Best Practice

Mental health: What to do while waiting for CAMHS

Pupil wellbeing Mental health Pastoral issues Behaviour Safeguarding SEMH
It’s a familiar scenario – a student needs specialist mental health support but the CAMHS waiting list is long and thresholds are high. Frances Akinde looks at what schools can do to support young people who face a long wait to access CAMHS
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With the reduction of support from Child and Adolescent Mental Health Services (CAMHS) due to increasingly complex needs and a lack of specialist professionals to meet demand, schools are increasingly being asked to offer more and more support for young people who are experiencing emotional distress and mental health difficulties. 

So, what do we do when we need to support our students but can’t access support from CAMHS? 

 

What is CAMHS? 

CAMHS is the healthcare service that supports and treats children and young people up until the age of 18 who are experiencing emotional distress and more severe mental health challenges.

Across the UK, each area has its own policy and strategy underpinning child and adolescent mental health. CAMHS are also configured slightly differently depending on where you are, but all contain essentially the same mix of preventive, early intervention, and specialist services. Most services are provided in outpatient and community settings. 

They deal with a wide range of emotional, behavioural, and psychiatric problems, including things such as eating disorders, autism, ADHD, depression and anxiety, post-traumatic stress, and early developmental trauma, psychosis, and those at risk of suicide. CAMHS can also support children and young people with physical health problems that impact on their wellbeing and those with learning difficulties. 

CAMHS teams can include psychiatrists, psychologists, social workers, nurses, and other mental health professionals. They can provide services including assessments, therapy, medication, and support for families and carers which is based on a tier system: 

  • Tier 1: Universal mental health services provided by professionals who do not specialise in mental health, such as school staff.
  • Tier 2: Mental health services provided by professionals with mental health specialisms, such as counsellors.
  • Tier 3: Specialist CAMHS.
  • Tier 4: Inpatient and highly specialised services.

 

A mental health crisis

Although CAMHS undoubtedly offers invaluable support, there is a growing number of children and young people who don’t meet the threshold.

Research published in 2020 found that 26% of referrals were rejected in 2018/19 – approximately 133,000 children and young people – and that rejection rates had not improved over the previous four years. Furthermore, children still waited an average of 56 days to begin treatment in 2019 (Crenna-Jennings & Hutchinson, 2020). 

In my experience, post-diagnosis support, which used to be routinely offered to young people typically after a diagnosis of ADHD or autism, is now being withdrawn due to lack of clinicians, placing the onus on schools and other support services to offer wraparound support. 

There are multiple reasons for this, including increasing rates of mental ill-health, increasingly complex needs, austerity, and funding cuts (BMA, 2020), and a shortage of specialists in some areas (CQC, 2022). 

NHS research published last year warns us that 18% of seven to 16-year-olds have a probable mental health disorder, with this figure rising to 25.7% of 17 to 19-year-olds – one in four. These figures have risen notably in the last five years (Newlove-Delgado et al, 2022). 

As much as it should not be the case, this perfect storm means it is falling onto the shoulders of schools and families to support a child while waiting for professional help. 

 

Identifying the warning signs

We often talk about a change in behaviour – such as irritation, withdrawal from activities, disruption, agitation – as a sign of problems emerging, although this is not always apparent. Equally, a student may mask their difficulties when they are at school to avoid drawing attention to themselves.

It is common that you are likely to see a gradual change in mood such as increased anxiety, frustration, a lack of interest in activities that they once enjoyed and a change in their usual demeanour. It is important that this is not dismissed, and that contact is made with key people around the student so that a full picture can be drawn. 

You may also see a change in academic performance such as a lack of motivation to complete tasks, or indeed the opposite – a perfectionist approach to work which results in them spending extended amounts of time trying to meet impossibly high standards. 

Younger children are less likely to be able to hide physical symptoms (such as headache, fatigue, or stomach aches) but they may not be able to articulate the cause of these. 

You may see a change in friendship groups or increased isolation and withdrawal from their peers. 

Self-harm and substance misuse may not always be easy to spot, as some students will go to great lengths to hide this. Watch out for increased absence or lateness in the first instance and a general sense of confusion and lack of concentration. 

In all cases, it is important that these things are communicated to key adults and support provided, even if the symptoms seem minor. 

 

Steps you can take to support 

Below I set out some approaches that can help to support young people while they await a CAMHS assessment or further intervention. See the end of the article for links to the resources cited. 

 

Culture: Promote positive mental health throughout your school for students and staff by sharing resources and encouraging students to talk about their mental health (and giving them the opportunity to do so). One great resource is the Gloucestershire Healthy Living and Learning’s Five Ways to Wellbeing. You can also check out Dr Pooky Knightsmith’s 2022 SecEd article, How to create a whole-school culture of mental health. Indeed Dr Knightsmith’s archive of articles for SecEd offer a range of useful insights (see resources).

Trauma-informed practice: As part of your school culture, take a trauma-informed approach and ensure that students who are experiencing mental health challenges have a trusted adult to talk to. See the work of Trauma Informed Schools UK. 

Internal referrals: Have a referral pathway within school specifically for students who are identified as struggling with their mental health. Does this ensure that immediate support is always given? What does this support look like? What is the follow up to this? Is it as robust as it needs to be? 

Support and resources: As a school you should have an up-to-date list of resources and organisations to which you can signpost students and their families. This can include charities such as YoungMinds, Anxiety UK, Mind, and Childline which all have a wealth of resources and support to offer. The Department for Education’s 2021 guidance document Promoting and supporting mental health and wellbeing in schools and colleges also includes a list of mental health and wellbeing resources. 

Check-ins: Ensure that you offer regular check-ins with trusted adults to ensure that the child is being monitored. This might necessitate a check-in when they arrive at school, during the day, and/or a phone call after school hours.

Assessments: Carry out assessments of educational needs led by your SENCO to ensure that any barriers to learning are identified and addressed. Complete a risk assessment to assess the risk of harm to the child or young person themselves, or others. 

Profiles: Ensure your students have profiles so that an overview of triggers can be identified, and the minor concerns of staff can be recorded to help build up an overall picture. Be mindful of whether you need to share all information with staff and who the key adults should be. Make sure all actions are outlined in a plan of support. For a good example of what this might look like see the Student Support File advice from the National Council for Special Education in Ireland. 

In-school professionals: You may be fortunate to have trained mental health first aiders and counsellors as part of your school team. If not, it would be beneficial to ensure that all pastoral staff (including form tutors) are trained mental health first aiders as a first step. Get information from Mental Health First Aid England. 

Support for staff: There is a range of training and support out there for school staff, not least the Classroom Wellbeing Toolkit published recently by the Anna Freud Centre and Early Intervention Foundation. The toolkit helps secondary school staff take steps to improve students’ mental health and wellbeing through everyday practices. The co-author of that toolkit, Jean Gross, wrote recently for SecEd on some of the advice in that resource. 

Senior mental health lead training: A grant of £1,200 for eligible state-funded schools and colleges in England is being offered by the DfE to train a senior mental health lead to develop and implement a whole-school or college approach to mental health and wellbeing. This training is not compulsory, but it is part of a government commitment to offer this training to all eligible schools and colleges by 2025 (see DfE, 2021). 

Policies and procedures: Check your school’s policies and procedures for highlighting concerns around a child’s mental health and seek guidance and support from others. Even if you think that some signs are not indicative of mental health support needs, they may warrant further investigation (for support, see Hurry et al, 2021).

Quiet spaces: Are there calm spaces within your school? If so, where are these and are they always readable available? Of course, all places of learning should be safe places – students need to feel safe and supported to thrive.

Behaviour: As discussed, poor behaviour might be communication of unmet needs or emerging issues. Do all staff consider the causes of poor behaviour? Do you have a reflection policy where students can be offered restorative conversations as an alternative to exclusions? Check-out the Youth Endowment Fund’s research review of interventions to prevent school exclusion and suspension (see further information).

Celebration: Do you allow time for students to talk about their interests within class or tutor time? Do you share the achievements of your students and provide opportunities for students to talk about their lives and share positive news?

Specialist mental health screeners: There are several open access screeners that schools can use to identify whether a student may need additional support. These will be helpful when making a referral and can also provide a baseline against which progress can be measured. These include:

  • The Strengths and Difficulties Questionnaire: A brief emotional and behavioural screening questionnaire. Click here.
  • The Revised Children's Anxiety and Depression Scale, which assesses the frequency of anxiety and depression symptoms in youth aged eight to Click here.
  • Adolescent Psychotic-Like Symptom Screener, designed to assess a variety of psychotic symptoms. Click here.

 

Talking to students 

We must ensure that regular conversations are taking place about mental health and wellness across your school. When carrying out the screening activities above or indeed when talking to troubled young people, consider the following approaches: 

  • Never rush – don’t make the student feel like they are taking up your time.
  • Start the conversation with a positive statement such as "I noticed that you don’t seem yourself lately. I just wanted to check-in and see if everything is okay."
  • Use open-ended questions to encourage students to share their thoughts and feelings: "How have you been feeling lately?" "What's been on your mind?" “I wonder if…”
  • Listen without judge Repeat what they’ve said: “What I’ve heard, correct me if I’ve got that wrong…” and listen actively. Try not to make a judgement or assumptions about what they have shared. This is particularly important if a student reveals that they are engaging in risky behaviour such as substance misuse. It is particularly challenging to hide our own emotions when dealing with a student describing their self-harming behaviours or things they have done to others.

 

Final thoughts 

It is important to be mindful of what support you may be asked to offer while waiting for CAMHS intervention. Ensure that the support you are putting in place does not cross over into Tier 2 support as this may lead to a referral being rejected. 

And lastly but by no means least, look after yourself. Be mindful of your own experiences, needs and mental health and ensure that you are getting training, support and ideally supervision. 

Frances Akinde is a SEND advisor, art advocate and neurodiversity champion. She is a former secondary special headteacher. Read her previous articles and find her on the SecEd Podcast via www.sec-ed.co.uk/authors/frances-akinde

 

Resources 

Further information & references 

  • British Medical Association (BMA): Beyond parity of esteem: Achieving parity of resource, access and outcome for mental health in England, 2020: https://bit.ly/3JfTEt0
  • Care Quality Commission (CQC): Monitoring the Mental Health Act in 2021 to 2022, 2022: https://bit.ly/42In6P7
  • Crenna-Jennings & Hutchinson: Access to child and adolescent mental health services in 2019, EPI, 2020: https://bit.ly/3NwlbIX
  • Hurry et al: The role of schools in the mental health of children & young people, BERA, 2021: https://bit.ly/3JdfrkI
  • Newlove-Delgado et al: Mental health of children and young people in England 2022, NHS Digital, 2022: http://bit.ly/3AX0zTC