Child and Adolescent Mental Health Services (CAMHS) is the name for

NHS The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

-provided services in the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...

for children, generally until school-leaving age, who are having difficulties with their emotional well-being or are deemed to have persistent behavioural problems. CAMHS are organised locally, and the exact services provided may vary, often by local government area.

History

In Europe and the United States child-centred mental health did not become a medical specialty until after

World War I World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...

. In the United Kingdom children's and young people's mental health treatment was for decades the remit of the Child Guidance Movement increasingly working after

World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposing ...

with local educational authorities and often influenced by psychoanalytic ideas. Provision in NHS hospitals was piecemeal across the country and disconnected from the youth justice system. However opposition to

Psychoanalysis PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...

with its pioneering research work into childhood and adolescence, which was poorly understood by proponents of the

Medical model ''Medical model'' is the term coined by psychiatrist R. D. Laing in his ''The Politics of the Family and Other Essays'' (1971), for the "set of procedures in which all doctors are trained". It includes complaint, history, physical examinatio ...

, caused the service to be abandoned in favour of evidence-based medicine and

evidence-based education Evidence-based education (EBE) is the principle that education practices should be based on the best available scientific evidence, rather than tradition, personal judgement, or other influences. Evidence-based education is related to evidence-base ...

. This led to the eclipse of the multidisciplinary child guidance approach in the 1990s and a public policy-motivated formal take-over by the

. The development of CAMHS within a four-tiered framework started in 1995. In 1998, 24 CAMHS Innovation Projects started, and the

Crime and Disorder Act 1998 The Crime and Disorder Act 1998 (c.37) is an Act of the Parliament of the United Kingdom. The Act was published on 2 December 1997 and received Royal Assent in July 1998. Its key areas were the introduction of Anti-Social Behaviour Orders, Sex ...

established related youth offending teams. In 2000 the NHS Plan Implementation Programme required health and local authorities to jointly produce a local CAMHS strategy. In November 2008 the independent CAMHS Review was published. From about 2013 onward major concerns have been expressed about reductions in CAMHS, and apparently increasing demand, and in 2014 the parliamentary

Health Select Committee The Health and Social Care Select Committee (abbreviated to HSC, HSCC and HSCSC) is a Departmental Select Committee of the British House of Commons, the lower house of the United Kingdom Parliament. Its remit is to examine the policy, administra ...

investigated and reported on provision. In 2015 the government published a review, and promised a funding increase of about £250 million per year. However the funds were not ring-fenced and as of 2016 only about half of England's

Clinical commissioning group Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integ ...

s had increased local CAMHS funding. CAMHS funding remains a popular topic for political announcements of funding and the current aim is to increase funding to the level that 35% of young people with a disorder are able to receive a specialist service. Different models of service organisation are also advocated as part of this transformation. In Scotland, between 2007 and 2016 the number of CAMHS psychologists had doubled, reflecting increased demand for the service. However in September 2020, 53.5% of CAMHS patients in Scotland had waited for an appointment longer than the 18 weeks target, and in Glasgow the average waiting time was 26 weeks. 131 new CAMHS beds were commissioned by NHS England in 2018, increasing the existing 1,440 bed base by more than 10%. 56 will be in London, 12 at

Bodmin Hospital Bodmin Hospital is a community hospital in Bodmin, Cornwall, England. It is managed by the Cornwall Partnership NHS Foundation Trust. History A new facility was procured under a Private Finance Initiative contract in 2000 to replace both ...

and 22 at St Mary’s Hospital in Leeds.

Service framework

In the UK CAMHS are organised around a four tier system: :;Tier 1 ::general advice and treatment for less severe problems by non-mental health specialists working in general services, such as

GPs The Global Positioning System (GPS), originally Navstar GPS, is a satellite-based radionavigation system owned by the United States government and operated by the United States Space Force. It is one of the global navigation satellite sy ...

school nurse School nursing, a specialized practice of public health nursing, protects and promotes student health, facilitates normal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, bridge the gap b ...

s, social workers, and voluntary agencies. :;Tier 2 ::usually CAMHS specialists working in community and primary care, such as

mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental hea ...

workers and counsellors working in clinics, schools and youth services. :;Tier 3 ::usually a multi-disciplinary team or service working in a community mental health clinic providing a specialised service for more severe disorders, with team members including psychiatrists, social workers, board certified behaviour analysts, clinical psychologists, psychotherapists and other therapists. :;Tier 4 ::highly specialist services for children and young people with serious problems, such as day units, specialised outpatient teams and in-patient units.

Specialist CAMHS – Tiers 3 and 4

Generally patients cannot self-refer to Tier 3 or 4 services, which are sometimes called ''specialist CAMHS''. Referrals can be made by a wide range of agencies and professionals, including GPs and school nurses. The aim is to have a team led by a consultant psychiatrist, although other models exist and there is limited evidence of what system works best. It is suggested that there should be a consultant psychiatrist for a total population of 75,000, although in most of the UK this standard is not met. The Tier 4 service includes hospital care, with about 1,450 hospital beds provided in England for adolescents aged 13 to 18. Typical conditions that sometime require hospital care include depression, psychoses, eating disorders and severe anxiety disorders. The service may, depending on locality, include: * Art therapy * Child psychiatry * Clinical psychology * Drama therapy *

Educational psychology Educational psychology is the branch of psychology concerned with the scientific study of human learning. The study of learning processes, from both cognitive and behavioral perspectives, allows researchers to understand individual differences in ...

* Family therapy *

Music therapy Music therapy, an allied health profession, "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music t ...

* Occupational therapy *

Play therapy Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological as ...

* Psychiatric nursing * Social worker interface * Speech therapy *

Child psychotherapy Child psychotherapy, or mental health interventions for children have developed varied approaches over the last century. Two distinct historic pathways can be identified for present-day provision in Western Europe and in the United States: one t ...

*Forensic CAMHS, working with young offenders or those at risk of offending

Performance

As of December 2016, some young English people with eating disorders were being sent hundreds of miles away to Scotland because the services they required were not available locally. Not withstanding good care in Scotland it was said that being away from friends and family compromised their recovery. In response the government had adopted a policy of ending such arrangements by 2021, and had allocated a cumulative £150M to improve local availability of care. There are concerns that not enough is being done to support people at risk of taking their own lives. 1,039 children and adolescents in England were admitted to beds away from home in 2017–18, many had to travel over from home. Many had complex mental health issues frequently involving a risk of self-harm or suicide, like severe depression, eating disorders, psychosis and personality disorders. In 2017-18 at least 539 children assessed as needing Tier 3 child and adolescent mental health services care waited more than a year to start treatment, according to a '' Health Service Journal'' survey which elicited reports from 33 out of the 50 mental health trusts.

References

External links