This document provides guidance to
practitioners, managers and commissioners on the capacity and
provision of specialist child and adolescent mental health services
(CAMHS) in England, Ireland, Northern Ireland, Scotland and Wales.
Evidence is collated from a number of sources, including published
and unpublished literature and examples of best practice. During
consultation the document was shared with practitioners,
non-statutory organisations, policy makers and commissioners from
the agencies of health, social care, education and justice across
the five jurisdictions.
The guidance is designed to be a support for service
development that is based on assessment of need. It emphasises that
local factors should be taken into account, including deprivation
indices, the numbers of black and ethnic minority children and
whether the area is rural or urban.
For Tier 2/3 CAMHS, an
epidemiologically-needs-based service for 0-16 year olds requires a
minimum of 20 whole time equivalent (wte) clinicians per 100,000
total population. Teams must have a range of clinical professionals
with cognitive, behavioural, psychodynamic, systemic and medical
psychiatric skills. Team capacity should be set at 40 new referrals
per wte per year. Clinician keyworker caseload should average at 40
cases per wte across the service, varying according to the type of
cases held and the other responsibilities of the clinician.
Specialist CAMHS work with Tier 1 professionals is best provided by
dedicated Primary Mental Health Workers, working as a team and
closely linked to Tier 2/3 CAMHS. Matching demand and capacity is
essential to ensure effective service provision.
Recommendations for the remit and
staffing of Tier 4 services are given, including specialist
community intensive treatment services, day services and in-patient
services. It is recommended that 20 to 40 in-patient CAMHS beds per
1 million total population are required to provide for children and
adolescents up to the age of 18 years with severe mental health
problems and that bed occupancy should be 85% to ensure
availability of emergency beds.
The authors did not find sufficient evidence to enable
recommendations for staffing levels for CAMHS for 16-18 year olds,
but argue that significant extra resources are needed to extend
services to include this age group. There was a paucity of evidence
on infant mental health services and mental health services for
children and adolescents with learning disability, substance misuse
and forensic problems. However, the mental health needs of these
groups must be met and should be provided for by specialist
This document is recommended to anyone who is struggling to
answer the questions, ‘what should specialist CAMHS be doing and
how many people does it need to do it?’