Being told that your child should be referred to CAMHS – Child and Adolescent Mental Health Services – is rarely accompanied by a clear account of what happens next. The referral is sent, and families often wait weeks or months to hear whether it has been accepted, and then longer still for an actual appointment. The experience can feel like bureaucratic indifference to a child in genuine distress.
Understanding how CAMHS works – its funding structure, its thresholds, what accelerates a referral and what slows it down – doesn't solve the problem of underfunded child mental health services, but it makes the process considerably more navigable for families working within it.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers child mental health services and support.
What CAMHS Is and What It Does
CAMHS (also referred to as CYPMHS – Children and Young People's Mental Health Services) is the NHS specialist mental health service for children and young people typically up to age 18 (and in some areas 25 for young people with ongoing needs). It provides assessment, diagnosis, and treatment for the full range of mental health conditions: anxiety and depression, eating disorders, OCD, PTSD, psychosis, neurodevelopmental assessment (ADHD, autism), self-harm, and more.
CAMHS is organised in tiers. CAMHS Tier 1 is provided by non-specialist settings – GPs, health visitors, school nurses, and teachers. Tier 2 is CAMHS-trained practitioners working in community settings. Tiers 3 and 4 are specialist CAMHS services: community CAMHS teams (Tier 3) and inpatient settings (Tier 4). When families talk about "CAMHS," they usually mean the community specialist team at Tier 3.
CAMHS is not the only mental health resource for children: school counsellors, school mental health support teams (operating in some areas under the Trailblazer programme), community charities (Place2Be, YoungMinds Partners in Change), and GP-based counselling are all relevant depending on the nature and severity of need. CAMHS is the appropriate route for conditions requiring specialist assessment or intensive treatment.
The Referral Process
Referrals to CAMHS are typically made by GPs, school SENCOs or pastoral staff, paediatricians, or other health professionals. In some areas, families can self-refer.
The quality of the referral letter significantly affects whether the referral is accepted and how quickly it is processed. A strong referral includes: the specific symptoms and behaviours of concern (concrete descriptions, not just "low mood" or "anxiety"), how long they have been present, the functional impact on the child's daily life (school, social relationships, sleep, eating), what has already been tried (school counselling, GP intervention), whether there are safeguarding concerns, and the level of clinical urgency.
Parents can directly contribute to the referral information by providing a written account of their concerns to the referring professional – specific incidents, patterns observed at home, the timeline of deterioration, and how it is affecting family life. This written account can be attached to or accompany the referral.
Thresholds and Triage
CAMHS in most areas operates a triage process after referral. Not all referrals result in acceptance onto the waiting list: the service assesses whether the presentation meets the threshold for CAMHS, which is supposed to be equivalent to moderate-to-severe mental health need. Presentations that are mild or that can be managed at a lower tier are often redirected or discharged with brief advice.
The reality is that CAMHS thresholds have risen as waiting lists have grown and funding has been constrained. Children who would have been seen by CAMHS a decade ago may now be told they don't meet the threshold. This is a system pressure problem, not a clinical judgment, but it affects families directly.
If a referral is rejected and parents believe the severity was not conveyed adequately, they can ask the referring professional to revise and resubmit with more detail. A more explicit description of functional impairment – what the child cannot do because of their difficulties – often helps.
Waiting Times
CAMHS waiting times in England have been a persistent political and clinical concern. NHS Digital data has documented median waiting times in many areas exceeding 18-24 weeks between referral and initial assessment, with some areas significantly longer. The waiting time target (four weeks from referral to treatment) is not met consistently.
While waiting, families should be given some indication of what to do if things worsen significantly. If a child's mental health deteriorates while waiting – particularly if self-harm escalates or there are expressions of suicidal intent – the appropriate route is not to wait for the CAMHS appointment: it is to contact the GP urgently, call NHS 111, or, if there is immediate risk, attend A&E, where a child presenting with a mental health crisis should be assessed by a mental health liaison team.
Resources while waiting: the YoungMinds Parents Helpline (0808 802 5544) provides advice for parents whose child is waiting for CAMHS. Charities including Place2Be, Kooth (an online mental health platform for young people), and NSPCC Childline (0800 1111) provide support that doesn't require a referral.
At the First Appointment
The initial CAMHS appointment is an assessment, not a treatment session. It typically involves the clinician meeting with both the child and the parents (sometimes together, sometimes separately), gathering a full developmental and psychiatric history, understanding the presenting concerns, and beginning to formulate a diagnosis or differential.
The initial assessment may take place over one or more sessions. It may be conducted by a range of professionals – a clinical psychologist, a psychiatrist, a specialist nurse, or a social worker, depending on the service and the presentation.
After the assessment, families are given a formulation (an understanding of the presenting difficulties), a provisional diagnosis if appropriate, and a plan. The plan might include further assessment, referral to a specific CAMHS pathway (such as the eating disorders team or the neurodevelopmental pathway), individual therapy, group therapy, parental guidance, or, in some cases, medication.
What to Do If CAMHS Is Not Sufficient
CAMHS capacity varies enormously, and families sometimes find that even accepted children don't receive adequate support. Options beyond CAMHS include:
Private psychology or psychiatry: expensive but accessible without waiting lists. BABCP (British Association for Behavioural and Cognitive Psychotherapies) provides a therapist directory that includes those who work with children.
Voluntary sector provision: Place2Be provides counselling in schools; Kooth provides online counselling for young people aged 11+; Mind, Samaritans, and specialist charities for specific conditions (Beat for eating disorders, OCD-UK for OCD, ADHD UK) provide condition-specific support.
NICE guidelines provide the evidence base for what treatments are recommended for specific conditions: families who are being offered treatments that differ from guidelines can ask the clinician to explain why.
Key Takeaways
Child and Adolescent Mental Health Services (CAMHS) provide specialist mental health assessment and treatment for children and young people in the UK. Referral is typically via GP, school, or other professional. CAMHS has been under significant pressure: waiting times are long in most areas, and children who are referred are not always accepted onto the waiting list. Understanding how the referral pathway works, what information helps, and what to do while waiting makes the process less opaque for families. For urgent presentations, there are more direct routes to emergency assessment.
