Children and young people who are
experiencing difficulties that could be related to their mental
health are usually first identified within Tier 1 services, for
example by a teacher,
GP
or
health visitor
. Similarly, parents/carers
who identify that their child is experiencing difficulties will
usually first seek help from services at that level. Children and
young people with an identified need may be subsequently referred
into specialist CAMH services (falling within Tiers 2–4) for
assessment and
intervention
if necessary.
In Scotland, CAMH services are generally
delivered through a tiered model of service organisation, as shown
in the diagram below:
The
following
describes in more detail the services provided at each tier of CAMH
service operation.
Tier 1
Child and adolescent mental health
services at Tier 1 are provided by practitioners working in
universal services who are not mental health specialists. This
includes:
- GPs
- health visitors
- school nurses
- teachers
- social workers, and
- youth justice workers and voluntary agencies.
Tier 1 practitioners are able to offer
general advice and
treatment
for less severe problems. They contribute
towards mental health promotion, identify problems early in the
child or young person’s development and refer to more specialist
services.
Tier 2
Mental health practitioners at Tier 2
level tend to be CAMH specialists working in teams in community and
primary care
settings (although many will
also work as part of Tier 3 services). They can include, for
example:
- mental health professionals employed to deliver primary mental
health work, and
- psychologists and counsellors working in GP practices,
paediatric
clinics, schools and youth services.
Tier 2 practitioners offer
consultation
to families and other practitioners.
They identify severe or complex needs requiring more specialist
intervention, assessment (which may lead to treatment at a
different tier), and training to practitioners at Tier 1 level.
Tier 3
Tier 3 services are usually
multidisciplinary teams
or services working
in a community mental health setting or a child and adolescent
psychiatry
outpatient
service, providing a service for children
and young people with more severe, complex and persistent
disorders. Team members are likely to include:
- child and adolescent psychiatrists
- social workers
- clinical psychologists
- community psychiatric nurses
- child psychotherapists
- occupational therapists, and
- art, music and drama therapists.
Tier 4
Tier 4 encompasses essential tertiary
level services such as
intensive community treatment services
,
day units and
inpatient
units. These are generally services for the
small number of children and young people who are deemed to be at
greatest risk (of rapidly declining mental health or serious self
harm) and/or who require a period of intensive input for the
purposes of assessment and/or treatment. Team members will come
from the same professional groups as listed for Tier 3. A
consultant child and adolescent psychiatrist or clinical
psychologist is likely to have the clinical responsibility for
overseeing the assessment, treatment and care for each Tier 4
patient.