Child and Adolescent Mental Health Services (CAMHS)
The Child and Adolescent Mental Health Service (CAMHS) provides two levels of support to children and young people facing mental health difficulties or illness. Secondary CAMHS is designed to step in when universal health services and our Primary CAMHS team cannot meet a child or young person's needs. The Specialist CAMHS team work with young people where both universal and targeted support has been unable to meet their needs, and long-term support is required.
We work with children and young people with their families to assess moderate to severe mental health difficulties and support children and young people achieve positive, stable mental health where universal services cannot do so. Our aim is to help the children and young people we work with manage everyday life.
We recognise that growing up is a difficult time for every child and young person as changes in lifestyle, environment or behaviour can spark concerns in anyone. That is why we will always start by looking at how a child's/ young person's family and friends can help them and why we try to avoid 'labels' or diagnoses wherever possible.
Our secondary CAMHS team are fully trained and include:
- Child and adolescent psychiatrists
- Clinical psychologists
- Systemic family therapists
- Child psychotherapists
- Occupational therapists
- Mental health learning disability nurses
- Social workers
We liaise closely with our SEND service colleagues, linking with pastoral teams in schools and with other professionals involved in a child's/ young person's circle of support. We often receive referrals from those services too, which means we already know who else is supporting a child/ young person and can co-ordinate with them. We work really hard to connect with universal sources of support too, the kind of support anyone could access, like school counsellors and educational psychologists.
The difference between primary CAMHS and Specialist CAMHS lies in the length of time and level of specialised support that we offer children and young people.
We work with children and young people under 18 who live in Wiltshire. We work with young people who meet our referral criteria.
Before children and young people come to one of our teams, there should usually have been a primary intervention, unless there is evidently a more serious mental health challenge. For more information please see our universal mental health support page.
We do not accept referrals for behavioural needs, anger management and neuro-development conditions, like Autistic Spectrum Disorders or Attention Deficit Hyperactivity Disorder, unless there is an accompanying mental health concern.
Wait time: 4 weeks
Length of time we work with young people: Until stability, usually 10-12 sessions on average.
Referrals to Specialist CAMHS must be made by a professional who knows the child/ young person or family. This could include:
- Teacher / SENCO (special educational need care officer - educational professional)
- Health visitor
- Social worker
- Integrated youth services (youth worker)
Referrals are received by Single Point of Access, where they are screened for safeguarding concerns. If necessary, an emergency response, or out of hours response is initiated. If there is a non-emergency, but still urgent need, this will be met within 7 days. Otherwise child/ young people will be offered an appointment in 4 weeks.
An initial appointment will be held at a CAMHS office in Salisbury, Melksham or Marlborough.
At this appointment, a member of the CAMHS team will carry out a professional assessment and capture the wider context of the young person's life, describing any difficulties they have, the impact of their need on their ability to cope with day-to-day life and other contributing factors.
The professional will then draw up a care plan with the child/ young person and / or their family. The Care Plan is co-ordinated with other health and educational professionals and reviews of a child's/ young person's care will involve relevant health, education and social care professionals wherever possible.
Working with the home, school and multi-agencies, interventions for a young person are planned. We will work closely with young people and their family to set new goals as old ones are reached.
When we think things are going well for a young person, and expect them to continue to go well, we will create a discharge plan with the support of their family. This will include plans for how a young person will cope with life independently and capture the ideas and techniques we've helped them develop. However, if a young person feels unable to cope after discharge from our service, they can self-re-refer within a year.
The Outreach Service for Children & Adolescents (OSCA) service provides wrap around crisis support for brief periods, and outreach support where required.
We work with children and young people to help them achieve positive, stable mental health. This means being able to manage every day life where they otherwise may not. It also means being able to continue managing their everyday lives after support from our team has ended, with or without support from universal services
An initial appointment will be held at a CAMHS office in Salisbury, Melksham or Marlborough.
Interventions, which are programmes of support, are then held in schools, in a child's/young person's community, at their home or at a CAMHS clinic, depending on level of need and approach set out in their Care plan. Our service covers all of Wiltshire and we have offices in Salisbury, Melksham and Marlborough.
After the young person turns 17, the CAMHS professional will assess whether the young person is likely to meet Adult Mental Health services criteria. If they do, the transition process begins and a CAMHS worker will involve Adult Mental Health services in a young person's interventions for at least 6 months where possible. In exceptional circumstances, CAMHS will remain involved in your young person's care for around 6 weeks after 18th birthday. Where Adult mental health criteria are not met, young people and their families are prepared for this through their Care Plan from 17 ½ and signposted towards other forms of universal support. This can be a daunting time for young people and their families, but we plan ahead and make sure the support we give teenagers is tailored to help them cope with adult life independently.
When someone moves in or out of county, referrals need to be made through their new local GP. If you are moving into Wiltshire we will continue to provide your child or young person with care until a local assessment can be arranged.
It is important that your voice is heard wherever possible when decisions are being made about your life and future. At the age of 16 you are presumed to have mental capacity - this means that you are able to make choices about your own life.
This means at 16, your family and professionals you work with are likely to ask you more questions about what you want and why. It might be helpful to think about:
- What do you think a good adult life would look like for you?
- How involved do you want your family to be?
- How much support would you like in making decisions about your health, your job or your home?
Turning 16 does not mean you need to make decisions by yourself. Your family, friends and health professionals will still be there to support you. It just means you now you get more choice.
Understanding Mental Capacity
The Mental Capacity Act is supported by 5 key principles:
A presumption of capacity - this means every adult has the right to make his or her own decisions and must be assumed to be capable of doing so unless it is proved otherwise. This means that it cannot be assume you can't make a decision for yourself just because you have a particular medical condition or disability.
Individuals being supported to make their own decisions - you must be given practical help to make decisions before anyone treats you as not being able to make them. This means your family and professionals who work with you should make every effort to encourage and support you to make the decision for yourself. If it is decided that it would be impossible for someone to make a decision for themselves, it is still important that the person be involved as far as possible in making decisions.
Unwise decisions - people have the right to make decisions that others might regard as unwise or eccentric. You can't be treated lacking the ability to make decisions for this reason. This is because everyone has their own values, beliefs and preferences, which may not be the same as those of other people.
Best interests - anything done for or on behalf of a person who lacks mental capacity must be done in their best interests.
Less restrictive option - someone making a decision or acting on behalf of a person who lacks capacity must consider whether it is possible to decide or act in a way that would interfere less with the person's rights and freedoms of action, or whether there is a need to decide or act at all. Any intervention should be weighed up in the particular circumstances of the case.
It is important that you understand what decisions you are making in your life. If you or your family feel you find decision making difficult, a 'mental capacity assessment' can be done.
This kind of assessment looks at whether a person can manage the key elements of making a decision:
- Understanding the information they are being told
- Weighing up the pros and cons of a decision
- Remembering the information
- Tell another person about the decision they have come to
It can be carried out for an individual, or for a specific circumstance. For example, some people have understanding (capacity) about some decisions in their life but not other decisions. Every effort needs to be made to make sure the individual concerned has the best chance of making and telling people about that decision. This is crucial.
As this assessment should be carried out based on circumstance, the professionals involved will vary. However, it is important for individuals and their families to understand these principles and are supported to discuss these options.
If you have concerns, talking to your lead worker might be a good place to start.
If you are moving into supported living, it is important that you can make decisions about your finances and signing a tenancy agreement. If these are things you do not feel ready for, you will need the continued support of their family or friends. This is why your family and friends are there, so do not worry about asking for or needing their support.
Of course, there are ways others can make it easier for you to understand the choice you are faced with, like using an easy ready version of documents or having someone you trust to talk it over with.
If a person does not have the capacity about this, there is a process which an allocated worker will guide a parent/carer through so it can be signed on the person's behalf.
Important people (family/professionals) should be involved in this whole process.