Download CAMHS Referral Criteria

July 2015
NHS Highland CAMHS
CAMHS REFERRAL GUIDANCE AND CRITERIA
NHS Highland and the Highland Council currently provide Child & Adolescent Mental Health Services to children and young people
from birth to eighteen years of age if in full time education. Young people aged 16 and over who are not in full time education should
be referred to Adult Mental Health Services
Tier 2 CAMHS (Primary Mental Health Worker Service)
Requests for a service from the Primary Mental Health Worker Service are appropriate when focused targeted therapeutic intervention at an
early stage is likely to have long term benefit to the well being of the young person and their family.
Referrals to the service are made through direct consultation with your local Primary Mental Health Worker. The purpose of consultation is to
make information about children’s mental health accessible to all those professionals working with children within Highland. Requests for
consultation are accepted from ALL child care professionals including school staff, specialist services, members of a Family Team, GPs,
Voluntary Organisations etc. During consultation the PMHW may accept a request for a direct service with a child/young person. Additional
guidance can be found here.
Tier 3 CAMHS Referral
Referral to Tier 3 CAMHS at the Phoenix Centre is appropriate when a child or young person is experiencing severe, complex mental health
difficulties. These are likely to have been present for some time, and/or to be having a significant impact on their daily functioning and well
being.
Referrals to our service are considered urgent if:
 A child/young person is experiencing significant suicidal ideation, or has made a suicide attempt
 A child/young person has a suspected psychotic illness/symptoms
 A child/young person has experienced rapid recent weight loss, a concerning BMI and eating disorder cognitions.
 A child/young person is considered to be an immediate risk to themselves or others associated with mental health issues
 In the circumstance of medical non-compliance when this presents an immediate health risk
When there are concerns that a child or young person might need an urgent mental health assessment we would recommend referrals are
discussed with a CAMHS clinician prior to referral submission. Referrals of an urgent nature out with normal working hours and at weekends
should be directed to A&E.
All other referrals would be considered for routine appointments.
July 2015
NHS Highland CAMHS
Tier 4 CAMHS Referral
Tier 4 referrals should also be directed to the Phoenix Centre and would be considered for young people with significant mental health
difficulties which fulfil one or more of the following criteria;



Too high risk to attempt to treat with usual out-patient resources for example immediate suicide risk, psychotic with disorganisation,
significant self harm or violent behaviour.
Requiring intensive assessment or treatment (equivalent to more than weekly out-patient contact and more than one CAMHS
professional).
Not responding to usual out-patient treatment – which may be because they need re-assessment or more intensive input.
Requesting a Service
Requesting a service from Tier 3/4 CAMH Service should be made using our referral form and the most recent Child’s Plan if one is available.
We require specific information to ensure that the correct intervention can be targeted to the right child/young person. If a referrer is not sure
what information to include, s/he can contact us to discuss the referral. It is important that those referring have met with the parent(s)/carer(s)
and the referred child/young person and that they are in agreement with the request for service.
Referrals can be sent by post to:
Child and Adolescent Mental Health Service
The Phoenix Centre
Raigmore Hospital
Inverness
IV2 3UJ
By email:
[email protected]
Or via:
SCI Gateway
We will respond to all referrals received, informing both referrer and the referred child/young person of the outcome.
We have our own webpage which includes details of what our service offers and what to expect when you come along.
The Royal College of Psychiatrists have also produced a helpful brochure on what to expect from CAMHS which can be downloaded from:
http://www.rcpsych.ac.uk/PDF/CAMHS%20inside%20outx.pdf
CAMHS REFERRAL GUIDANCE
July 2015
NHS Highland CAMHS
Introduction to this Guidance
This guidance document is intended to assist those in front line services to know when to refer to NHS Highland CAMHS, as well as offering
suggestions for advice or where to go to get more information. The guidance is designed to improve access to CAMHS for those children and
young people who need it most whilst at the same time making sure that other sources of help can be accessed where appropriate. Referrals
are accepted from a number of professional groups including GPs, Public Health Nurses, Health Visitors, Paediatricians, Teaching Staff, Other
Hospital Doctors (including Dentists), Allied Health Professionals, Educational Psychologists, Social Workers, Reporter to the Children’s Panel.
NHS Highland CAMHS
NHS Highland CAMHS operates within a tiered model of service delivery which includes both stepped care (as a problem becomes more
severe in nature the type of help that is available becomes more specialised) and matched care (the idea that there should be an accurate and
properly informed match of need to provision at the earliest stage of a child or young person’s presentation).
CAMHS 4 Tier Model of service delivery
Specialist
Inpatient &
Intensive
Community outreach
CAMHS operates within the principles of Getting It Right For Every Child using a tiered model of intervention
that includes the established staged approach to service delivery. This approach ensures that services are
delivered via stepped care (the principle being as a problem becomes more severe in nature the type of help that
is available becomes more specialised) and via matched care (the principle being there should be an accurate
and properly informed match of need to provision at the earliest stage of a child or young person’s presentation).
Tier 4
Specialist CAMHS
Team
Tier 1: Also referred to as universal services. The child’s needs are addressed through normal class
room/nursery management/by public health nurses, health visitors, social workers, children’s service workers.
CAMHS has no direct involvement at Tier 1 but remains committed to building capacity and confidence within
universal services via training and consultation.
Tier 3
PMHW – Training/consultation
to increase capacity & confidence.
Consultation & direct work with children
& young people
Universal services have a role in promoting
children’s emotional health consisting of all primary
care agencies including GP’s, school nursing, health
visitors, children’s service workers and schools
Tier 2: Also referred to as a single agency response when concerns continue despite universal services
intervening. ‘My World’ Assessment undertaken, need/risk analysed and may be detailed within a child’s plan.
Additional staff may become involved; children may receive some specific support i.e. children’s service
worker, family social work, health visitor etc. Request for service to Tier 2 CAMHS can be considered at this
stage, via consultation.
Tier 2
Tier 1
Tier 3: Also referred to as a single agency response where concerns continue and targeted support is requested.
Advice, plus recommendations sought. This may be from special educational services (e.g. Educational
Psychology). Children should have Child’s Plan. PMHWs can offer a bridge into Tier 3 CAMHS. Referral
directly to Tier 3 CAMHS can be considered.
Tier 4: Also referred to as a multi-agency plan or stage 4 interventions. Significant support from one or more
agencies is required and the child may require a co-ordinated support plan (CSP). A small minority of children
may enter at this tier if their mental health deteriorates rapidly. They may receive inpatient care & will require a
agency response.
Specialist CAMHS are nearly always involved at this stage.
CAMHS multi
REFERRAL
CRITERIA
July 2015
Problem
ADHD
Anxiety
NHS Highland CAMHS
Description
Attention Deficit Hyper-activity Disorder
is characterised by a pervasive lack of
attention, impulsivity and hyperactivity
across situations and settings – at
home, school, and in public – which
began before 7 years of age.
Referral Pathway
For all children the normal route to
assessment would be through referral to
Community Paediatrics. If the outcome is
unclear or a severe/complex presentation is
described a referral to Tier 3 CAMHS may
be considered.
Families with children who display
difficulties in these categories should
have already received significant advice
and intervention from other
professionals such as paediatricians,
health visitors, social workers and
educational support services before
referral to Tier 3 CAMHS is made.
Anxiety is a normal and common part of
childhood. In most cases, anxiety in
children is temporary, and may be
triggered by a specific stressful event.
CAMHS would not normally assess a child
for ADHD until they have completed at least
one term within P1.
In some cases, anxiety in children can
be persistent and intense, interfering
with a child’s daily routines and
activities.
Anxiety disorders include phobias,
general anxiety, panic or persistent
unexplained physical symptoms, such
as headache or stomach-ache, where
physical cause has been excluded.
Bereavement:
Children’s response to grief will vary
dependent on age, cognitive and
developmental stage. Quite often it can
be the subsequent change in
The PMHW Service may offer consultation
to those adults supporting the child/young
person when their behavioural needs are
causing concern.
Those with recently emerging, less severe
difficulties may be directed to the PMHW
Service via consultation.
Children who show persistent or severe
symptoms of anxiety should be referred to
Tier 3 CAMHS. These cases would include
the following:
 Where the child’s development or
level of functioning has been
seriously affected or there has been
a sudden deterioration.
 Where the anxiety appears to be out
of proportion to the family
circumstances.
 Where there is a significant impact
on the parent/carer-child
relationship - please describe in
referral.
Consult with PMHW in the first instance
describing what support has already been
offered and how the difficulties are affecting
the child’s day to day functioning. The
Advice
www.adhdtraining.co.uk/
www.boxofideas.org/
You may wish to find out more at:
www.moodjuice.scot.nhs.uk/anxiety
www.shapeofmind
www.youngminds.org.uk
www.anxietyuk.org.uk
www.stressandanxietyinteenagers.com
Although painful for everyone including
professionals, you may wish to give the child
& family some time to experience a normal
grief process
July 2015
NHS Highland CAMHS
circumstances or other family members’
reactions that can prove difficult for the
child.
Conduct/Behaviour
problems
Challenging and defiant behaviour can
present as a normal part of childhood
development. Sometimes such
behaviour can become out with parental
control, impact on the child’s
developmental progress and emotional
well being and also on family
functioning.
PMHW may work directly with the
child/young person or may signpost to other
services that can provide bereavement
support.
You may want to consider referral to Tier 3:
 When the loss has had an extreme
impact on the child and their
functioning, or when the child is
experiencing difficulties after
bereavement support.
 If the child is experiencing
significant distress and / or
difficulties following a bereavement
/ loss that has occurred in extreme
circumstances (e.g. trauma, illness,
suicide or accident).
Initial presentations of defiant or
challenging behaviour should be addressed
by Tier 1 and consultation with PMHW if
necessary. Early intervention is preferable
in such cases and often leads to better
outcomes.
You may wish to consider referral to CHAS at
Home (the Highland outreach service for the
Children’s Hospice Association of Scotland),
where support is provided for children &
parents who are bereaved.
www.chas.org
www.rd4u.org.uk
www.winstonswish.org.uk
www.childbereavement.org.uk
http://www.rcpsych.ac.uk/healthadvice/parent
sandyouthinfo/parentscarers/behaviouralprobl
ems.aspx
http://www.youngminds.org.uk/for_parents/pa
rent_helpline
Tier 3 CAMHS would consider referrals
http://incredibleyears.com/
when conduct problems are a result of
significant disruption to the parent-child
http://www.solihullapproachparenting.com/
relationship, are having a significant impact
on a child’s emotional well being, and there http://www.mellowparenting.org/
is an indication that a mental health
intervention could result in positive change.
We may in the first instance consult with the
other professionals involved with a
child/family. Referrals are best made via a
Child’s Plan so we can be clear on what
has already been offered.
Children who are out with parental control
should be referred to the Care and
July 2015
Depression/Low
Mood
Eating Disorders
NHS Highland CAMHS
Low mood is a normal part of childhood,
in most cases is temporary and might
well resolve on its own.
Protection Practice Lead within the local
family team in the first instance. Young
people whose behaviour has included
offending should be referred to the Youth
Action Team.
GPs may advise and review prior to referral
as often difficulties can resolve without
intervention.
In order for referral to CAMHS to be
appropriate difficulties should be more
than age appropriate variation of mood.
There should be a significant change
from previous levels of functioning and
an impact on daily living.
Where symptoms are mild or moderate in
nature, a consultation with a PMHW will
help clarify what support may be
appropriate and whether they should
provide some direct intervention to the
child/young person.
This may include disturbances of mood,
sleeping, irritability, a decrease in
energy, social isolation, school
performance may be affected and
thoughts of self-harm may be
expressed.
For persistent and severe symptoms, or if
concerns exist regarding significant suicidal
thoughts then referral to Tier 3 CAMHS
may be appropriate.
Bipolar disorder is rare in children in
adolescents.
Anorexia is characterised by a refusal to
maintain a minimally normal body
weight or an intense fear of gaining
weight.
Bulimia is characterised by binge-eating
and purging and maintaining adequate
body weight.
Where there is concern in relation to an
eating disorder it is advisable to discuss
with GP in the first instance to consider
medical investigations (blood, weight,
height, BMI etc) prior to referral. These
assessments not only give us an
indication of their BMI but assists with
If there has been a recent rapid weight loss
(1kg+ per week with ED cognitions present)
with no physical cause, request urgent Tier
3 CAMHS appointment.
If the symptoms are less severe but there is
some concern that a young person has
some distorted thinking or body image,
consult with PMHW in the first instance.
The PMHW may work directly with the
child/young person or may signpost other
services that can provide support.
For more info:
www.moodjuice.scot.nhs.uk/depression.asp
www.shapeofmind.scot.nhs.uk
www.depressioninteenagers.com
www,beatingtheblues.co.uk
www.breathingspacescotland.co.uk
This is an example of the sort of screening
questions that can be helpful however any
decision on referral will be based on relevant
history and clinical presentation:

Do you make yourself sick because you
feel uncomfortably full?

Do you worry you have lost control over
how much you eat?

Have you recently lost more than 1 stone
in a 3 month period?

Do you believe yourself to be Fat when
others say you are too thin?

Would you say food dominates your life?
July 2015
Early Years and
Attachment
Insecurities
NHS Highland CAMHS
prioritisation as we would want to
prioritise those children with low BMI.
Sometimes the school nurse is also a
good source of support in helping to
assess a child you suspect may be of
low weight.
Problems within this age range can take
many forms and it would be usual for
universal services to have had
significant input to a family.
Difficulties would include significant
emotional or behavioural difficulties in
the age group 0 – 5 years, including
difficulties within the parent-child
relationship.
Additional guidance can be found in the
NHS Highland Infant Mental Health
Guidelines and NHS Highland Perinatal
Mental Health Guidelines.
Enuresis and
Encopresis
Both are categorised as elimination
disorders and involve the inability to
control urination or soiling in those
deemed old enough to exercise control.
If the young person answers yes to 2 of
these questions consider referral.
www.b-eat.co.uk
CAMHS involvement with this age range
should be secondary not primary.
Consequently, families should have already
received significant advice and intervention
from other named professionals such as
paediatricians, health visitors, social
workers and educational support services
including within Nursery.
Therefore referrals should include
information on what has been attempted
and who is involved.
Consultation is available from the PMHW
service in the first instance. For more
complex difficulties, consultation from Tier 3
CAMHS may be sought and dyadic
interventions would be considered.
Refer to paediatrician in the first instance
who will then refer to other specialist
services if appropriate.
PMHWs are committed to a programme of
training and development for Tier 1
professionals and may be involved in direct
work to support parents where issues arise
(for example, delivering Video Interaction
Guidance).
Often with these types of difficulties the
relationship between the parent and child is
the focus of intervention; therefore it is useful
to know what has already been attempted.
You may wish to find out more information
from www.eric.org.uk which includes a free
downloadable toolkit for parents and
professionals
Initial screening and treatment should
be undertaken by paediatrician to rule
out physical causes.
Family
Relationship
Problems
Family relationship problems can result
in emotional distress which presents in
a variety of ways in children and young
people.
Concerns about a young person’s safety
within a family should be immediately
addressed to the Care and Protection
Practice Lead within the local family team.
Families may be struggling to
communicate effectively or to
Specialist CAMHS does not mediate
residence and contact arrangements for a
http://www.relationships-scotland.org.uk/finda-local-service/family-mediationservices/highland
July 2015
NHS Highland CAMHS
understand why they are having
problems within their relationships.
Feeding and
Faltering Growth
Faltering growth is a common
occurrence and health visitors play a
key role. Most children with faltering
growth will be detected by the primary
health care team and supported within
the community.
Feeding problems include:

children with behavioural
feeding problems in the context
of chronic illness/medical
problems;

severe and chronic selective
eaters;

infant feeding problems and
failure to thrive;
child/young person. Families could instead
be advised to approach Family Mediation
Highland or discuss with their solicitor, as
appropriate.
Referral to Tier 3 CAMHS could be
appropriate when difficulties are complex or
entrenched and there is a clear mental
health component. It would be advisable to
contact the Phoenix Centre prior to making
a referral.
Consult Health Visitor/Public Health Nurse
in the first instance. Refer on to
paediatrician as necessary.
www.childrenfirst.nhs.uk/families/features/beh
aviour/fussy_eaters.html
Initial screening and treatment should be
undertaken by the paediatric team. CAMHS
referrals often come via this route.
The PMHW can offer consultation to Health
Visitors/ Public Health Nurses.

Children / young
people Looked
After or Looked
After Away from
Home
Emotional eating difficulties (e.g.
food phobias) or in the context
of somatic problems such as
chronic fatigue syndrome.
Children are looked after and looked
after away from home for many varied
reasons. Their legal situations are also
very varied and complex.
Referrals for children in this category
need to identify whether a child or
young person has a mental health
Referrals to specialist CAHMS are best
made by the responsible social worker
(Lead Professional).
LAC and LAAC young people can present
with mental health needs of varying nature.
PMHWs offer training (see self-harming
behaviours section) and consultation to foster
parents and staff in residential units to
support them.
If concerns exist they will have been
discussed in multi agency groups. Local
authority services and CAMHS aim to work
July 2015
Young People with
Learning
Disabilities and/or
Young People with
Autism Spectrum
Disorder (ASD)
NHS Highland CAMHS
difficulty or other condition that results
in persistent symptoms of psychological
distress, as well as an associated
serious and persistent impairment of
their day to day social functioning. OR,
an associated risk that the child/young
person may cause serious harm to
themselves or others.
Where symptoms are mild or moderate in
nature a consultation with a PMHW will help
clarify what support may be appropriate and
whether they should provide some direct
intervention to the child/young person.
Learning disability and/or Autism
Spectrum Disorder (ASD) on its own is
not grounds for referral to Tier 3
CAMHS. For CAMHS to become
involved there have to be additional
concerns about mental health or
significant behavioural problems.
Children and young people with a
learning disability or ASD can present
with any of the mental health problems
described in this document but their
presentation and identification may be
complicated by factors such as
cognitive difficulties, social and
communication difficulties and sensory
sensitivities.
We will also accept referrals from
locality ASD teams who require a
CAMHS assessment to complete the
CAMHS do not conduct initial diagnostic
assessments for learning disability.
Paediatricians, Educational Psychologists
and pre-school special teachers assess
children for learning disability.
For persistent and severe symptoms,
referral to Tier 3 CAMHS may be
appropriate.
CAMHS do not accept referrals to initiate
ASD diagnostic assessments.
Professionals concerned about a
child/young person with ASD can refer to
the Highland Framework for Assessment
and Diagnosis of Autism Spectrum
Disorders, a multi-disciplinary framework
agreed by Highland Services. If a CAMHS
assessment is required as part of this
assessment, the locality team (paediatrician
& speech and language therapist) can refer
to CAMHS.
together to provide a common, coordinated
framework across all agencies that support
the delivery of appropriate, proportionate and
timely help to all children as they need it.
This includes not subjecting children to
multiple assessments or to repeat information
that other agencies hold. Therefore it is
important that information is shared and
accessed through, for example, the
Integrated Assessment Framework, or
Staged Intervention process and Child
Protection processes. Given these principles
(GIRFEC) it is important that professionals
who are concerned about children utilise their
existing referral protocols into our Service
rather than suggest to the family that they
attend their GP.
It is helpful to know how the child/family is
affected by their symptoms - how their day to
day functioning is affected.
www.cafamily.org.uk
National Autistic Society offers information
and support
http://www.autism.org.uk/
CHIP+ offers information, support and advice
to the families and carers of children and
young people with additional support needs,
and to professionals who work with them.
www.chipplus.org.uk
Tier 3 CAMHS also offers consultation to
those professionals working with children and
young people with a learning disability and/or
ASD who are not referred or open cases to
Tier 3 CAMHS.
July 2015
NHS Highland CAMHS
ASD diagnostic assessment.
Obsessive
Compulsive
Disorder (OCD)
Characterised by the presence of
both obsessions and compulsions that
take a lot of time and get in the way of
activities.
These will be either distressing or
disabling and interfere with the child’s
functioning across settings e.g. school
and home. This behaviour can also be
as the result of anxiety or a change.
Young people aged 18 and over should be
referred to adult learning disability services.
Children often experience obsessions and
compulsions as part of normal childhood
behaviour and they can often disappear
without intervention. Therefore when
considering specialist referral the situation
has to be distressing, disabling and
interfere with the child’s day to day
functioning.
If pervasive and evident across settings
then a referral to the Tier 3 CAMH Service
may be considered.
Paediatric Health
Psychology
Guidance on referrals to the paediatric
health psychology service can be found
here.
Please refer to separate guidance prior to
making a referral.
Psychosis
Psychosis is rare in children and
adolescents but may involve transient
states or short episodes of delusions,
hallucinations, disorganised speech or
behaviour.
Referral to Tier 3 CAMHS is indicated.
Psychosomatic
Difficulties
Physical complaints with no apparent
medical basis may be a reflection of
emotional distress.
Children should have completed
physical investigations prior to referral
to rule out any organic cause so that the
child and family will accept the idea
some psychological cause for the
difficulties. Better outcomes can be
achieved by preparing the family in this
way
This behaviour can often be due to a change
therefore establishing normal routines may
affect a positive change
www.ocdyouth.ipo.kcl.ac.uk
Info site run by Royal Maudsley Hospital on
OCD
www.ocduk.org
Includes Information and Guide for parents of
young children
www.ocduk.org/pdf/children.pdf
www.ocduk.org/pdf/youngpeople.pdf :
www.ocduk.org/pdf/ParentsOCDGuide.pdf :
Information and guide for parents of children
worried about OCD
www.rcpsych.ac.uk/mentalhealthinfo/mentalh
ealthandgrowingup/psychoticillnessyoungpeo
ple.aspx
If urgent, contact CAMHS within normal
working hours. Outside this time contact
Accident and Emergency if emergency
assessment is required.
Where a child is experiencing physical
symptoms initial referral to a paediatrician is www.there4me.com
recommended.
Website for children and young people (1216) who have got fears and worries. Run by
Where symptoms are mild or moderate in
NSSPCC
nature a consultation with a PMHW will help
clarify what support may be appropriate.
www.rcpsych.ac.uk/mentalhealthinformation/
mentalhealthproblems/physicalillness/unexpla
For persistent and severe symptoms which inedphysicalsymptoms
have a significant impact on the child’s
Royal College of Psychiatrists Website
functioning referral to Tier 3 CAMHS may
be appropriate.
July 2015
Post Traumatic
Stress Disorder /
Acute stress
disorder
.
School Refusal
Self Harming
Behaviour
NHS Highland CAMHS
PTSD is linked with an extreme
traumatic stress involving direct
personal experience of an event that
involves actual or threatened death or
serious injury. The event is reexperienced in one or more of the
following ways: flashbacks, nightmares
related to the event, re-enactment
through play, intense emotional arousal,
numbness around memories and
physical symptoms such as tummy
aches and headaches.
Schools and education departments
have their own resources (e.g. inclusion
support workers, educational
psychologists and behavioural support
services) which should to be exhausted
prior to referral.
Deliberate self harm without suicidal
intent takes many forms and can be
seen as a way of dealing with difficult
feelings that build up.
Self harm here would have the absence
of suicidal intent.
It is important to know whether there are
legal proceedings pending and to clarify the
purpose of assessment (for legal
processes, or to receive treatment).
Where children and young people are
currently experiencing trauma such as
domestic violence a referral to the Family
Team is likely to be appropriate.
Where symptoms are of recent onset, and
are mild or moderate in nature, a
consultation with a PMHW will help clarify
what support may be appropriate.
Psychological intervention is unlikely to be
possible where the child's living situation
continues to be insecure and traumatic.
www.cedarfv.org.uk/
For persistent and severe symptoms,
referral to Tier 3 CAMHS may be
appropriate.
A summary of school/education department
involvement and action will be essential
before a referral can be accepted therefore
we would normally expect a child to be
subject to a staged intervention.
CAMHS will not accept referrals for school
truancy only and referrers should consult
with other Children’s Services and/or the
Highland Council Educational Psychology
Service in the first instance. Schools can
also access the PMHW Service for
consultation.
If you are concerned that the self harming
behaviour is indicative of a disturbance of
emotional and psychological well-being
then you should refer to CAMHS.
Where symptoms are mild or moderate in
nature or appear to be due to a specific and
recent incident or event, a consultation with
a PMHW will help clarify what support may
be appropriate.
For persistent and severe symptoms,
referral to Tier 3 CAMHS may be
appropriate.
www.handsonscotland.co.uk/topics/anxiety/sc
hool_refusal.html
Self harm at this level can be very anxiety
provoking for professionals.
PMHWs are committed to providing training
and development opportunities to Tier 1
professionals to assist them to deal with
things like self harm. They can provide or
signpost towards training in Mental Health
Awareness (Scottish Mental Health First Aid
for Young People) and suicide prevention
(ASSIST).
www.selfharm.uk.org
www.harmless.org.uk/downloads
July 2015
Self harming
Behaviour with
suicidal intent
Tics and Tourette’s
Syndrome
NHS Highland CAMHS
Self harming behaviour with significant
suicidal intent and suicidal acts should
always be taken seriously.
Tics are not dangerous, and most
reduce spontaneously as a young
person matures. Families often seek
help when:
1. A young person is becoming self
conscious about their tics
2. The tics are a focus for teasing or
bullying.
Overdose and other incidents of serious
self-harm should be sent directly to A&E in
the first instance. The ward or hospital will
then refer on to CAMHS.
Referrals from hospital will be prioritised &
referral protocols are already in place. A
follow-up appointment from the Tier 3
service should always be arranged.
If the tics are secondary to anxiety, then a
holistic view is best and it's worth referring
to our guidance on anxiety.
If the tics are part of a neurodevelopmental
disorder than a community paediatrician
may be more appropriate as the first point
of referral.
http://www.nhs.uk/Conditions/Tics/Pages/Intr
oduction.aspx
http://www.handsonscotland.co.uk/topics/unu
sual/tic.html
Inappropriate Referrals to CAMHS
In order to improve accessibility for children and young people, we also need to clarify which presenting difficulties are not appropriate to refer to
specialist CAMHS.
(a) Children/Young People with Behavioural Difficulties as a Response to Normal Life Events. These are sometimes called “normal
adjustment reactions”. Unfortunately, we are unable to provide a service to children and young people whose behaviours are associated with a
normal reaction to recent life events (e.g. bereavement, parental separation). Although challenging these are often within developmental and
cultural norms. Some indication of mental health disorder needs to be evident in the behaviour for a referral to be appropriate. It is also
important that CAMHS is a secondary or specialist route of referral when behaviour is being considered as the primary route should always be
universal and primary care services that can support families within their own home.
(b) Children/Young People Whose Difficulties Occur only at School Please note that specialist CAMHS does not provide a service for
children and young people whose problems are solely related to specific learning or behavioural difficulties within the classroom. Schools have
their own referral route and protocols for supporting such children. For these children/young people it is usually more appropriate for educational
services to become involved to address the difficulties. If a referral to CAMHS is appropriate it is best made through the child’s plan.
(c) Children/Young People Whose Parents are in Dispute within Legal Proceedings
July 2015
NHS Highland CAMHS
Children of separated / divorced parents who are in legal dispute about residence and /or contact arrangements or other issues are not
specifically excluded in these guidelines though the decision to refer needs to be carefully considered on a case by case basis.
If there are ongoing legal proceedings then it is usually better to consider a referral after the legal proceedings have been concluded and legal
agreements or Order(s) have been made regarding the matters which are in dispute. Please note that it is for the Courts to order independent
reports on the child, not the separate parties to the proceedings, and these reports cannot be obtained via a referral to specialist child
mental health services. Please note that specialist CAMHS does not mediate residence and contact arrangements for the child/young person.
The parent(s) could instead be advised to approach the Family Mediation Service or discuss with their solicitor, as appropriate.
(d) Children/Young People Whose Primary Difficulty is Substance Misuse
AND
(e) Children/Young People Whose Difficulty is Described as Offending Behaviour In both of these circumstances it is important that a
coordinated integrated assessment of the child or young person’s situation is undertaken. This is the responsibility of the local authority youth
action team and/or the child forensic psychology service.