Child and Adolescent Mental Health Services

**CAMHS** stands for **Child and Adolescent Mental Health Services**. It is the name for mental health care for children and young people in the UK. CAMHS supports children and young people with emotional and mental health problems. It also supports their families. The service is sometimes called **Children and Young People’s Mental Health Services** (**CYPMHS**).

CAMHS includes support from the NHS, schools, charities, and local services. What help is available can be different depending on where you live.

## Tiers framework

**Tiers of CAMHS** CAMHS services are often divided into four levels. These are called "tiers.":

**Tier 1**

Support from people who are not mental health specialists. They offer basic advice and support for early or mild difficulties. Help might come from:

- GPs
- Teachers
- School nurses
- Social workers
- Youth workers

**Tier 2**

Services from trained mental health staff working in the community. You might see a counsellor or mental health nurse in school or at a clinic. They help with common issues like mild anxiety or low mood.

**Tier 3**

Specialist mental health teams for moderate to serious difficulties. These teams include nurses, psychiatrists, psychologists, and therapists. They often work in community mental health centres.

**Tier 4**

Very specialist services for children and young people with serious mental health needs. This may include hospital care or day services. For example: if someone is at high risk of suicide, has an eating disorder, or is experiencing psychosis.

### Specialist CAMHS – Tiers 2 to 4

Tiers 2 to 4 are sometimes called Specialist CAMHS. These services usually need a referral from a professional like a GP, teacher, or school nurse. It is harder to refer yourself (or your child) to the higher tiers without help.

A good specialist CAMHS team might include:

- a child psychiatrist
- a psychologist
- mental health nurses
- therapists (like family, play, or art therapists)
- occupational therapists and social workers

Tier 4 services are for the most serious cases. These may involve being cared for in a hospital or intensive help at home.

There are about 1,450 hospital beds in England for children aged 13–18 who need mental health care.

## Alternatives to the tiers system

Some people believe the 4-tier model is too rigid. New ways of working include:

**CAPA** (**Choice and Partnership Approach**)

Helps services manage long waiting lists, and gives children and families more choice and helps teams work better together.

**CYP-IAPT** (**Children and Young People’s Improving Access to Psychological Therapies**)

Focuses on using evidence-based therapies, which include CBT, family therapy, and parenting support. This approach gives training to existing staff (instead of hiring new types of workers).

**THRIVE Framework**

Focuses on what help is needed, not what tier a person is in. The five THRIVE needs are:

1. Thriving (no mental health needs)
1. Getting advice
1. Getting help
1. Getting more help
1. Getting risk support (for people who may not benefit from help but still need watching over)

## Performance

CAMHS services are under pressure. Some problems include:

- Long waiting times – many young people wait months or even over a year.
- Not enough local beds – some young people have to go far away for hospital care.
- Not enough staff – there are not enough trained people in some areas.

In 2017–18, over 1,000 children were sent far from home to get care in hospital. Some had to travel over 100 miles. In November 2023, over 239,000 children were waiting for a CAMHS assessment in England.

What families and young people say they need:
- Shorter waits and faster access to help
- Clear, honest information
- Staff who listen and care
- Help with real-life skills
- Plans for what happens after support ends
- Respect for privacy and independence
- Involvement in decisions about their care

## Services for mental health crisis

A mental health crisis is when someone feels they are not safe; may harm themselves or others; or needs help urgently. Between 2016 and 2020 in Wales, there were nearly 52,000 mental health emergencies for people aged 11–24.

Many families do not know where to get help in a crisis. This means that A&E (Accident and Emergency) is often the first place people go, even though it may not always be the best option. To improve crisis care, people need to know where to go, and services need to be available quickly.

**Crisis help can include**:

- phone or text lines
- school support
- emergency assessments
- home visits
- hospital care (if needed)

**Good crisis care needs**:

- fast help
- clear info about where to go
- services that work together
- support for families too

## History

Mental health care for children became more common after World War I. In the UK, child guidance clinics worked with schools and families to help children with mental health and behaviour problems. These services used ideas from psychoanalysis and were not always part of the health system.

In the 1990s, the NHS took over many child mental health services. This led to the creation of CAMHS, which was designed to offer more medical and evidence-based care.

The four-tier model was introduced in 1995. In the years that followed, the government introduced new laws and strategies to improve services, such as youth offending teams and local mental health plans.

### Recent Changes and Current Plans

CAMHS has been reviewed many times. Reports have often said the service is hard to access, different across the country, and not always based on strong evidence.

From 2014, concerns about rising demand and long waiting times led to government promises of more funding. In 2015, a review called Future in Mind suggested major improvements, and £250 million per year was promised. However, this money was not protected in all areas, and not all local NHS groups increased CAMHS funding.

Today, the goal is to support 35% of young people with a mental health condition through specialist services. This includes offering support up to age 25, creating school-based teams, and making crisis care available all the time.

In Scotland, the number of CAMHS staff increased between 2007 and 2016. But in 2020, more than half of young people waited longer than the 18-week target for an appointment. In Glasgow, the average wait was 26 weeks.

In England, current plans are based on the 2017 Green Paper and the 2019 NHS Mental Health Implementation Plan. These focus on prevention, early help, more staff, and better access to care. However, the COVID-19 pandemic made it harder to carry out these plans, and demand for services has continued to grow.