Website of the Department of Health

2.1 The importance of psychological well-being in children and young people, for their healthy emotional, social, physical, cognitive and educational development, is well-recognised. There is now increasing evidence of the effectiveness of interventions to improve children's and young people's resilience, promote mental health and treat mental health problems and disorders, including children and young people with severe disorders who may need admission.

2.2 Ten per cent of five to fifteen year olds have a diagnosable mental health disorder. This suggests that around 1.1 million children and young people under eighteen would benefit from specialist services. There are up to 45,000 young people with a severe mental health disorder. Around forty per cent of children with a mental health disorder are not currently receiving any specialist service.

2.3 Similar numbers of children and young people with less serious mental health problems will need some help. In most cases, this will be provided by services in primary health care, social care, education (including early years) and the voluntary sector.

2.4 In a minority of cases, the nature and severity of the mental disorder may lead to a period of in-patient care. For some of these, where there is a significant risk of harm to the child or to others it may also be necessary to provide treatment under the Mental Health Act 1983. There are some circumstances in which parents and practitioners, faced with difficult treatment decisions, are reassured by the clear legal authority provided by the Act, which also provides safeguards for the child's rights. Under the Government's reform of the legislation, it is proposed to introduce new and improved safeguards for children and young people.

2.5 Mental health problems in children are associated with educational failure, family disruption, disability, offending and antisocial behaviour, placing demands on social services, schools and the youth justice system. Untreated mental health problems create distress not only in the children and young people, but also for their families and carers, continuing into adult life and affecting the next generation.

2.6 It is important to recognise that supporting children and young people with mental health problems is not just the responsibility of specialist CAMHS. In many cases, the intervention that makes a difference will come from another service. For example, a child presenting with behavioural problems may make better progress if his/her literacy problems are also addressed, in which case an input is required from education. The lack of provision in one service may impact on the ability of other services to be effective. Partnership working is an essential requirement of high quality service provision.

2.7 Some children in special circumstances have greater needs regarding their mental health. Looked after children are five times more likely than their peers to have a mental health disorder. Children and young people with significant learning disabilities are three to four times more likely to have a mental disorder and at least forty per cent of young offenders have been found to have a diagnosable mental health disorder.

2.8 Improvement, Expansion and Reform (1), which set out the Priorities for the 2003-06 planning round, set the expectation that comprehensive mental health services for children and young people would be available in all areas by 2006 (the requirements for a 'Comprehensive CAMHS' are outlined in Appendix 2). This should include early intervention and mental health promotion. It also states that CAMHS is to be increased by at least 10% each year across the service according to agreed local priorities (demonstrated by increased staffing, patient contacts and/or investment).

2.9 National Standards, Local Action (2), which sets out the priorities for 2005/06- 2007/08 for the NHS, emphasises the need to improve outcomes for individuals and maintain the levels of service achieved through the 2003-06 planning round. Performance against existing commitments which extend beyond April 2005 will feed into the Healthcare Commission's performance rating of NHS bodies, including NHS Foundation Trusts.

2.10 This standard highlights the need to improve service provision at all levels from universal services, promoting mental health and providing early interventions, to highly specialised services. The familiar terminology of four tiers of provision that has guided the commissioning and planning of services over recent years still stands; this is outlined in Box 1 and described in detail in Appendix 1.

2.11 Services for children and young people should be provided irrespective of their gender, race, religion, ability, culture or sexuality. This standard emphasises the importance of improving access to CAMHS to ensure greater equity is achieved. These developments can only occur if specialised CAMHS provision is strengthened in terms of capacity and skills and through planned commissioning processes which are undertaken in partnership with service providers.