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:
Or via: nhshighland.phoenixcentre@nhs.net
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 th e 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 Tier 4
Inpatient &
Intensive
Community outreach
Specialist CAMHS Tier 3
Team
PMHW
– Training/consultation
to increase capacity & confidence. Tier 2
Consultation & direct work with children
& young people
Universal services have a role in promoting children’s emotional health consisting of all primary Tier 1 care agencies including GP’s, school nursing, health visitors, children’s service workers and schools
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 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 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 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
CAMHS REFERRAL CRITERIA .

July 2015
Problem
ADHD
Anxiety
Bereavement :
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.
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.
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.
Children’s response to grief will vary dependent on age, cognitive and developmental stage. Quite often it can be the subsequent change in
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.
CAMHS would not normally assess a child for ADHD until they have completed at least one term within P1.
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
NHS Highland CAMHS
Advice www.adhdtraining.co.uk/ www.boxofideas.org/
You may wish to find out more at: www.shapeofmind
www.youngminds.org.uk
www.anxietyuk.org.uk www.moodjuice.scot.nhs.uk/anxiety 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 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.
Tier 3 CAMHS would consider referrals when conduct problems are a result of significant disruption to the parent-child relationship, are having a significant impact on a child’s emotional well being, and there 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
NHS Highland CAMHS
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 http://incredibleyears.com/ http://www.solihullapproachparenting.com/ http://www.mellowparenting.org/

July 2015
Depression/Low
Mood
Eating Disorders
Low mood is a normal part of childhood, in most cases is temporary and might well resolve on its own.
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.
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.
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
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.
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.
For persistent and severe symptoms, or if concerns exist regarding significant suicidal thoughts then referral to Tier 3 CAMHS may be appropriate.
NHS Highland CAMHS
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
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.
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
Enuresis and
Encopresis
Family
Relationship
Problems 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.
Both are categorised as elimination disorders and involve the inability to control urination or soiling in those deemed old enough to exercise control.
Initial screening and treatment should be undertaken by paediatrician to rule out physical causes.
Family relationship problems can result in emotional distress which presents in a variety of ways in children and young people.
Families may be struggling to communicate effectively or to
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
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.
Specialist CAMHS does not mediate residence and contact arrangements for a
NHS Highland CAMHS
If the young person answers yes to 2 of these questions consider referral. www.b-eat.co.uk
http://www.relationships-scotland.org.uk/finda-local-service/family-mediationservices/highland

July 2015
Feeding and
Faltering Growth
Children / young people Looked
After or Looked
After Away from
Home understand why they are having problems within their relationships.
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;

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 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.
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.
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.
NHS Highland CAMHS www.childrenfirst.nhs.uk/families/features/beh aviour/fussy_eaters.html
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) 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.
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
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.
For persistent and severe symptoms, referral to Tier 3 CAMHS may be appropriate.
CAMHS do not conduct initial diagnostic assessments for learning disability.
Paediatricians, Educational Psychologists and pre-school special teachers assess children for learning disability.
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.
NHS Highland 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
Obsessive
Compulsive
Disorder (OCD)
Paediatric Health
Psychology
Psychosis
Psychosomatic
Difficulties
ASD diagnostic assessment.
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.
Guidance on referrals to the paediatric health psychology service can be found here.
Psychosis is rare in children and adolescents but may involve transient states or short episodes of delusions, hallucinations, disorganised speech or behaviour.
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
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.
Please refer to separate guidance prior to making a referral.
NHS Highland CAMHS
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
Referral to Tier 3 CAMHS is indicated.
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 recommended.
Where symptoms are mild or moderate in nature a consultation with a PMHW will help clarify what support may be appropriate.
For persistent and severe symptoms which have a significant impact on the chil d’s functioning referral to Tier 3 CAMHS may be appropriate.
www.rcpsych.ac.uk/mentalhealthinfo/mentalh ealthandgrowingup/psychoticillnessyoungpeo ple.aspx
www.there4me.com
Website for children and young people (12-
16) who have got fears and worries. Run by
NSSPCC www.rcpsych.ac.uk/mentalhealthinformation/ mentalhealthproblems/physicalillness/unexpla inedphysicalsymptoms
Royal College of Psychiatrists Website

July 2015
Post Traumatic
Stress Disorder /
Acute stress disorder
.
School Refusal
Self Harming
Behaviour
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 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.
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.
NHS Highland CAMHS
Where children and young people are currently experiencing trauma such as domestic violence a referral to the Family
Team is likely to 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/ 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 NHS Highland CAMHS
Self harming
Behaviour with suicidal intent
Tics and Tourette’s
Syndrome
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 ch ild’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.