Q&A with Prof Cathy Richards from CAMHS

CAMHS Professional Advisor Prof Cathy Richards answers questions all about Children and Adolescent Mental Health Services. In the interview Cathy shares what CAMHS is, the process of being referred and what happens once you receive an appointment. 

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What is mental health?

Mental health is about how we're doing. It is made up of how we interact with people, our friendships, our relationships with our families, how we are managing things like schoolwork, college and how we're feeling in ourselves. Mental Health affects how we think, feel and act. So when we are mentally healthy and things happen to us that are a bit challenging, we feel like we know that we've got stuff that we can do that will help. There are people that we can go to that will help and support us. But it's something that can change and so we might be doing pretty well in terms of our mental health. But that doesn't mean that there won't be days or weeks that still feel much more of a challenge. It can describe a point in time, I feel 10 out of 10 today or it can describe a time period. And for most of us if even if we feel that our mental health is pretty good, we're still likely to have some ups and downs within that.  I think mental health is used interchangeably for mental ill-health, which is quite different.

What is the difference between mental health and mental ill-health?

I think when we're starting to think about mental ill-health and people's mental health not being good, it is when there are difficulties in terms of feeling bad within ourselves, some of the things that we think and say to ourselves might be really negative and critical and a bit without hope of things getting better. We might be having difficulties in our relationships within our family and with our friends and at work or at school. We might also have difficulty concentrating on things like schoolwork and day to day tasks. We'll find that the things we used to enjoy and bring us pleasure, just don't feel as good anymore. So everything just feels a bit rubbish.

What should I do when my mental health is not so good?

That depends on what we mean about not so good. So if we're having a bad month and normally things are okay, then I think there are lots of really good suggestions on sites like AyeFeel and all of the resources and strategies that people are sharing at the moment like what they do to help them to stay well. It's important to take action to  after ourselves and practice doing things that help us feel better. I think the other thing to do is to talk to the people that we are close to and we trust, tell them how we're doing and ask for help and advice, maybe ask someone to help us  in accessing some help if that's what they think we need.

A good coping strategy is to go back to what things that you used to enjoy, and actually planning those in even if in the moment, you don't think you are going to enjoy them. Remember to stay in touch with people, sometimes when we're feeling not so good it's easy to pull back from people that we are close to and that we might normally be able to talk to, have a laugh with or play sport with because we're just not feeling up to it. The problem with that is that can then leave us feeling even worse. So if we can find a way to get in contact and ask for a bit of help, or just turning up to football or band practice or something like that, then actually, those things will help us to feel better over time. In the first instance, it might be a huge effort but it is worth it.

If you are feeling really bad and it's been for more than a few weeks, that's when you might want to start thinking about talking to your GP or talking to people such as your parents / carers who support you or somebody at school to ask for advice about how to do that and what next steps you might want to take.

How can I tell if I (or someone I know) might need help or support?

I think it's a bit about being curious. If we noticed that our behaviours change and the way that we feel has changed, then to wonder what's going on and what we might be able to do to help ourselves. There are lots of things we can do.

As friends, it's noticing and being curious and just asking are you okay or how are you doing? It is okay to say to your friend ‘I just haven't seen you for ages and you just seem a bit different from how you normally are or you're just a bit quiet whereas normally you'd have said stuff. It might just be that you're feeling tired or it might be that things are not so good’.

Sleep is really important. We know it is one of the things that we can do to help ourselves stay well. Our sleep and getting up patterns get harder if we're not feeling so good. Regular mealtimes are also really important .What we see as people's sleep deteriorates, then often their mental health will also deteriorate. And  if somebody is anxious or low, then that has an effect on their sleep so it can become a bit of a negative cycle of things getting worse and worse.

What is CAMHS?

CAMHS stands for Child and Adolescent Mental Health Service. It is the NHS specialist service for children and young people who have moderate to severe mental health difficulties that are affecting their day-to-day living. When things have been difficult over time and getting on with the ordinary stuff in life just becomes impossible and too hard it's a service that is there to offer assessment , treatment and to raise awareness of services in the community that can help. CAMHS is made up of a mix of professions that  include psychologists, psychiatrists, nurses, occupational therapists, dietitians and lots of others. It can help children, young people and families to find out what's going on and to share together an understanding of what the difficulties might be, and to look at what might help in terms of addressing those difficulties. 

What is the age range of CAMHS?

CAMHS in most areas goes up to age 18. In some areas, it only goes up to 16 but most areas are moving up to 18.  

How would I get a referral to CAMHS?

That can vary in different areas. In most areas, if you go to your GP and talk about the difficulties they will help you to think about whether or not CAMHS is the right place for referral and the GP can make the referral. In other areas referrals can come from somebody at school like pupil support or there might be a child / young persons planning meeting where the support plan identifies that a referral to CAMHS would be a good idea. In some areas a referral can also come from somebody that you're working within youth work or in a third sector organisation. In addition referral might come from a mix of other professions like social work or paediatricians . 

Is there an alternative to CAMHS?

The Scottish Government has invested significantly in Community Services to provide this support for children and young people where CAMHS isn't the right service but they still need help and support. Those might be services that are available in school through school counselling, through the community or through  youth work or a specialist third sector organisation. There's also lots of online support which is available and a lot of that is available for free. Another option  some people pursue is private providers . Always check with professional organisations if you're going to a private provider so you know the kind of training and governance the private service  has .

There are lots of alternatives for children, young people and families. These supports really vary from area to area, but every area should have information about what's available. 

How could I access CAMHS through school?

The thing to do would be to talk to your guidance teacher or pupil support teacher about how you're doing and feeling and then think with them about how to access CAMHS/ other support. They would know the way to access your local CAMHS service if that was the appropriate place.

Some areas are developing something they're calling single points of access where lots of agencies who work with children, young people, and families are coming together to coordinate the offers of support available  in that local area. There will be staff at school who know what the local system is and will be able to support and help you to think about that. 

What happens once I am on the waiting list, and what can you do in the meantime?

That varies from place to place. In some places you'll be offered an initial appointment to check that CAMHS is the right service for you and also help you to identify things you can do to help yourself and to help you access community support if there is going to be a wait before specialist assessment or treatment begins. In other areas, you may go straight onto a waiting list. There are lots of things you can do whilst waiting that would help depending on what your difficulties are. Some local CAMHS services will also have web pages with advice. There are lots of different kinds of online and community services. In some areas, those community services and health services are working together to think together about the services that are on offer for children, young people and families. People then don't go from place to place but actually are thought-about together and offered some initial support. 

What happens when I get an appointment?

That will partly depend on why you're going to CAMHS. Usually, if you're going for an assessment appointment you'll meet a clinician from the team who will talk to you about what things are that you're worried about. You'll be asked if you want to come with family or other people that are important to you. You can then talk to the clinician and they will think with you about whether there are things that the service could offer that would meet those goals . They are happy to let you know about other services that might be available in the area that might be more suitable for you. 

If you're coming for a treatment appointment, then that would be to meet with one of the CAMHS clinicians . If you're going because of low mood or anxiety you're likely to  receive talking treatment .

The staff working CAMHS are doing so because they really value working with children, young people and families so they will be keen to meet you. It's usual  to feel nervous before an appointment but the reassurance is that you're going to see people who really want to see you and are really interested to hear what you think about the difficulties that you're experiencing. And if you're feeling really anxious or nervous, then talk to your parents or your friends to get support for that. Ask somebody to  go to the appointment with you, they can either come in with you or they can wait for you while you're having the appointment. Please do get the support you need to get to the appointment.

What happens after I go for an appointment?

Depending on what your treatment goals are you will meet with a clinician who might ask you to fill in some questionnaires so that you can both monitor how things are going to see if things are getting better. They will probably set some treatment goals with you and check in about how you think you're doing with those. And then after a few sessions, they'll review how you're getting on and if you feel like you're making progress. They might think with you about whether they need to add in something else to treatment or whether there's support in the community that would be more likely to help. Usually, there would be weekly or fortnightly meetings with the clinician . After a few appointments usually you will review how things are going and either decide to meet for a couple more sessions and to finish because most of the work is being done, or to plan another four or five and then review again depending on what the difficulty is. It's usually something that is time-limited, and focused on working on the goals that you want to achieve in terms of the treatment. Sometimes as you attend appointments, it might become clear that there are other things that are important to think about as well. Everybody is different so there's not one way of describing exactly what will happen. Across the UK averages in terms of how many appointments young people have with CAMHS is around 7 or 8 but there's huge variation.  

The CAMHS clinician will also speak with you about confidentiality and communicating with your GP, school and others who support you so that the support you receive is as effective as possible.

What happens if I am being seen by CAMHS and I turn 18?

There is information online about transition care planning in terms of guidance for young people about what their rights are, what they should expect and how to prepare for that. So if somebody is in treatment, we would expect that there would be a discussion with them about whether they still have significant mental health problems and further treatment from Adult Mental Health Services is indicated or whether the support they need now can be best access from community services .

If the decision is that Adult Mental Health Services are needed then you will be asked to identify what the treatment goals would be. Then there would be a planned joint meeting with colleagues in the adult services to think about next steps.

If you're on a waiting list and you're 17 and you then turn 18, get in touch with CAMHS to find out what's going to happen and have a discussion with them about whether or not the services that are available for adults would be suitable for you . If you've been seen previously and were discharged from CAMHS, and then later on you want to go and get some more support for mental health services, then the best thing to do  would be to go and talk to your GP and ask them about local services for adults to get referred at that point. 

What if I am feeling anxious or nervous about contacting CAMHS?

It's really ordinary and a usual experience to feel nervous and anxious about it. It's a very personal thing to go and talk to somebody that you don't know about stuff that's been troubling you and feels really upsetting. It's really difficult. If we've got good people in our lives that we can talk to and asking them to support us with getting help is an incredibly sensible thing to do. If we feel like we shouldn't ask them because it's causing them bother then it's always worth thinking, if they were worried about something we would want them to talk to us. The chances are we'd say ‘yes’ so it's always better to ask for help and your friend/ parent can say ‘no’ if they've not got time. The other thing is to find out from other people that have been to mental health services and get advice from them.

Practical things like finding out where the appointment is so you know how to get there can help. You can also go with family or friends to the appointment or they can sit and wait for you. The people working in CAMHS really like working with children and young people. That's what they do and so they will do their very best to listen carefully and put you at ease and are used to young people coming in feeling really anxious and uncomfortable. It will take courage to go and it's a difficult thing to do but really well worth it. 

Find out more

Visit our #AyeFeel page for loads of information and support for mental health and wellbeing.

For more tips on managing stress or anxiety try looking at our page called Tammy's techniques.

You can practice mindfulness with our range of free activities, including yoga and breathing exercises.

If you feel like you or someone you know may need support, look at our page on who to contact for mental health support.

If you are a parent, a carer or a parent-to-be, visit us ParentClub.scot for parenting hints, tips and tricks!