Finding the right help, at the right time. Who is best to help?

Mental health and psychological wellbeing problems are by far the biggest health issue for children and young people under the age of 18.  Best evidence suggests that at least one in ten children are likely to have a mental health problem at any given time, and most adult mental health problems start in childhood. 

We also know that getting the right help, at the right time is the most effective way to deal with these conditions.  So it is important to get the child or young person to the right help as early as possible – the best help is getting the child support at the right level depending on the severity of problem they have.

The best intervention is prevention.  If young people get the right support in families, schools and communities, may mental health problems can be averted. 

Unfortunately, some young people, even with good support, go on to develop mental health problems that need more specialist help.


Universal, Targeted and Specialist CAMHS

Prof intro

CAMHS are divided in to three tiers or – each tier is best placed to deal with different levels of severity of mental health problem.  These tiers can be represented as a pyramid (see figure ?? above)  - at the lowest tier - called Tier 1, or Universal CAMHS – are professionals who are best places to deal with the largest number of children and young people who experience low levels of emotional distress – professionals such as school teachers, GPs, Social Workers, school nurses. 

This is the largest part of CAMHS and deals with the biggest numbers of children.  This tier deals best with issues such as distressing but normal reactions to difficult life events: bereavement, parental separation, and other big life changes, behavioural problems, distress caused by friendships issues, and other general day-to-day upsets. Universal services are provided by professionals who have some knowledge and some training in dealing with psychological distress and low level mental health problems.  For most children, support at this level along good with family support, is the best intervention. 

The second tier – Tier 2 or Targeted Services, are for children and young people who experience mild to moderate mental health issues, that cannot be dealt with by Universal Services, either because the problems are so severe or because they go on for a long period of time. 

These might be children who have mild to moderate anxiety (simple phobias, OCD that is too disabling, depression and low mood (without strong suicidal thoughts), some eating disorders, and moderate behavioural problems, psychological distress around sexuality.

Targeted Services are provided by professionals who have specific training working with children and young people with mental health problems.  In Hertfordshire the bulk of services at this level are provided by services which are called Step2, and the school counselling service.

If children and young people have moderate to severe mental health problems, such as severe depression, anxiety disorders that are life severely restricting (e.g. OCD that is preventing a child getting to school), acute eating disorders  - anorexia, severe self-harm, suicidal thoughts, concerns about hearing voices or seeing frightening things that others cannot see – this is where Specialist CAMHS is the likely best help. 

Specialist CAMHS is made up of highly trained professionals with specific training dealing with moderate to severe mental health problems in children and young people.


Is it a mental health problem?Mental health problems in children can be difficult to spot for a number of reasons; sometimes children hide their problems because they are afraid of the symptoms and/or afraid of the stigma of mental ill-health. Also, some professionals do not feel confident to talk to young people about what might be a mental health problem.  (For further information and training on mental health issues in children please visit the MindEd e-learning website)

To get the right help at the right time for a young person, where possible, it is important to understand what is behind the psychological distress they might be showing to decide who might be best to help.

For example if a young person is distressed because they are struggling in school  - it is helpful to consider if the school is the best place to help first – could the problem be a due to an undiagnosed Learning Disability? Would the Special Educational Needs (SEN) or Educational Psychology services be the best place to help? Or is this a drug and alcohol issue? Would A-DASH be the best service to help? Or is the problem due to some very difficult family issues – is there a safeguarding issue?  Children’s Services might be the best place to help.


Other related problems and who can help:

Concerns about developmental or neurological problems such as: tics, learning disabilities, development delay, dyspraxia, autistic spectrum disorders (ASD) – contact the Community Paediatric Service.

East Herts :

Community Paediatric Department, Tewin Child Development Centre, QEII Hospital, Howlands, Welwyn Garden City, Herts, AL7 4HQ 

North Herts:

Community Paediatricians, Child Development Centre Danestrete,  Stevenage.  SG1 1HB

South Herts:

For those living in Potters Bar: Community Paediatricians, St Albans Children’s Centre, Church Crescent, St Albans AL3 5JB. Tel: 01727 891100 

For those living in Borehamwood, Elstree, Shenley, Radlett, Watford areas: Community Paediatricians, Peace Children’s Centre, Peace Prospect, Watford WD17 3EW.  Tel: 01923 470600 

West Herts: 

Hemel: Community Paediatricians, Pat Lewis Child Development Centre, Heath Lane, Hemel Hempstead, Herts HP1 1TT.  Tel: 01442 230893  Fax: 01442 219177

St. Albans: Community Paediatricians, Child Development Centre, Children’s Centre, Church Crescent, St. Albans, Herts AL3 5JB  Tel: 01727 891100 Fax: 01727 891102 

Note Paediatrics do not accept referrals of children over 16 years old

Concerns about the safety of a child – concerns that the distress may be due to neglect or abuse – contact Children’s Services.

If the problem is largely school related – liaise with the school to consider appropriate school based support which may include completing Common Assessment Framework