The Thames Valley Forensic Child and Adolescent Forensic
Mental Health Team (FCAMHS Team): Developing a
Mental Health Service for Young People Across the Thames
Valley.
Information for Locality Specialist CAMHS Teams and Allied Mental Health
Professionals (updated September 2009)
Comments and Feedback to Dr Nick Hindley, 0845 2191465
nick.hindley@obmh.nhs.uk
1) Introduction
Young people under 18 in contact with the criminal justice system, or those elsewhere
presenting serious risk of harm to others, have high rates of mental health problems
and have traditionally not accessed core child and adolescent mental health services
(CAMHS). This group of young people with complex needs is highlighted in the
National Service Framework for Children as requiring special consideration. In March
2004, a child and adolescent forensic mental health service was established in
Oxfordshire after detailed multidisciplinary consultation, to work with this group of
young people across a variety of custodial and other settings. The service has since
developed to fulfil a wider regional role (see below).
The service is now funded by a combination of:
 central NHS prison in-reach monies mediated by Oxfordshire PCT (for prison
in-reach provision to HMYOI Huntercombe)
 regional specialist commissioning funding for the regional community
component of the service
Service level agreements operate for both components of service provision.
The team offers a range of services and interventions to a specific geographical area
(Oxfordshire, Buckinghamshire, Berkshire and Milton Keynes). The team provides
specialist child and adolescent mental health expertise at a variety of levels and to a
variety of institutions and networks working with young people under 18 years old in
the criminal justice system. The scope of the team’s remit is broad and is highlighted
in figure 1.
2) General Functions
The multidisciplinary team functions on several levels in all environments:
 As a resource for information
 As a means of formal consultation
 As a service providing specialist assessments and interventions
 As a training resource for front-line workers
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
As a means of informing and developing strategic links between
mental health services and the criminal justice system.
3) Specific Functions
a) Mental Health In-reach to HMYOI Huntercombe (380 15-18 year old sentenced
male inmates)
The team provides multi-disciplinary child and adolescent mental health input to the
prison as well as providing supervision for primary mental health workers. There is a
strong liaison function within the prison and with boys’ home services across the
south of England.
b) Regional Tier 4 Child Tertiary Referral Service for Oxfordshire, Berkshire,
Buckinghamshire and Milton Keynes
The service is principally a tertiary referral service for CAMHS teams (including
CAMHS/YOT linkworkers) although contact from other agencies is not excluded.
The team wishes to be accessible to all agencies (eg. social services, YOTs, prisons,
courts, solicitors, education etc) which may have contact with risky young people or
young people in the criminal justice system who have mental health difficulties. For
this reason initial contacts about possible referrals are welcomed from all agencies;
however, referrals for assessments are usually only accepted with the knowledge and
active support from local CAMHS tier 3 services.
Other Functions within regional role include:
i) Child and Adolescent Forensic Mental Health Input to Other Custodial
Settings
The existence of a specialist service covering a specified geographical area
allows for the possibility of input from the service to custodial institutions not
previously linked in a coherent way.
ii) Liaison with Locality CAMHS and YOT’s
The team has worked to establish good working and training relationships with
local services. It seeks to promote good local arrangements for mental health
working between locality specialist CAMH teams and YOTs. The ultimate
aim of this area of strategic development will be to develop coherent practice
models based on local initiatives (eg CAMHS/YOS mental health
linkworkers) supported by the specialist FCAMHS team.
The team maintains strong liaison links with individual CAMHS and YOS
teams and provides specialist support for CAMHS/YOS linkworkers.
iii) Liaison and Advice to Courts and the Legal System
The team seeks to act on various levels in its contact with courts and the wider
legal system i.e. as both a resource for general advice and more formal
consultation as well as a provider of specialist assessments and management
advice. The emphasis in this area would be to support local services to develop
appropriate skills to carry out this function themselves with recognition that in
particularly complex cases the team’s direct input will be required. (This latter
role will require direct funding on a case by case basis).
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iv) Wider Strategic Functions
 Linkage with national in-patient services
 Linkage with services elsewhere involved in mental health provision to
young people in secure or community settings
 Informing policy and forming strong links with national organisations
responsible for strategic development
 Providing professional training for individuals wishing to obtain the
necessary experience to work in this area of expertise
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4) Referral Process (see Figure 2)
Referral criteria are as follows:
 The young person is under 18 years old
 The young person has already had a mental health assessment where mental
health needs have been identified and remains in contact with local CAMH
services
 The young person is in contact with the criminal justice system (serious
offences) or is presenting with risk of serious harm to others
Referral process:
 The referrer will provide clear reasons for referral and adequate background
information including baseline risk assessment
 The referrer will undertake an initial verbal consultation with a designated
member of the FCAMHS team
 Referrers will retain overall clinical responsibility for the young people they
refer. They should also identify a CPA case coordinator who will remain in
contact with the case throughout the period of FCAMHS team involvement.
Referral outcomes: there will be three possible outcomes for referrals which will be
fed back to referrers:
 Referral accepted for consultation to referrer/local network re general
management (no direct clinical involvement).
 Referral accepted for specialist assessment and advice re future management.
This outcome requires the home team and network to remain involved with the
case (e.g. by providing a care coordinator) and to participate in ongoing riskmanagement. Following the assessment the FCAMHS team will remain
involved, as appropriate, to support the local network to manage the case.
 Referral not accepted
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Figure 1: Proposed Schema for a Child and Adolescent Forensic Mental Health Service for the Thames Valley Area
Prison in-reach
Huntercombe YOI
Clinical and risk assessment,
interventions, mental health
promotion
Tertiary
referrals
Regional remit
(Oxon, Berks, Bucks, MK)
Clinical and risk
assessment, support for
local teams with serious
cases from multi-agency
environment
Other prison/
institutional liaison
Other
Regional remit
(Oxon, Berks, Bucks, MK)
Regional remit
(Oxon, Berks, Bucks, MK)
Specialist forensic CAMHS
consultation





Multi-agency liaison
across South of England
(mental health, criminal
justice, social services,
primary care, families etc.)




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Liaison with locality CAMHS
Liaison with YOT’s and courts
Liaison with other prisons
Liaison with national
adolescent forensic services
Liaison with adult forensic
teams
Informing service development
Teaching frontline practitioners
Specialist training resource
Representation on national
professional and strategic
groups
Figure 2: FCAMHS Team: Regional Community Forensic Service: Referral Pathway for Young People under 18
Locality Tier 3 CAMHS
or
CAMHS/YOT link worker



Assess
Liaise
Interventions as
needed
Multiagency
Environment
Advice
Forensic mental
health support
needed
FCAMHS Team
Local
Background
information
+
discussion with team
member
CAMHS
service
aware and
supportive?
GP
Social services
YOT
Courts/legal
Other
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Formal
consultation
Specialist
assessment
and
management
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