Cambridge Independent Neuroscience and Psychiatry Services
Seeing a Psychiatrist

What is CAMHS?

Child and Adolescent Mental Health Services (CAMHS) work with children, young people and families when children or young people have concerns relating to mental illness or neurodevelopmental problems such as ADHD.

CAMHS teams are usually made up of child psychiatrists (often with and without CCTs in Child Psychiatry), psychologists, social workers, nurses, therapists and trainees.  Trainees, for instance doctors specialising in Child Psychiatry, can be very valuable team members.  Trainees are sometimes paediatricians or doctors who have worked in Medicine or Surgery.  They often offer extensive experience and skills in other fields and are valuable team members.    

Teams frequently treat families, rather than individual children, although this varies depending on context.  Children and young people can request that their families not be involved, this will be considered carefully weighing risk and benefit.  CAMHS teams often work with children and young people without family involvement, although most would agree that family involvement is preferable (if appropriate).  Please see Confidentiality and Gillick Competence for more information.    

Professionals can see families in a clinic and can sometimes arrange to visit families at home or see young people at school.

Some teams divide themselves into specialist teams, such as an ADHD or Eating Disorder teams, which may offer benefits and problems. Problems may include more than one waiting list for one child if comorbidities are identified and therefore a delay in treatment, which can affect prognosis and risk.  Children also complain about 'having to tell my story over and over' to different teams and professionals. It is often in the child's best interest to be assessed and treated within the same team, with professionals where a relationship of trust has been built.     

Our recommendation is to ensure that the team who will be assessing and treating your child will also assess and treat any other comorbidities and/or complications and not refer your child to another team (often with a waiting list).  For instance, if your child is in the ADHD team and develops low mood, assessment and management of his or her low mood should remain within the ADHD team without delay.  Comorbidities can affect the management and treatment plan, it is often important to have one specialist responsible or 'in charge' of your child's assessment and treatment.   

As mentioned before, we recommend that your child is seen by a Child Psychiatrist
(with CCTs in Child and Adolescent Psychiatry) if mental illness or neurodevelopmental disorders (such as ADHD or ASD) is suspected, so that medical causes, differential diagnoses and comorbidities can be assessed for through comprehensive assessment.   

A comprehensive risk assessment should be completed during every appointment with a mental health professional or team member.

Please feel free to ask questions and discuss the team's impression and recommendations, including risk assessment and management plan with professionals.  Share your concerns with your team.  It often helps to write concerns down.  Your views are important.  

What are mental health problems?

Mental health problems or difficulties are very common amongst children and adults. 

Children or young people do not develop mental health difficulties because they are not strong enough or because they did something wrong.

Anyone can develop mental health difficulties; your teacher at school, your best friend, the most popular child in school, the greatest athlete, the homeless person that passes you in town, or your doctor.  

Professionals refer to mental health difficulties when people feel so low, anxious, irritated, confused or angry, that it interferes significantly with their daily life, well-being and development.  Mental health difficulties can affect school work, friendships, family relationships, interests and quality of life. 

Children and adults sometimes struggle to cope, and then use strategies which might not be helpful to relieve distress, such as drinking alcohol, using illicit drugs or self harming.  

How can we help?

We routinely screen for neurodevelopmental disorders such as ADHD or Autism, or other serious mental illness such as Depression or PTSD, which might need a specific treatment. 

Professionals also meet with families and young people to discuss alternative coping strategies and how to put these strategies in place.  

Treatments vary from individual and family therapies to medication.  Most professionals aim to avoid medication in children and young people, where possible.

Risk assessment is also a very important part component of our work, professionals usually assess whether a person is a risk to themselves or others as a matter of routine, and work with other professionals to ensure that safety remains the number one priority.

What should I expect during my first / follow up appointment?

Seeing a psychiatrist is similar to seeing a GP. Your doctor, you and/or your family sit on chairs, like in a lounge, and 'have a chat'. Appointments usually last 45 minutes, but can last longer if required.  Sometimes, if necessary, physical health is checked, for instance, blood pressure and pulse.  Follow up appointments may be of shorter duration.  

Professionals have different styles and ways of working, based on their own training, experience, personalities and especially based on their goals for the first appointment. 

They will likely ask you what your goals are for the first appointment and they will tell you a bit about the team, how the team works and what their goals are for the first appointment.  It is often helpful to write your questions or concerns down before your appointment so that you don't forget.  It is also helpful to know what you hope to achieve during a first session; most people want a question answered such as - Do I have PTSD?

A psychiatrist's first priority is often associated with ruling out immediate or high risk and serious medical and mental health problems (to be able to provide you with clarity and an understanding of what is causing you distress and impairment), so you are likely to be asked quite a few questions to begin with.  Most psychiatrists will however remain sensitive to how you are feeling and will make sure you feel as comfortable possible during the session. 
Always remember that you can say that you need a break at any time.

Psychiatrists will want you to tell your story in your own way and in your own time, as you feel comfortable.  

Professionals know that the questions that they are asking are sometimes about topics that are hard to talk about and that it can be stressful to meet a new person and talk about personal issues. 

Professionals will want you to have a positive experience of meeting with them, whilst also making the first session useful to you and addressing your concerns, providing you with some answers.

Most patients and their families leave their appointment and is happy to return if indicated. Parents often say that they have never seen their child talk so openly and so much to a someone they didn't know and children usually say that the appointment was "not stressful".  
Adults often reflect on therapeutic sessions by saying "felt like chatting to a friend".  Most children and adults want to attend follow up sessions. 

Should Child Psychiatrists see Adults?

Consultants in Child and Adolescent Psychiatry trained and worked in Adult Psychiatry for 3 years before they started training and working in Child Psychiatry (usually for 3 years).  Adult Psychiatrists train and work in Adult Psychiatry for more or less 5-6 years.  Adult Psychiatry training usually includes 6 months of therapeutic training.  Child Psychiatry usually includes more therapeutic training, as children are usually treated through therapeutic intervention.  Some consultants in Child Psychiatry, such as our directors, have a specific interest in therapy, which means that they can provide a unique therapeutic service to adults.

We review all referrals and self-referrals of adults and children to ascertain whether we are the appropriate service to effectively meet needs.   

Assessment of 0-4 years old?

Child Psychiatrists assess in more ways that just discussion, for instance through observation, play, drawing and non-verbal interaction.  

Most Child Psychiatrists are qualified to, and will be comfortable to assess a child of any age.

What is a Child Psychiatrist?
A Child & Adolescent Psychiatrist is a qualified medical doctor who has specialised in Child and Adolescent Psychiatry and has their
CCTs in Child and Adolescent Psychiatry.  

A medical undergraduate degree course, MBChB, is generally 6 years in duration, depending on the particular academic institution.  Most doctors work in General Medicine, Paediatrics and Surgery after their primary medical qualification for a few years.  

Doctors then specialise in Psychiatry and work in Adult Psychiatry for more or less 3 years.  Doctors who want to specialist in Child and Adolescent Psychiatry, then work as Specialist Registrars in Child and Adolescent Psychiatry for an additional 3 years where their work and training is focused on children with complex neurodevelopmental problems, such as ADHD and ASD, as well as mental illness, such as depression, anxiety and psychotic disorders.  

Focused specialist training is essential to enable a accurate diagnosis and formulation.  Doctors specialising in Child Psychiatry see more or less 100 children per year with complex mental health and neurodevelopmental difficulties (and their assessment, treatment and therapeutic work are supervised by experienced Child Psychiatrists).  

During this 6 year post graduate qualification, a doctor obtains a MRCPsych qualification, which includes two levels of specialist exams through the Royal College of Psychiatrists. MRCPsych is obtained half way during training and 
is not an indication that a doctor is a Child Psychiatrist, a specialist or has completed specialist training

Once a doctor has specialised in Child and Adolescent Psychiatry, which is usually a minimum of 12-14 years after his/her medical training started, he/she is awarded 
CCT's in Child and Adolescent Psychiatry and called a consultant in Child and Adolescent Psychiatry or Consultant Child Psychiatrist and included on the Specialist Register of the GMC (General Medical Council).  Professionals and families can check CCTs of doctors on the GMC website.  

We recommend asking all specialists, consultants, doctors or therapists working in Child Psychiatry whether they have their CCTs in Child and Adolescent Psychiatry, or in another speciality or psychiatric discipline, such as Adult Psychiatry.  

Specialist qualifications of all specialists or consultants can also be checked on the GMC website.  Adult psychiatrists are sometimes allowed to work as consultants in Child Psychiatry without CCTs in Child Psychiatry, for instance, through locum agencies.   Paediatricians (who have specialised in Paediatrics or who are staff grade doctors who work in Paediatrics, but never specialised in Paediatrics) are also often asked to see children with neurodevelopmental (ADHD or ASD) problems.  Mental health training (and experience) is often very limited during specialist training in Paediatrics; sometimes limited to a few hours or days during their training.  This is often confusing for parents. 

It is important to know that mental illness and disorders often present very differently in children compared to adults, which is why assessment by a Consultant Child Psychiatrist is important in our opinion. 

It is also important to know that many medical disorders, reactions to stressors, mental illnesses and neurodevelopmental disorders in children can look very similar (differential diagnoses).  Child Psychiatrists are medical doctors and usually aim to rule out medical / organic causes as the first priority, during their assessment. 

Comorbidities, where more than one disorder is present at the same time, such as ADHD and Depression, is unfortunately common in children with neurodevelopmental and mental health problems.  Child Psychiatrists monitor for comorbidities and complications during initial assessments and follow up appointments. 

Mental illness and neurodevelopmental disorders can be very complex and it is important that your specialist gives you a detailed formulation or impression along with recommendations from a medical (including mental health and neurodevelopmental), psychological and social point of view to help you to understand what your or your child is struggling with and how to achieve the best outcome. 

Please know that medical and specialist training, degrees and job descriptions (such as staff grade or specialist registrar) vary from time to time and with location.  It is important to ensure that you know that the specialist that you are seeing has the training and experience required, not only to make or exclude the diagnosis that you are worried about, but also to exclude other medical and mental health problems and causes (differential diagnoses). 

How to choose a Psychiatrist?

Ensure that you seek advice from a specialist, trained in the field of Child Psychiatry, with appropriate specialist qualifications.  
The GMC website will indicate whether your doctor has the qualifications;
CCTs in Child and Adolescent Psychiatry

As mentioned earlier, some consultants in Child Psychiatry will not have specialist training in Child Psychiatry (for instance they will have CCTs in Adult Psychiatry).  Some Child Psychiatrists (with CCTs in Child Psychiatry) will have more Child Psychiatry experience than others when they qualify (for instance some doctors spend more time learning and working using different therapies) and some doctors will have experience in particular fields such as PTSD, Substance Abuse or Eating Disorders.  

Some doctors focus on research and academic work, management, service development or work with adults, rather than clinical work with children and do not regularly see many children.  Some doctors divide their time between different roles for instance research work and clinical work.  Most doctors take on different roles and it may be relevant to know which roles your doctor prefers.    

Some doctors choose to do work for the Courts, offering their services to solicitors, which might mean they focus more on assessments, rather than treatment, although this is not always the case.   

Another important consideration is the therapeutic experience your doctor has; some doctors have a good balance of training and experience in various therapies, some doctors focus on one or two therapies, whilst some doctors do not have an interest in therapeutic work and has little recent training and experience. 

We suggest that you ask your doctor or therapist about her or his training, roles, experience, as well as his or her special interests, such as depression, ADHD, Autism, specific therapies, service development, charitable work, Court work or research work.  

Do not feel uncomfortable to ask your doctor or therapist questions about your care or your child's care.  Most doctors or therapists will be happy to provide you with more information regarding their backgrounds, as they, like you, would like to make sure that you are seeing the correct doctor or therapist. 
Seeing a Psychologist

A Psychologist studies and obtains a degree in Psychology (usually 4-5 years). 

Psychologists often study further, and obtain a doctorate qualification (PhD) in a specific area in Psychology; Clinical Psychologists.
A psychologist is not a medical doctor. Psychologists with PhDs are often referred to as 'doctor' and this can sometimes be confusing to families or children.  Parents often inform us that their child has been seen by a medical doctor, when they were seen by a psychologist.

Psychologists meet with families and children to offer a range of unique and valuable services. 
For instance, psychologists can offer individual therapy, ranging from behavioural therapies to psychodynamic therapies, and group therapies, depending on training and interest.
Psychologist can also offer psychometric testing and a range of other tools that can be a helpful and valuable part of assessment and supporting young people and families.  

Psychologists are very valuable members of Child Mental Health Teams.

We recommend asking your psychologist about her training, experience and interests.  

Multi-Disciplinary Professionals

Professionals from various backgrounds, such as Nursing or Social Care, work in Child and Adolescent Mental Health Services (CAMHS). 
Professionals are often trained in various therapies and often have a unique and valuable skill sets.  Working in a multi-disciplinary team is very valuable, as professionals consider presentations from various aspects and learn from each other through collaborative working, and children and families benefit in this way.  

Never feel uncomfortable to ask the person that you are seeing about their mental health training, experience, roles and interests, especially relating to working with young people and children. 

It is also imperative to know that you can ask to see a different person, if you feel that you do not "click" (that your personalities are not well suited) with the person that you are seeing.

There can be various reasons for not "clicking" and it is often helpful to give it a bit of time and explore it with the professional that you are seeing.  To move forward, however, it is important that you feel comfortable and that you trust the professional that you are seeing. 

Don't worry that professionals will take it personal, be disappointed or angry if you ask to see another person.  Professionals have your best interests at heart and know that professional styles are different.  Their only concern will likely be relating to your progress and they will want you to be open and honest with them at all times.
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