A Guide to CAMHS:
What It Is, How It Works, and What to Do When It Doesn't

CAMHS (Child and Adolescent Mental Health Services) is one of those terms you hear constantly in SEN spaces, and it can feel opaque — not least because the service itself varies enormously depending on where you live. Some families are told their child needs CAMHS and then wait eighteen months. Some are told their child doesn't qualify. Some get seen quickly and find it genuinely helpful. And some discover, after a long wait, that CAMHS isn't the right service for what their child actually needs.

This guide is not about whether CAMHS is good or bad. It's about understanding what you are dealing with — what the service is, who it's for, how the referral pathway works, what to expect at appointments, and what your options are if the system doesn't deliver what your child needs.

What CAMHS is and is not

CAMHS stands for Child and Adolescent Mental Health Services. It is the NHS provision for children and young people under 18 who are experiencing significant mental health difficulties. It covers presentations including anxiety, depression, self-harm, eating disorders, obsessive-compulsive disorder (OCD), post-traumatic stress, psychosis, and mental health conditions that co-occur with neurodevelopmental conditions like autism and ADHD.

What CAMHS is not, in most areas, is an autism or ADHD diagnostic service. Those assessments usually go through a separate neurodevelopmental pathway — either through CAMHS in areas that have integrated this, or through a separate community paediatrics or assessment service. If you are seeking a diagnosis, your GP will know which route applies in your area. See our guides on getting an autism assessment and getting an ADHD assessment for more on those pathways.

CAMHS also does not typically provide occupational therapy, speech and language therapy, or educational support — those have their own separate referral routes, usually via community paediatrics, school, or your child's EHCP or SEN Support plan.

The tier system

CAMHS is formally organised into four tiers, though the names and structures vary by NHS Integrated Care Board (ICB) area. When parents say "we've been referred to CAMHS," they almost always mean Tier 3.

In practice, the boundaries between tiers are not always clean, and different areas organise things differently. Some areas have renamed their services entirely. If you are unsure what tier you are being referred to, ask the referrer explicitly.

How referral works

In most areas, referrals to specialist CAMHS (Tier 3) come from professionals — GPs, paediatricians, school SENCOs, educational psychologists, and social workers. You cannot usually self-refer directly to Tier 3 CAMHS. The most common route for parents is via the GP.

When making or supporting a GP referral, it helps to be specific about:

Waiting times — the honest picture

CAMHS waiting times are one of the most difficult parts of the current system. The NHS Benchmarking Network reported that as of March 2025, approximately 255,000 children and young people across the UK were waiting for community mental health care. Around 27% of those had waited more than 18 weeks from referral to treatment. Waiting times vary significantly by area: some services measure waits in weeks, others in many months.

While waiting, families are often left with very little. There is no substitute for what CAMHS should be providing — but there are things that can help:

What to do if your child's referral is rejected

Referral rejection is more common than most parents expect. Research cited by the Education Policy Institute (2019) suggested that around 26% of CAMHS referrals in England were rejected. A 2024 STADIA trial published in the Journal of Child Psychology and Psychiatry found that 44% of children referred to CAMHS for emotional difficulties had their referral rejected. The most common stated reasons are that the child does not meet the current severity threshold, or that the presenting difficulty is not considered appropriate for CAMHS specifically.

If your child's referral is rejected, the first step is to ask for the specific reason in writing. The letter of rejection should explain this, but if it does not, ask the referrer (your GP or paediatrician) to follow up and get clarity.

What to expect at a CAMHS appointment

If the referral is accepted, you will usually be contacted for a triage call or first appointment. CAMHS appointments typically involve both parent and child, at least initially. The first appointment is usually an assessment — one or sometimes two sessions — where the clinician gathers information about your child's history, current symptoms, and how difficulties are affecting daily life.

You will be asked to describe what you are seeing at home. The clinician will also speak to your child directly, and may ask to speak to them separately for part of the appointment, particularly if they are older (usually 12 and up, sometimes younger). Be as specific and concrete as possible — the same approach as the referral letter. What you actually observe, when, and what the impact is.

The assessment may lead to: further assessment sessions, a waiting list for a specific therapy or intervention, a referral within CAMHS to a more specialist pathway (eating disorders, psychosis, early intervention), or a decision that a different service is more appropriate. Ask at the end of any assessment appointment what the next steps are and what the expected timeline is.

If your child is in crisis

CAMHS is not a crisis service. If your child is in immediate danger — at risk of suicide, self-harm, or harm to others — do not wait for a CAMHS appointment. Go to your GP for an emergency appointment, go to A&E, or call 999. You can also call 111 or the Samaritans on 116 123 at any time of day or night. If your child is already under CAMHS care, the team will usually have given you an emergency contact number — use it if things escalate outside of appointment hours.

If your child is struggling but not in immediate crisis, and the wait for CAMHS feels unsurvivable, going back to the GP to flag that the situation has worsened since the original referral can sometimes prompt a re-triage and faster access.

Related guide

School Anxiety & School Refusal

School anxiety and refusal often co-occur with the mental health difficulties that lead families to CAMHS. This guide covers what's behind it and how to work with school.

→