What are Child and Adolescent Mental Health Services (CAMHS)?

Introduction

Child and Adolescent Mental Health Services (CAMHS) is the name for NHS-provided services in the United Kingdom for children, generally until school-leaving age, who are having difficulties with their emotional well-being or are deemed to have persistent behavioural problems.

CAMHS are organised locally, and the exact services provided may vary, often by local government area.

Brief History

In Europe and the United States child-centred mental health did not become a medical specialty until after World War I. In the United Kingdom children’s and young people’s mental health treatment was for decades the remit of the Child Guidance Movement increasingly working after World War II with local educational authorities and often influenced by psychoanalytic ideas. Provision in NHS hospitals was piecemeal across the country and disconnected from the youth justice system. However opposition to Psychoanalysis with its pioneering research work into childhood and adolescence, which was poorly understood by proponents of the Medical model, caused the service to be abandoned in favour of evidence-based medicine and evidence-based education. This led to the eclipse of the multidisciplinary child guidance approach in the 1990s and a public policy-motivated formal take-over by the NHS.

The development of CAMHS within a four-tiered framework started in 1995. In 1998, 24 CAMHS Innovation Projects started, and the Crime and Disorder Act 1998 established related youth offending teams. In 2000 the NHS Plan Implementation Programme required health and local authorities to jointly produce a local CAMHS strategy.

In November 2008 the independent CAMHS Review was published.

From about 2013 onward major concerns have been expressed about reductions in CAMHS, and apparently increasing demand, and in 2014 the parliamentary Health Select Committee investigated and reported on provision. In 2015 the government published a review, and promised a funding increase of about £250 million per year. However the funds were not ring-fenced and as of 2016 only about half of England’s Clinical commissioning groups had increased local CAMHS funding. CAMHS funding remains a popular topic for political announcements of funding and the current aim is to increase funding to the level that 35% of young people with a disorder are able to receive a specialist service. Different models of service organisation are also advocated as part of this transformation.

In Scotland, between 2007 and 2016 the number of CAMHS psychologists had doubled, reflecting increased demand for the service. However in September 2020, 53.5% of CAMHS patients in Scotland had waited for an appointment longer than the 18 weeks target, and in Glasgow the average waiting time was 26 weeks.

131 new CAMHS beds were commissioned by NHS England in 2018, increasing the existing 1,440 bed base by more than 10%. 56 will be in London, 12 at Bodmin Hospital and 22 at St Mary’s Hospital in Leeds.

Service Framework

In the UK CAMHS are organised around a four tier system:

TierDescription
1General advice and treatment for less severe problems by non-mental health specialists working in general services, such as GPs, school nurses, social workers, and voluntary agencies.
2Usually CAMHS specialists working in community and primary care, such as mental health workers and counsellors working in clinics, schools and youth services.
3Usually a multi-disciplinary team or service working in a community mental health clinic providing a specialised service for more severe disorders, with team members including psychiatrists, social workers, board certified behaviour analysts, clinical psychologists, psychotherapists and other therapists.
4Highly specialist services for children and young people with serious problems, such as day units, specialised outpatient teams and in-patient units.

Specialist CAMHS – Tiers 3 and 4

Generally patients cannot self-refer to Tier 3 or 4 services, which are sometimes called specialist CAMHS. Referrals can be made by a wide range of agencies and professionals, including GPs and school nurses.

The aim is to have a team led by a consultant psychiatrist, although other models exist and there is limited evidence of what system works best. It is suggested that there should be a consultant psychiatrist for a total population of 75,000, although in most of the UK this standard is not met.

The Tier 4 service includes hospital care, with about 1,450 hospital beds provided in England for adolescents aged 13 to 18. Typical conditions that sometime require hospital care include depression, psychoses, eating disorders and severe anxiety disorders.

The service may, depending on locality, include:

  • Art therapy.
  • Child psychiatry.
  • Clinical psychology.
  • Educational psychology.
  • Family therapy.
  • Music therapy.
  • Occupational therapy.
  • Psychiatric nursing.
  • Social worker interface.
  • Speech therapy.
  • Child psychotherapy.
  • Forensic CAMHS, working with young offenders or those at risk of offending.

Performance

As of December 2016, some young English people with eating disorders were being sent hundreds of miles away to Scotland because the services they required were not available locally. Not withstanding good care in Scotland it was said that being away from friends and family compromised their recovery. In response the government had adopted a policy of ending such arrangements by 2021, and had allocated a cumulative £150M to improve local availability of care. There are concerns that not enough is being done to support people at risk of taking their own lives. 1,039 children and adolescents in England were admitted to beds away from home in 2017-2018, many had to travel over 100 miles (160 kilometres) from home. Many had complex mental health issues frequently involving a risk of self-harm or suicide, like severe depression, eating disorders, psychosis and personality disorders.

In 2017-2018 at least 539 children assessed as needing Tier 3 child and adolescent mental health services care waited more than a year to start treatment, according to a Health Service Journal survey which elicited reports from 33 out of the 50 mental health trusts.

Book: Camouflage: The Hidden Lives of Autistic Women

Book Title:

Camouflage: The Hidden Lives of Autistic Women.

Author(s): Dr Sarah Bargiela.

Year: 2019.

Edition: First (1st), Illustrated Edition.

Publisher: Jessica Kingsley Publishers.

Type(s): Hardcover and Kindle.

Synopsis:

Autism in women and girls is still not widely understood, and is often misrepresented or even overlooked. This graphic novel offers an engaging and accessible insight into the lives and minds of autistic women, using real-life case studies.

The charming illustrations lead readers on a visual journey of how women on the spectrum experience everyday life, from metaphors and masking in social situations, to friendships and relationships and the role of special interests.

Fun, sensitive and informative, this is a fantastic resource for anyone who wishes to understand how gender affects autism, and how to create safer supportive and more accessible environments for women on the spectrum.

Book: Avoiding Anxiety in Autistic Children: A Guide for Autistic Wellbeing

Book Title:

Avoiding Anxiety in Autistic Children: A Guide for Autistic Wellbeing.

Author(s): Luke Beardon.

Year: 2020.

Edition: First (1st)

Publisher: Sheldon Press.

Type(s): Paperback and Kindle.

Synopsis:

One of the biggest challenges for the parent of any autistic child is how best to support and guide them through the situations in life which might cause them greater stress, anxiety and worry than if they were neurotypical.

Dr Luke Beardon has put together an optimistic, upbeat and readable guide that will be essential reading for any parent to an autistic child, whether they are of preschool age or teenagers. Emphasising that autism is not behaviour, but at the same time acknowledging that there are risks of increased anxiety specific to autism, this practical book gives insight into the nature of the anxiety experienced by autistic people, as well as covering every likely situation in which your child might feel anxious or worried. It will help you to prepare your child for school, to monitor their anxiety around school, and also to be informed about the educational choices available to your child. It will give you support to help make breaktimes less stressful for them and how to help them navigate things like eating at school and out of the house.

Educationally, this book will take you and your child right up to the point of taking exams and leaving school; socially and emotionally it will cover all the challenges from bullying, friendships, relationships, puberty and sex education. It will give suggestions for alternatives in the scenarios that might cause anxiety or confusion in your child; it will also give a full understanding of your child’s sensory responses and such behaviours as masking, or echopraxia.

As the parent of an autistic child, you may find their path to adulthood different to the one you had expected to take, but as this book makes clear, autism should be celebrated and affirmed. Avoiding Anxiety in Autistic Children helps you to do just that, with practical strategies that will help happiness, not anxiety, remain the over-riding emotion that colours your child’s memories of their early years.

Anxiety Youth vs Healthy Youth: Threat-Anticipatory Psychophysiological Response Differences

Research Paper Title

Threat-anticipatory psychophysiological response is enhanced in youth with anxiety disorders and correlates with prefrontal cortex neuroanatomy.

Background

Threat anticipation engages neural circuitry that has evolved to promote defensive behaviours; perturbations in this circuitry could generate excessive threat-anticipation response, a key characteristic of pathological anxiety. Research into such mechanisms in youth faces ethical and practical limitations. Here, the researchers use thermal stimulation to elicit pain-anticipatory psychophysiological response and map its correlates to brain structure among youth with anxiety and healthy youth.

Methods

Youth with anxiety (n = 25) and healthy youth (n = 25) completed an instructed threat-anticipation task in which cues predicted nonpainful or painful thermal stimulation; the researchers indexed psychophysiological response during the anticipation and experience of pain using skin conductance response. High-resolution brain-structure imaging data collected in another visit were available for 41 participants. Analyses tested whether the 2 groups differed in their psychophysiological cue-based pain-anticipatory and pain-experience responses. Analyses then mapped psychophysiological response magnitude to brain structure.

Results

Youth with anxiety showed enhanced psychophysiological response specifically during anticipation of painful stimulation (b = 0.52, p = 0.003). Across the sample, the magnitude of psychophysiological anticipatory response correlated negatively with the thickness of the dorsolateral prefrontal cortex (pFWE < 0.05); psychophysiological response to the thermal stimulation correlated positively with the thickness of the posterior insula (pFWE < 0.05).

Limitations: Limitations included the modest sample size and the cross-sectional design.

Conclusions

These findings show that threat-anticipatory psychophysiological response differentiates youth with anxiety from healthy youth, and they link brain structure to psychophysiological response during pain anticipation and experience. A focus on threat anticipation in research on anxiety could delineate relevant neural circuitry.

Reference

Abend, R., Bajaj, M.A., Harrwijn, A., Matsumoto, C., Michalska, K.J., Necka, E., Palacios-Barrios, E.E., Leibenluft, E., Atlas, L.Y. & Pine, D.S. (2021) Threat-anticipatory psychophysiological response is enhanced in youth with anxiety disorders and correlates with prefrontal cortex neuroanatomy. Journal of Psychiatry & Neuroscience. 46(2):E212-E221. doi: 10.1503/jpn.200110.

Is There Value in Targeted Screening & Intervention Programmes of Anxiety in Young Adult Offspring with Parental Mental Health Problems?

Research Paper Title

Associations of maternal and paternal mental health problems with offspring anxiety at age 20 years: Findings from a population-based prospective cohort study.

Background

Epidemiological studies indicate that children of parents with mental health problems are at an increased risk of developing anxiety disorders.

Few studies have investigated this relationship in young adults.

Methods

Participants were from the Raine Study, which is a multi-generational birth cohort study in Australia. Maternal anxiety and depression in late childhood were assessed using the Depression, Anxiety, and Stress Scale (DASS-42), and paternal lifetime mental health problems were assessed using a self-reported questionnaire.

The short form of DASS-42 (DASS-21) was used to assess anxiety symptoms among offspring at age 20. Negative binomial regression model was used to quantify the association. Data were available for 1,220 mother-offspring and 1,190 father-offspring pairs.

Results

After adjusting for potential confounders, the researchers found an increased risk of anxiety in young adult offspring exposed to maternal anxiety in late childhood and paternal lifetime mental health problems. However, they observed no increased risks of anxiety in offspring exposed to maternal depressive symptoms. Their sensitivity analysis based on the log-binomial model (binary outcome) as well as the linear model (log-transformed data) confirmed the robustness of the main results.

Conclusions

The findings suggest there can be value to consider and apply targeted screening and intervention programmes of anxiety in the young adult offspring with parental mental health problems.

Reference

Ayano, G., Betts, K., Lin, A., Tait, R. & Alati, R. (2021) Associations of maternal and paternal mental health problems with offspring anxiety at age 20 years: Findings from a population-based prospective cohort study. Psychiatry Research. doi: 10.1016/j.psychres.2021.113781. Online ahead of print.

Can Participation in HIIT Improve Cognitive Function & Mental Health in Children & Adolescents?

Research Paper Title

Review of High-Intensity Interval Training for Cognitive and Mental Health in Youth.

Background

High-intensity interval training (HIIT) has emerged as a time-efficient strategy to improve children’s and adolescents’ health-related fitness in comparison to traditional training methods. However, little is known regarding the effects on cognitive function and mental health.

Therefore, the aim of this systematic review was to evaluate the effect of HIIT on cognitive function (basic information processing, executive function) and mental health (well-being, ill-being) outcomes for children and adolescents.

Methods

A systematic search was conducted, and studies were eligible if they:

  1. Included a HIIT protocol;
  2. Examined cognitive function or mental health outcomes; and
  3. Examined children or adolescents (5-18 years) old.

Separate meta-analyses were conducted for acute and chronic studies, with potential moderators (i.e. study duration, risk of bias, participant age, cognitive demand, and study population) also explored.

Results

A total of 22 studies were included in the review. In acute studies, small to moderate effects were found for executive function (standardised mean difference [SMD], 0.50, 95% confidence interval [CI], 0.03-0.98; P = 0.038) and affect (SMD, 0.33; 95% CI, 0.05-0.62; P = 0.020), respectively. For chronic studies, small significant effects were found for executive function (SMD, 0.31; 95% CI, 0.15-0.76, P < 0.001), well-being (SMD, 0.22; 95% CI, 0.02-0.41; P = 0.029), and ill-being (SMD, -0.35; 95% CI, -0.68 to -0.03; P = 0.035).

Conclusions

The review provides preliminary review evidence suggesting that participation in HIIT can improve cognitive function and mental health in children and adolescents.

Because of the small number of studies and large heterogeneity, more high-quality research is needed to confirm these findings.

Reference

Leahy, A.A., Mavilidi, M.F., Smith, J.J., Hillman, C.H., Eather, N., Barker, D. & Lubans, D.R. (2020) Review of High-Intensity Interval Training for Cognitive and Mental Health in Youth.

Is there a Relationship between Diet & Mental Health in Children & Adolescents?

Research Paper Title

Relationship between diet and mental health in children and adolescents: a systematic review.

Background

The researchers systematically reviewed 12 epidemiological studies to determine whether an association exists between diet quality and patterns and mental health in children and adolescents; 9 explored the relationship using diet as the exposure, and 3 used mental health as the exposure.

They found evidence of a significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents.

They observed a consistent trend for the relationship between good-quality diet and better mental health and some evidence for the reverse.

When including only the 7 studies deemed to be of high methodological quality, all but 1 of these trends remained.

Findings highlight the potential importance of the relationship between dietary patterns or quality and mental health early in the life span.

Reference

O’Neil, A., Quirk, S.E., Housden, S.E.Q., Brennan, S.L., Williams, L.J., Pasco, J.A., Berk. M. & Jacka, F.N. (2020) Relationship between diet and mental health in children and adolescents: a systematic review. American Journal of Public Health. 104(10), pp.e31-42. doi: 10.2105/AJPH.2014.302110.

Book: Internet Addiction in Children and Adolescents

Book Title:

Internet Addiction in Children and Adolescents: Risk Factors, Assessment, and Treatment.

Author(s): Kimberly S. Young and Cristiano Nabuco de Abreu (Editors).

Year: 2017.

Edition: First (1st).

Publisher: Springer Publishing Co Inc.

Type(s): Paperback and Kindle.

Synopsis:

This is the first book to thoroughly examine how early and easy access to the Internet and digital technologies impacts children and adolescents. Experts in the field examine the research that shows the social, cognitive, developmental, and academic problems that can result when children spend excessive time in front of screens. As a whole, the book provides an invaluable resource for those who need to assess, treat, and prevent Internet addiction in children and adolescents.

Internet Addiction in Children and Adolescents:

  • Provides tools that help predict a child’s level of risk for media-related problems.
  • Examines how to diagnose and differentiate Internet addiction from other psychiatric conditions.
  • Explores evidence-based treatment approaches and how to distinguish pathology from normal development.
  • Shows how to create inpatient treatment programs and therapies to address media addiction.
  • Highlights the psychological, social, and family conditions for those most at risk.
  • Evaluates the effects of the excessive use of electronic games and the Internet on brain development.
  • Explores the physical risks that result from excessive media use and strategies for combating the problem.
  • Examines school-based initiatives that employ policies and procedures designed to increase awareness of excessive media use and help educators identify students who misuse technology, and that provide strategies of intervention and communication with parents.
  • Identifies signs of problem Internet behavior such as aggressive behavior, lying about screen use, and a preference for screen time over social interactions.
  • Outlines the risk factors for developing Internet addiction.
  • Provides strategies for treatment and prevention in family, school, and community settings.

Practitioners and researchers in psychology, social work, school counseling, child and family therapy, and nursing will appreciate this book’s thorough review of Internet addiction among children and adolescents. The book also serves as an engaging supplement in courses on media psychology, addiction counseling, abnormal psychology, school counseling, social issues, and more.

Book: Coping Skills for Teens Workbook

Book Title:

Coping Skills for Teens Workbook – 60 Helpful Ways to Deal with Stress, Anxiety and Anger.

Author(s): Janine Halloran (Author), Amy Maranville (Editor), and Meg Garcia (Illustrator).

Year: 2020.

Edition: First (1st).

Publisher: Encourage Play, LLC.

Type(s): Paperback and Kindle.

Synopsis:

A teen version of the #1 Bestselling Coping Skills for Kids Workbook, this version is written specifically with a tween/teen audience (age 11+) in mind.

There are 60 coping strategies included in the book, and it is divided into Coping Styles to make searching for a coping skill easier.

This book also includes several pages to support teens as they work on their coping skills, including: Feelings Tracker Worksheet Identifying Triggers and Making a Plan Positive to Negative Thoughts Worksheet Journal Pages Wellness Worksheets, including a Self-Care PlanThere’s also a rich resource section full of apps, books, card decks, and other resources to help teens deal with stress, anxiety and anger.

Linking PTSD and the Parents of Children with Cancer

Research Paper Title

Post-Traumatic Stress Symptoms among Lithuanian Parents Raising Children with Cancer.

Background

The study aims to evaluate post-traumatic stress symptom expression among Lithuanian parents raising children with cancer, including social, demographic, and medical factors, and to determine their significance for the risk of developing post-traumatic stress disorder.

Methods

The study was carried out in two major Lithuanian hospitals treating children with oncologic diseases. The cross-sectional study included 195 parents, out of which 151 were mothers (77.4%) and 44 were fathers (22.6%). Post-traumatic stress symptoms were assessed using the Impact of Event Scale-Revised. To collect the sociodemographic, childhood cancer, and treatment data, we developed a questionnaire that was completed by the parents. Main study results were obtained using multiple linear regression.

Results

A total of 75.4% of parents caring for children with cancer had pronounced symptoms of post-traumatic stress disorder. The female gender (β = 0.83, p < 0.001) was associated with an increased manifestation of symptoms, whilst higher parental education (β = -0.21, p = 0.034) and the absence of relapse (β = -0.48, p < 0.001) of the child’s disease reduced post-traumatic stress symptom expression.

Conclusions

Obtained results confirmed that experiencing a child’s cancer diagnosis and treatment is extremely stressful for many parents. This event may lead to impaired mental health and increased post-traumatic stress disorder (PTSD) risk; hence, it is necessary to provide better support and assistance to parents of children with cancer.

Reference

Baniene, I. & Zemaitiene, N. (2020) Post-Traumatic Stress Symptoms among Lithuanian Parents Raising Children with Cancer. Children (Basel, Switzerland). 7(9), pp.116. doi: 10.3390/children7090116.