Child And Adolescent Mental Health Services: national service specification

Annex 2: Definition of CAMHS Professionals and Services

Tier 3 CAMHS

Tier 3 CAMHS works with children and young people from 0 years up to the age of 18 years who present with significant mental health problems. The team is based in a local area, is multi-disciplinary, made up of nurses, clinical and applied psychologists, social workers, psychiatrists and occupational therapists as the main professions, with access to systemic and family psychotherapists, child and adolescent psychotherapists, speech and language therapists and dieticians as required. These professionals provide consultation and advice to other professional groups and agencies. CAMHS provides specialist diagnostic assessment and provides psychological, systemic and/or pharmacological therapy. They also work with other the staff in the other services out with CAMHS. CAMHS is available for consultation to other professionals concerned about children and young people's emotional wellbeing and mental health issues. CAMHS Tier 3 teams deliver the National Referral to Treatment Standard so are key to delivering the CAMHS Service Specifications.

Substance Misuse Service

CAMHS substance abuse services provide support for the management and treatment of children and young people with co-morbid mental health and substance misuse problems. This may be provided with the Tier 3 CAMHS team, or by a more specialist Tier 4 team over a larger area. CAMHS substance abuse services will work along with other community based agencies that deliver services to help young people who are misusing substances whether legal or illegal. Therapeutic intervention will be aimed at reducing or stopping substance misuse through discussion on the physical, psychological, social, educational, systemic and legal issues related to their substance misuse. CAMHS substance abuse services also offers opportunities for consultation and educational group sessions to professionals, children and young people their families and carers.

Eating Disorders Service

CAMHS Eating Disorders services treat children and young people under 18 years who have difficulties with their eating patterns. Examples of eating disorders are Anorexia Nervosa, Bulimia Nervosa and Eating Disorders Not Otherwise Specified (EDNOS). This can be provided within a Tier 3 CAMHS team, or by a dedicated Tier 4 team working across a larger area. CAMHS/Eating Disorders services will provide a family and individual assessment and a range of interventions are available, such as Motivational Work, Individual Therapy, Family Therapy (e.g. Family Based Treatment), Individual Nutritional Assessment, education and reviews. Various group supports may also be provided such as nutritional education and carers support which may be provided over a specific number of weeks.

Intensive Home Treatment Service

A CAMHS nursing/medical/AHP team available in the community to reduce and/or manage children and young people who are at immediate risk or who need intensive therapeutic care. The primary objective of this service is to prevent admissions to acute hospital care. Where admission is required, this service is aimed to provide earlier step down from in-patient psychiatric care.

Crisis Service

CAMHS crisis services provides a 24/7 emergency/crisis response assessment and management service, working alongside other agencies (Police, ED, SWS etc.) and may provide support as required to these agencies. CAMHS Crisis services work intensively with children and young people and their families/carers as required to respond to mental health crisis immediately. CAMHS crisis services ensure children and young people are safe and receive appropriate follow up care, including medical and psychiatric inpatient care where require, social work and other services response. CAMHS crisis services will work closely with the Crisis supports under development for the Children and Young People's Mental Health and Wellbeing Programme Board.

Gender Identity Service

This service will provide assessment, specialist interventions/treatment and therapeutic support to young people who have issues regarding their gender and also includes work with families. These services often work over a larger area, and works in collaboration with Tier 3 CAMHS teams offering consultation and liaison (and with wider children's services) as necessary and appropriate. Gender identity services link with and/or signpost users and carers to other relevant voluntary/community sector organisations for additional information and support. This service could be delivered on a regional or a national basis.

Forensic CAMHS

This service supports a range of agencies and professionals in addressing the mental health and risk management needs of young people presenting with high risk behaviors. This is conducted through clinical consultations and specialist assessments. This will often include young people in the criminal justice system, prison and secure care. This service should be delivered on a regional basis with links to and from the National Secure Inpatient Psychiatric Service (opening in 2022).

LD/Intellectual Disability CAMHS Service

This service works with children and young people with Intellectual Disabilities/Learning Disabilities (ID/LD) and mental health difficulties or complex behavioral difficulties. It provides comprehensive assessment and specialist, multidisciplinary, therapeutic interventions, broadly similar to mainstream CAMHS, with additional interventions/treatment approaches tailored to the needs of children young people with ID/LD e.g. behavioral and communication interventions. ID/LD CAMHS understands the complex genetic, neurological or physical health difficulties which often impact on the mental health and development of children and young people with ID/LD and tailor their approach accordingly.

ID/LD CAMHS work along with other specialist services involved with children and young people with ID/LD particularly education, social work and community paediatric teams. NHS Scotland are considering the case for a National CAMHS Inpatient Service. Children and Young People with Complex Neurodevelopmental Problems and mental health risks and impact may also be referred to this team where the risks and impact are beyond the supports available in Core CAMHS and wider children's services.

Liaison CAMHS

This service provides CAMHS input to acute physical healthcare settings, recognising that children and young people who are frequent attenders and in-patients have a higher incidence of mental health disorders. This is particularly the case for children and young people with neurological conditions and chronic health conditions. Psychiatrists, nurses and clinical psychologists work with paediatric and adult healthcare colleagues to provide mental health promotion, early intervention and treatment services so that children and young people receive high quality holistic care for emergency and routine presentations. They also support children and young people admitted to acute healthcare settings as a consequence of mental health disorders e.g. for physical stabilisation of a child or young person with an eating disorder or where they present with an acute crisis. Therapeutic work comprises of psychological and psychopharmacological therapies based on careful assessments and joined up working with acute physical healthcare colleagues.