated Children in Care team and if CAMHS support is needed this will be requested.

If a child in care is placed outside their home county the Children in Care Team will carefully consider the needs of the young person. The service offered must take into account clinical need and what a placement is being contracted to deliver by the commissioning Local Authority.  

We always make an independent screening decision and assessment. Whilst we always want to receive information and consider the views and care being offered by private providers our clinicians may reach different assessment conclusions and we are not obliged to continue treatment started by others. This includes medication. We can’t move CYP up the waiting list to continue treatment started privately as this disadvantages CYP and families who have not accessed private support.

Families are recommended to consider the potential for ongoing costs when commencing private assessment or treatment.

We will also not disadvantage any CYP or family who choose to access private help, the CYP needs and access will be considered on an equal basis to all others. This is in line with Department of Health Guidance – Guidance on NHS patients who wish to pay for additional private care (publishing.service.gov.uk)

There are many teams in Gloucestershire Health and Care NHS Foundation Trust who work with children and young people. This includes:

Crisis Support – a service for those aged 11 years and upwards (including adults) who are new referrals in a Crisis situation OR are children or young people who are waiting for or receiving treatment who present in crisis outside CAMHS operating hours. The Crisis team role is designed to be brief and support to CYP will be passed back to CAMHS at the earliest opportunity.

Eating Disorders – There is a designated Eating Disorders Service with a separate referral system. There can be times when needs seem to cross the assessment and treatment offers of both CAMHS and ED. The teams are very used to considering together with a CYP and family as to which service will be most helpful and will share expertise/ joint work when needed. Referrers should be reassured that the referral will be past to the other team if indicated.

Gloucestershire Recovery in Psychosis (GRIP) – This team offers a service for those aged 14 to 65 who are experiencing a first episode of psychosis, and those with at risk mental state (ARMS) aged 14 to 35 years. Sometimes it will be known at referral that GRIP is likely the appropriate service in which case the CYP referral will be passed on to that team. Other times it may not be recognised that a GRIP referral is appropriate until intervention with CAMHS has commenced. The CAMHS and GRIP team will negotiate together to ensure the CYP receives the most appropriate care to meet their needs.

Pregnant/New Parents Perinatal Team – People who are pregnant or in the year post birth require care and support that is suited to these needs. CAMHS provides the Mental Health care and support that these CYP may need and will seek guidance from the Perinatal Team when necessary.

If when we look at the referral information we think CAMHS is not the right service to help then the young person/ family and referrer are contacted by letter to let them know including any suggestions for other help that might be useful. We also suggest that they go back to the referrer if they have any future concerns.

The child or young person/ family will receive a letter offering them an appointment date and time. The letter includes contact details to re-arrange this appointment if it can’t be attended. Please contact us at the earliest opportunity if an appointment needs to be re-arranged as missed appointments increase waiting times for everyone. We have a target to offer our first contacts within 4 weeks. The letter will outline where the appointment is and whether the appointment is face to face/ video/ or telephone. An estimation is given in the letter of how long the appointment is likely to last.

We often include questionnaires with the letter that help us explore and understand a child’s needs. We ask that these are completed before you come to the appointment and then brought to the assessment appointment to show the clinician

If a child/ young person/ family or referrer or other professional who knows the child are concerned that they are becoming more unwell and may need more urgent help then they should contact our CAMHS Duty Workers via 0300 421 4899 and describe their concerns.

A multi-disciplinary team of clinicians will meet and use a set format and clinical discussion to establish whether a child/ young person’s needs are urgent. If it is suspected that needs are urgent then the child/ young person/ family will be contacted and offered a review appointment. Sometimes children/ young people will then be offered CAMHS treatment more swiftly, other times they will be supported so that they can continue to wait. The more children who are seen urgently means that others will wait longer so we have to make a careful, fair and consistent decision based on the clinical needs. Same day support can be offered in the most severe of situations alongside the Crisis Resolution and Home treatment team.

Most children, especially pre-teens, rely on a parent or carer to bring them to appointments. A child who does not attend an appointment has therefore not been brought to the appointment. Some older teens are managing their own appointment schedule independently but those doing so without parent or carer support may have limited experience in achieving such tasks and/ or be facing additional challenges in day to day life.

Clinicians take all this to into account when thinking about next steps if a child/ young person/ family don’t attend an appointment. Usually the first step will be to contact and try to establish why the child/ family didn’t come. Next steps will depend on the clinical needs of the child/ young person and their individual situation.

Sometimes it might be felt necessary for CAMHS to contact another agency to offer help to the child/ family. Where ever possible the child/ young person/ family will be informed of this. The circumstances in which this may occur are outlined in the Privacy Notice. Sometimes it will be mutually agreed between the child/ young person/ family and CAMHS that it is appropriate for the child/ young person to be discharged. We will do our best to contact families and if this is not successful we will contact the original referrer or any other named professionals supporting the child/ family to agree next steps. See discharge section of FAQ for steps taken in this event of discharge.

If the child/ young person/ family is receiving treatment and need to cancel an appointment then they should use the contact details provided to them by their named clinician at the earliest opportunity to re-arrange. If the clinicians number is not known then the base they work in can be contacted (Acorn House 0300 421 4899/ Evergreen House 0300 421 4224). If it is not known then phone either base and give the clinicians name and the administration team will send a message to them.

If the child/ young person/ family is receiving treatment and think they want to stop that treatment then they should talk to the treating clinician at the earliest opportunity and decide together what are the best next steps. If CAMHS think that there may be risks to the child/ young person if treatment is stopped then they will talk to the child/ family about other services they may want to inform. It is outlined in the Privacy Notice the situations in which other agencies or services may be contacted without child/ young person/ family agreement.

Sometimes CAMHS feel that we have offered all useful treatment options and are ready to discharge but the child/ young person/ families or other professionals do not feel the child is ready for this. CAMHS will listen to these concerns but we may still consider it clinically appropriate to discharge the child/ young person.

CAMHS hopes to be able to address any concern children, young people, families or other professionals have about our service directly and would be happy to receive contact by the methods described above. In the first instance if the child/ young person is waiting for a CAMHS service then the duty number (Acorn House) should be called. If the child/ young person is in treatment and has a named worker then it is best to discuss your concerns with them. If a child/ young person or family feel their concerns haven’t been resolved by talking to the duty worker or named worker then they can ask to discuss their concerns with the duty manager or the named worker’s manager as appropriate.

If none of these approaches resolve the concerns then:

Children/ young people and families can get in touch to express a concern or complaint by:

• Completing an on line form that can be accessed via Give us your views > Glos Health & Care NHS Foundation Trust (ghc.nhs.uk)
• Telephoning to speak with someone from the GHC Trust Patient Care and Experience Team on: 0300 421 8313
• Emailing the Patient Care and Experience Team at: experience@ghc.nhs.uk;

Other Professionals with concerns about our service:

Initially try to resolve the concern professional to professional. If this is not successful then follow the Gloucestershire Safeguarding Children Partnership processes for addressing this to raise this through management routes until the issue is resolved. 

CAMHS has both targets set at a National level and targets agreed locally with the Integrated Care Board (known as Key performance Indicators – KPI). Our data is routinely compared to other services in our region and nationally. We are also subject to inspection by the Care Quality Commission and the results of these inspections are published and can be found on line. We have also chosen to be part of the Quality Network for Community CAMHS (QNCC). This is a network of CAMHS teams across the UK who visit each other annually to provide a peer review, being a critical friend, sharing ideas and good practice.