IMPORTANT
NOTICE
Child and Adolescent Mental
Health Services (CAMHS)
The Phoenix Centre
Raigmore Hospital (Zone 11)
Inverness
IV2 3UJ
Telephone: 01463 704665
Textphone users can contact
us via Typetalk: Tel 0800
959598
www.nhshighland.scot.nhs.uk/
www.nhshighland.scot.nhs.uk
E-mail:
nhshighland.phoenixcentre@nhs.net
Date Typed:
Ref:
02.07.15
CAMHS/DT
Enquiries to: 01463 705597
EFFECTIVE FROM 6TH JULY 2015
ALL referrals to Phoenix Centre should be sent to:
Child and Adolescent Mental Health Services (CAMHS)
Phoenix Centre
Raigmore Hospital
Old Perth Road
Inverness
IV2 3UJ
or by email: nhshighland.phoenixcentre@nhs.net
Please ignore all previous versions of a CAMHS referral form you may have
REFERRING TO SPECIALIST CHILD AND ADOLESCENT MENTAL HEALTH SERIVCES –
BRIEF GUIDANCE AND REFERRAL FORM
All referrals should be sent to the Phoenix Centre using the referral form and/or a Child’s Plan if
it contains all of the information requested in the referral form.
The Phoenix Centre is open between 9am and 5pm, 5 days a week and can provide advice and
information regarding which referrals are appropriate, the services provided by Specialist
CAMHS and what information to highlight if there are concerns about a child or young person.
If there are concerns regarding a child or young person who might need an urgent mental health
assessment (e.g. evidence of early psychosis; risk of suicide or severe self harm; severe
depression; severe eating disorder), then it is advisable to phone and ask to speak to the duty
clinician as well as emailing information through.
Filling in the form
To make a referral to CAMHS it is essential to supply the information detailed in the referral
form. This is achievable by either completing the form and/or a Child’s Plan if it contains all of
the information.
The referral form is aimed to be a guide with a view to it being completed by the referrer
and the parent/carer/young person together. It is essential that we receive good quality
information to help us to assess the urgency and suitability of service. We need as much
information as possible about the current mental health concerns and what impact these are
having on the child or young person (C/YP). We also need information regarding the impact
that presenting problems have within the home (in the family) and at school.
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CHILD AND ADOLESCENT MENTAL
HEALTH SERVICES (CAMHS)
Phoenix Centre
telephone
numbers:
 01463 705597
 01463 704665
 01463 705473
REFERRAL FORM
DETAILS OF CHILD/YOUNG PERSON/FAMILY BEING REFERRED: (Delete one)
Male / Female
Has the young person consented to this referral? (Delete one)
YES / NO
Forename
CHI
Surname
Date of Birth
Address
School
Year
Postcode
Previous
names
≥16 Staying at school?
Ethnic Origin
Contact Tel.
First Language
Looked After Child
LD/ASD/ADHD (please confirm diagnosis)
YES / NO
YES / NO
PARENT/CARER
Are the young person’s parents/carers aware of this referral? (Delete one)
Who has parental responsibility? (Please tick)

Name
Relationship
YES / NO
Address
(if different)
Telephone
What other agencies are currently involved or has the child been referred to?
(PMHW, GP, Social Worker, School, Paediatrics, etc)
Agencies
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Contact Name
Address
Telephone
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RISK
Self Harm
Harm to Others
Please give details
Child Protection Plan in
place
Substance Abuse
Offending Behaviour
Other
Yes/ No
Category
REQUEST DETAILS
Presenting issues? (Please see referral criteria)
Duration
(When did this concern begin?)
Previous interventions and outcomes: (see referral criteria for specific Tiers)
Tier 1

Tier 2

Tier 3

Tier 4

With whom?
Brief/Relevant Medical History
Current medication
Medication sensitivities/allergies
What does the young person/family hope for from CAMHS involvement?
Is there a Child’s Plan in place?
(attach a copy)
YES/NO
Name of person completing this form
Signature
Designation
Address:
Date
Tel:
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