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.