Referral Criteria for Barnet Child and Adolescent Mental Health Services
Most young people with mild emotional or behavioural difficulties are best served by universal
services e.g. General Practitioners, schools, health visitors and community groups etc. Before
making a referral to CAMHS, these other options should be considered.
When the difficulties are complex and enduring and there is a significant impact on functioning,
referral to targeted community based services or specialist clinic based mental health services may
be appropriate.
The referral criteria in this document will enable you to determine whether it would be appropriate to
make a referral to mental health services in schools (Barnet Primary and Secondary CAMHS
Project) or specialist clinic based child and adolescent mental health services (CAMHS). The latter
includes specialist community adolescent services (BAS), services for children with mental health
problems associated with moderate to severe learning disabilities (SCAN) as well as the Paediatric
Liaison Service based at Barnet General Hospital.
The core business of CAMHS is:
The assessment and treatment of serious mental health disturbances and associated
risks in young people up to the age of 18 years.
Child Protection
If you are concerned that a child is at risk of physical, sexual or emotional abuse or neglect, you
must refer to Social Care in the first instance, specifying your concerns and following your agency’s
child protection guidelines. It would not be appropriate to refer to CAMHS before those concerns
have been addressed.
When there is ongoing Social Care involvement with a child/family, the Social Worker needs to be
advised of and in agreement with the referral to CAMHS, to ensure inter-agency liaison.
On a fortnightly basis, CAMHS and Social Care have a joint consultation meeting, where those
families with a high level of need and who may benefit from both services are discussed.
Chairman:
Chief Executive:
Michael Fox
Maria Kane
1
Problems Appropriate for CAMHS referral
1. Depression or Mood Disorder

When the young person has persistent low mood which is beyond age-appropriate mood
variation, of at least 2-3 weeks duration, (unless an urgent presentation /suicidal ideation in
which case see below under Self Harm)

Activities of daily living are affected– e.g. losses of interest in friends, school work,
disturbances of sleeping or eating.
The child should have been seen by the GP or other health professional for an assessment of
mental state, physical health and risk prior to referral.
2. Self Harm

Where there are concerns about self harm, the GP should be consulted initially for advice
on the urgency of the presentation. If there are concerns regarding milder forms of selfharming behaviours, a referral can be made to the Barnet Primary and Secondary Schools
project for an assessment.

If there is an acute risk of self harm, families should be sent directly to Accident &
Emergency Department for immediate medical care, and the protocol for management by
A&E/Paediatrics/CAMHS followed

If the self harm is chronic, we would advise a GP assessment regarding current risk and
mental state prior to referral to CAMHS, so that the young person can be prioritised
appropriately.
3. Psychosis

Where there are concerns around any unusual and sudden changes in behaviour or mood
e.g. paranoia – (verbally expressing this or avoidance of people/ activities because of this),
withdrawn and isolated, unusual movements or behaviours, lack of interest in others and
activities they used to enjoy), please request an emergency GP assessment who will decide
if an urgent referral needs to be made to CAMHS or A&E.
4. Anxiety including Post Traumatic Stress Disorder and Obsessive Compulsive Disorder
Chairman:
Chief Executive:
Michael Fox
Maria Kane
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

Significant anxiety which is persistent and affects day to day functioning.
Generally persistence of four or more weeks duration for Post Traumatic Stress (severe
distress occurring after a traumatic incident.)

An early referral for children and young people with Obsessive Compulsive Disorder is
recommended. This is when young people are overly preoccupied by repetitive behaviour
and rituals e.g. re checking behaviours and/or repetitive behaviours such as constant hand
washing, in response to upsetting thoughts and feelings.
5. Eating Disorders (Anorexia, Bulimia, and Highly Selective Eating)

GP to assess physical and mental state prior to referral.

For less severe cases of selective eating and fears about food in young children, ask for
support from the Health Visitor or School Nurse in the first instance. The Primary and
Secondary schools Project (Tier 2 CAMHS) may also be able to offer consultation to parents
and school staff who may be concerned about selective eating and fears about food in one
or more settings.
6. Significant Learning disability with co –morbidity of enduring challenging
behaviour/mental health problems
7. Complex Neurodevelopmental problems eg Autistic Spectrum, Asperger’s Syndrome,
ADHD, Tourettes and Complex Tic Disorders

Autistic Spectrum Disorders: For children under the age of 7 years, refer to
Community Paediatrics. Those older than 7 years of age, refer to CAMHS. Possible
presentations include:

Significant difficulties with the child’s peer group relationships/social
interactions with others.

Unusual or very fixed interests.

Marked preference for routine and difficulty managing change.

Bizarre or unusual behaviours.
Chairman:
Chief Executive:
Michael Fox
Maria Kane
3

ADHD For children under 5 years of age, consider referral to health visitors or
Community Paediatrics. Those children over 5 years of age, refer to CAMHS. Possible
presentation includes.

Persistent attention difficulties in two or more settings e.g. school /home

Unresponsive to behavioural intervention in school despite involvement of
school based support

Hyperactivity, impulsivity or inattention

Early age of onset and duration for more than 6 months
CAMHS cannot assess problems such as:

Dyspraxia: refer to Occupational Therapy

Dyslexia

Cognitive assessments: these are not carried out by CAMHS.
The Primary and Secondary schools Project (Tier 2 CAMHS) are able to offer consultation to
parents and schools, who may be concerned about their child’s presentation and may want to
discuss their options about the most appropriate service.
8. Medical Conditions and Physical Disabilities with mental health complications

Refer to Paediatricians who can refer to CAMHS if necessary

Paediatricians may refer to Barnet Paediatric Liaison Service in the first instance

Children with serious medical illness who are continuing to attend an out-of-borough
hospital (e.g. GOSH) may be more appropriately served by that hospital’s Liaison Team.
9. Somatisation Disorders, Hypochondriacal, Dissociative Disorders, Pain Syndromes &
Chronic Fatigue Syndromes
Joint work will be undertaken alongside the paediatric services.
10. Enuresis or soiling:
 An initial physical assessment is needed by GP/Paediatrics before a referral to CAMHS is
made.
Chairman:
Chief Executive:
Michael Fox
Maria Kane
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 Paediatric Enuresis Clinic at Vale Drive clinic provides assessment and interventions for
children aged over 7 years
 The Primary and Secondary schools Project (Tier 2 CAMHS) are able to offer
consultation to parents and schools, who may be concerned about their child, and
strategies may be suggested to help individuals to support the child.
11 .School Refusal

Refer to education support services in the first instance. A CAF should be completed
and all appropriate agencies engaged prior to CAMHS referral.

Refer to CAMHS if there is evidence of mental health concerns, e.g. where the child has
severe emotional distress linked to attending school. Symptoms include severe anxiety
and frequent symptoms of physical ill health which are medically unexplained.

The Primary and Secondary schools Project (Tier 2 CAMHS) are able to offer
consultation to parents and schools, at the early stages of school refusal. The child’s
refusal to come to school may be due to separation anxiety or difficult circumstances at
home. Advice and support may enable parents and school to implement strategies early
on to prevent consistent refusal to attend school.
12. Behaviour Problems and Conduct Disorders

Consider referral to one of the parenting support groups offered by Barnet in the first
instance.

If there are significant antisocial disorders e.g. truancy, stealing, destructiveness in
school then a CAF should be completed initially, to ensure relevant services are coordinated to address those concerns. These might include the Family Focus team and
Targeted Youth Services

Please also see section on behaviour problems mainly in the school setting for further
information.
13. Difficulties in the context of parental mental Illness

We would expect to work jointly with Adult Mental Health Services and other involved
agencies.

The Primary and Secondary schools Project (Tier 2 CAMHS) can work with children/
young people who are experiencing difficulties in the context of one or both parents
Chairman:
Chief Executive:
Michael Fox
Maria Kane
5
having lower level mental health difficulties, who don’t reach the threshold for adult
mental health services.
14. Substance Misuse Problems
Refer to Barnet Young People’s Drug and Alcohol Service (YPDAS) if that is the main presenting
problem
15. Looked after Children:
There is a dedicated service within CAMHS for Barnet children in care and adoption that supports
placements and stability
16. Children known to the Youth Offending Team:
Young people known to the Youth Offending Team can access the psychology service based within
that team and they can decide if the referral is more appropriate for CAMHS. If you are thinking of
referring a young person known to the Youth Offending Team, please consult with them first.
Barnet Primary and Secondary Project Workers working within the school setting (Tier 2
CAMHS)
Barnet Primary (BPP) and Secondary Project (BSP) offers consultation to school based
professionals in relation to children/young people causing concern. The aim of the
consultation is to provide early identification and brief intervention to children and young
people in relation to mental health needs, and to provide information, advice and support to
school based professionals.
This is a Tier 2 service which offers up to six appointments with the young person. Those
children, who have more significant difficulties which will require more sustained input,
should be referred to clinic based services. Examples of difficulties appropriate for referral to
BPP/BSP are given below. In all cases, consultation with allocated Primary Mental Health
Worker will help to identify the level of severity i.e appropriateness for Barnet Primary
/Secondary service or a need for referral to the specialist CAMHS .

concerns about a pupil showing early signs of anxiety and depression for over 2 weeks in
one or more than one setting eg. Fluctuations in behaviour and affect, consistently low in
mood, socially isolated, irritable, Barnet Primary and Secondary Project (Tier 2) can provide
Chairman:
Chief Executive:
Michael Fox
Maria Kane
6
consultations to school staff and parents on these cases aiming to monitor suggested
school and home based interventions. In addition upto 6 sessions of individual work may be
offered . Should concerns become more urgent at any point we would assist in making a
referral to Tier 3 CAMHS.

concerns about
pupils whose symptoms (eg. emotionally withdrawn, tearful, outbursts,
difficulties in managing worries or anxiety, change in appetite and weight, unable to sleep,
lacking in motivation in activities ) are impacting on a child’s functioning . Barnet Primary
and Secondary Project (Tier 2) can provide an initial consultation to assess the most
appropriate support. Following this it may be deemed appropriate for workers to provide
additional assessment and consultation to school staff and parents aiming to monitor
suggested school and home based interventions, and advise that a direct referral to be
made to either Barnet Primary and Secondary Project or Tier 3 CAMHS.

Relationship difficulties affecting the child’s emotional well-being and or social development
e.g. on going difficulty making or sustaining friendships, or coping with the effects of
bullying. – with the requirement that usual school supports have been put in place in the
first instance

Barnet Primary project supports young people having difficulties adjusting to the
transition to Secondary school. Young people already known to the Barnet Primary
Project who are vulnerable to experiencing difficulties with adjustment to Secondary
school transition due to mental health issues will continue to be supported by the
service for a time limited period within the Secondary school project.

Young people with emerging school attendance issues due to mental health concerns

Where there are family issues which are affecting the child’s ability to function at school
and/or at home e.g. effects of family break-up, consider consultation with BPP/BSP who
may provide consultations with school and discuss further with the team to decide whether it
may be appropriate to offer some initial sessions with the young person or parents. Cases
where there are on going legal proceedings will not be considered as appropriate for the
service. After consultation it may be thought more appropriate for the parents to consult with
Relate or Mediation e.g. offered by the Institute of Family Therapy .

If a pupil presents with behavioural problems e.g. low level behaviours such as tantrums,
attention seeking behaviours, or other non age appropriate behaviours, Barnet Primary and
Chairman:
Chief Executive:
Michael Fox
Maria Kane
7
Secondary Project (Tier 2) can provide an initial consultation to assess the most appropriate
support. If deemed necessary, telephone consultations to school staff a on these cases can
be provided over a period of 6 weeks aiming to monitor suggested school and home based
interventions. Following the 6 weeks if concerns still exist, we may offer up to a six session
intervention at school.
Please note an intensive model is now available for primary and secondary and specialist
schools to purchase under the Trust Business Plan – providing increased time input and a
range of models of working. Contact Breda O’Neill, Manager of Barnet Primary and
Secondary Project to discuss this further on 07855406123 or email :
Breda.O’Neill@barnet.gov
Problems not suitable for CAMHS referral but may be helped by other services
Family difficulties in the context of separation and divorce with no associated mental health
concerns

Children and young people may present with emotional and behavioural difficulties in
response to family stress – e.g. parental discord, divorce or separation, life adjustment
difficulties and parenting problems with no associated mental illness. Such referrals are not
appropriate for specialist mental health services, and referral to other agencies – e.g. Barnet
Parenting Groups, Mediation Services (such as that provided by The Institute of Family
Therapy) or Relate, should be considered. Parents may engage a solicitor who may seek a
legal resolution. It is usually inappropriate for CAMHS to get involved in cases where there
are ongoing contested legal proceedings as this makes it difficult to build therapeutic
relationships, and prevents us working with family members together. Reports for court
should be commissioned from professionals who work on a private basis. Once the legal
dispute is resolved then children displaying persistent emotional or behavioural problems
may be referred to CAMHS.
Some useful websites to direct families to are given below:
www.bbc.co.uk/relationships/couples/heartaches_divorce.shtml
www.practicalparent.org
www.youngminds.org.uk/divorce
http://www.instituteoffamilytherapy.org.uk/
Chairman:
Chief Executive:
Michael Fox
Maria Kane
8
Response to bereavement

CAMHS are unable to accept referrals for children/young people affected by bereavement
as more appropriate support can be offered by other agencies - e.g. Grief Encounter or
Winston’s Wish. Consider referral to CAMHS when the child/young person is experiencing
significant distress following a death that has occurred in traumatic circumstances (e.g.
suicide).

Barnet Primary and Secondary schools Project can offer consultation to Teachers and
parents where appropriate in relation to families and children/ young people in school who
have experienced a loss, and who may need support around processing their grief. In
addition the service is part of the support package provided to schools in the event of a
bereavement occurring within a school or community, and works closely with Educational
Psychology service to support children, families and staff in these circumstances.
Grief Encounter www.griefencounter.org.uk
Grief Encounter offers a flexible and accessible bereavement service which aims to professionally
care and respond to the needs of each service user. They aim to support every family with an
individual approach. Support is varied and can take the form of anything from a family Fun Day to a
one-on-one meeting. Their support can also extend to other family members, school and friends.
They run Residential Camps and have a Helpline which offers advice and support.
Winston's wish www.winstonswish.org.uk
email: info@winstonswish.org.uk
Winston's Wish is a charity that helps children deal with bereavement. There are sections on
helping children with the grieving process, including online activities and a 'skymap' of memories
where they can remember their loved ones. The helpline helps parents and children with the
process of loss.
3. Certain types of behaviour problems: If school staff are concerned about a child’s
behaviour in school, the SENCO should consider referring to other agencies prior to referral to
CAMHS, e.g an attempt should have been made to resolve the difficulties with the help of
universal or targeted services such as: community parenting groups or Family Focus teams if
appropriate . If the problem relates to school attendance, referrals should be made to the
Chairman:
Chief Executive:
Michael Fox
Maria Kane
9
Targeted Youth Support Service in the first instance. If there are associated learning difficulties,
then they can consult their Educational Psychologist. Please see section above on referrals
suitable for Primary and Secondary Project – Tier 2
A good source of information about services in Barnet for children, young people and their families
is
http://www.barnet.gov.uk/chypf.htm
If a child’s parents seek assistance with their parenting then refer them to the Parent Groups run by
Barnet . Parent support programs, groups and workshops cover all child age groups from birth to 18
years.

http://www.barnet.gov.uk/info/930035/parental_support_courses/561/parental_support_courses
(please access website for up to date information)
Other useful sites for further information:
Parentline Plus www.parentlineplus.org.uk
Tel: 0808 800 2222
A charity offering support and advice to anyone parenting a child. Information is given generally or
for specific ages. There are 'hot topics' and news articles in addition to tools for handling difficult
situations and online and telephone support services.
YoungMinds www.youngminds.org.uk
102-108 Clerkenwell Road
London EC1M 5SA
Tel: 020 7336 8445
YoungMinds is a national charity that promotes the mental health of children and young people.
Resources available include on-line leaflets, resource sheets, Young Minds publications, including
details of the contents of the Young Minds magazine and links to other relevant Internet sites.
If in doubt about the suitability or timing of a referral to CAMHS please ring our Access Coordinator on 020 8732 6619.
Chairman:
Chief Executive:
Michael Fox
Maria Kane
10
Access Team, Barnet Child and Adolescent Mental Health Services
(updated September 2012)
Chairman:
Chief Executive:
Michael Fox
Maria Kane
11