Being told your child needs a CAMHS referral rarely comes with a clear explanation of what happens next. The letter goes off, and then weeks or months pass before you hear whether the referral has even been accepted, let alone whether an appointment is on the way. For a family watching a child struggle, the silence feels like indifference.
Knowing how CAMHS actually works – how it's funded, where the thresholds sit, what makes a referral move faster – doesn't fix an underfunded system. But it makes the wait considerably less opaque, and it gives you levers you can pull while you wait.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers child mental health services and support.
For a comprehensive overview, see our complete guide to child health.
What CAMHS Is and What It Does
CAMHS (also called CYPMHS – Children and Young People's Mental Health Services) is the NHS specialist mental health service for under-18s, with some areas extending to 25 for young people with ongoing needs. It assesses and treats anxiety, depression, eating disorders, OCD, PTSD, psychosis, ADHD and autism, self-harm, and the rest of the clinical range.
The service runs in tiers. Tier 1 is non-specialist support from GPs, health visitors, school nurses, and teachers. Tier 2 is CAMHS-trained practitioners working in community settings. Tier 3 is the specialist community team – this is what most families mean when they say "CAMHS." Tier 4 is inpatient.
CAMHS isn't the only route. School counsellors, school mental health support teams (where the Trailblazer programme operates), Place2Be, YoungMinds Partners in Change, and GP-based counselling all matter, depending on what your child needs. CAMHS is the right route when the presentation needs specialist assessment or intensive treatment – not for everything.
The Referral Process
GPs make most referrals. School SENCOs and pastoral leads, paediatricians, and other health professionals can also refer. A handful of areas accept self-referral.
The referral letter does heavy lifting. A strong one names the specific symptoms and behaviours – not "low mood" but "stops eating breakfast on school days, has missed 12 days this term, told her father she wishes she didn't exist." It says how long this has been going on, what it's stopping the child from doing (school, friendships, sleep, eating), what's already been tried, whether there are safeguarding concerns, and how urgent the clinician thinks it is.
You can contribute directly. Write your own account – specific incidents, patterns at home, the timeline of when things changed, what's affecting family life – and ask the referrer to attach it. A parent's written account of a child's deterioration often carries information the referrer simply doesn't have.
Thresholds and Triage
After the referral arrives, CAMHS triages. Not every referral is accepted. The service is meant to take moderate-to-severe presentations; milder ones get redirected or discharged with brief advice.
In practice, thresholds have risen as waiting lists have grown. Children who would have been seen ten years ago are now told they don't meet the bar. That's a system pressure problem rather than a clinical one, but it lands on families the same way.
If a referral is rejected and you don't think the severity came across, ask the referrer to revise and resubmit. The thing that often shifts the decision is functional impairment described concretely: what your child can no longer do because of their difficulties. "Hasn't been to school in three weeks" lands differently from "school refusal."
Waiting Times
Waiting times in England remain a persistent problem. NHS Digital data has shown median waits of 18-24 weeks in many areas between referral and first assessment, with some areas considerably longer. The four-week target is rarely met.
You should be told what to do if things worsen while you wait. If your child deteriorates – self-harm escalating, suicidal intent, or a sharp drop in functioning – the route is not to wait for the CAMHS appointment. Contact the GP urgently, call NHS 111, or go to A&E if there's immediate risk. A child arriving at A&E in mental health crisis should be seen by the mental health liaison team.
Useful resources during the wait: YoungMinds Parents Helpline (0808 802 5544), Kooth (online mental health platform for young people, no referral needed), Place2Be (school-based counselling), and Childline (0800 1111).
At the First Appointment
The first appointment is an assessment, not a treatment session. The clinician meets the child and parents – sometimes together, sometimes separately – takes a full developmental and psychiatric history, and starts forming a picture of what's going on.
Assessment may run over more than one session. The clinician might be a psychologist, psychiatrist, specialist nurse, or social worker, depending on the team and the presentation.
By the end, you should leave with a formulation (their understanding of what's happening), a provisional diagnosis if one applies, and a plan. The plan might be further assessment, allocation to a specific pathway (eating disorders, neurodevelopmental, etc.), individual or group therapy, parental guidance, or medication.
What to Do If CAMHS Is Not Sufficient
CAMHS capacity varies wildly by area, and accepted children sometimes still don't get enough. Other options:
Private psychology or psychiatry: expensive, but no waiting list. The BABCP (British Association for Behavioural and Cognitive Psychotherapies) directory lists therapists who work with children.
Voluntary sector: Place2Be (counselling in schools), Kooth (online counselling for ages 11+), Mind, Samaritans, and condition-specific charities – Beat for eating disorders, OCD-UK, ADHD UK.
NICE guidelines set out what treatment is recommended for each condition. If you're being offered something different, you can ask the clinician why – there may be a good reason, and there may not.
Key Takeaways
Child and Adolescent Mental Health Services (CAMHS) provide specialist mental health assessment and treatment for children and young people in the UK. Referral is typically via GP, school, or other professional. CAMHS has been under significant pressure: waiting times are long in most areas, and children who are referred are not always accepted onto the waiting list. Understanding how the referral pathway works, what information helps, and what to do while waiting makes the process less opaque for families. For urgent presentations, there are more direct routes to emergency assessment.
