How can schools know when to make a CAMHS referral?

There are certain kinds of distress that can be managed by a school before a child is referred to a mental health service, explains Peter Fuggle

Distress is not the same as having a mental health issue, but most mental health issues are highly associated with distress. This means it can be hard to tell whether a child is experiencing the normal ups and downs of life, or the beginnings of a longer-term problem. So what should teachers do if they are worried about a child?

The first step is to have a brief conversation to ask how a child is, without too much intrusion. Be clear they haven’t done anything wrong, but that you are concerned about them.

Sometimes a child may say they are feeling bad because their cat has died or their mum’s gone to hospital, but children are not always forthcoming at first enquiry. The important thing is for the child to know you are concerned about them in a non-critical way.

READ MORE: Schools need more mental health support

If your concerns continue, you should check in again and gently probe a little further using particular adjectives. Are they feeling sad, or frightened or stressed? If this produces a nod then does the child have any idea why? If they can recall a recent event, perhaps it is about this rather than a longer-term difficulty.

Many children find it hard to say why they are feeling the way that they are.

Sometimes changes in mood may be due to major life events such as the loss of a grandparent, arguments between parents at home, threats of domestic violence or other very serious matters. But more commonly mood changes are linked to events such as peer relationships or feeling isolated, rejected or being bullied. Finding out the root problem makes a huge difference to finding the best way to help a child.

If you are still concerned after this second conversation, the next step is talking to the child’s parents or carers. Generally this should be done with the child’s knowledge and agreement, although there may be times when a child is reluctant to allow a parent to become involved. This may be a sign for further concern.

For many children, being taken seriously is one of the most important things. Young people are often looking for kindness from adults, and this may be the most important way you can help a child, rather than feel you have to do something more “therapeutic”.

For many children, being taken seriously is one of the most important things

It’s also wise to see whether the difficulty persists. This means checking in with the child perhaps once a week to enquire about their feelings. These conversations don’t have to take long: if the problem continues for about four weeks, it may be time to have a face-to-face with the child and their parent or carer.

It’s important to emphasise that the purpose of the call is not bad behaviour, but concern for the child’s wellbeing. At this point it is useful to consider what the parents’ view would be about getting additional help for their child, as well as any ideas that they might have about what might help. This could include things like supporting a child to rejoin a football team, for example.

At the meeting, draw up a joint plan with parents and review it in a about a month’s time. If there has been no improvement at this point, it may be time to investigate a referral to a specialist mental health service.

This kind of general approach is appropriate for many mild to moderate levels of distress, but would not be appropriate for extremely severe problems such as suicidal feelings, or indications of potential abuse or maltreatment, which require immediate action.

In the situations discussed here, the focus is on enabling the child to experience adults as behaving in a trustful way when they are in a state of distress, and this may be extremely important if more long-term and specialist forms of help become needed.

Peter Fuggle is director of clinical and service improvement at the Anna Freud National Centre for Children and Families

Read more on this theme:

Schools’ designated mental health leads will need support

Mental health support IS available for schools – we’re just really bad at telling them about it

Schools need more mental health support

Your thoughts

Leave a Reply

Your email address will not be published. Required fields are marked *