Child and Adolescent Mental Health Services (CAMHS)

We offer a number of services that aren't run from the Alder Hey hospital campus, including two sites in Liverpool and Sefton:

Liverpool FRESH CAMHS

Call 0151 293 3659 or fax 0151 724 6890 | Open a Google Map for directions

Sefton Specialist CAMHS/Primary Mental Health

Home Care service

Our team of Registered Nurses and support workers provide tailored care packages to patients with complex health needs and life-limiting conditions, in their home or school.

Families will be contacted in advance and be given the opportunity to decide if this service is right for them.

Children's complex needs service: North Sefton

Our service, led by the Complex Needs Manager, works with families to deliver tailored care plans and enhance the quality of life for children in north Sefton, after a patient has been discharged into our community service.

Our team of care support workers aims to provide a safe and smooth transition from hospital to home and provide care to patients in their home or an alternative location like their school. We also provide training for parents, carers, support staff and other agencies.

The service is for children and young people with life-limiting conditions, chronic ill-health or complex health needs where the family has a need for respite care. Patients must also be:

• Aged up to 18 years
• Living in north Sefton
• Registered with a north Sefton GP
• Technology dependent

Referrals to this service are provided by professionals involved in the patient's care

This service is open from 9am to 5pm, Monday to Friday (excluding bank holidays) and is based at:

Ainsdale Centre for Health and Wellbeing
164 Sandbrook Road
Ainsdale
PR8 3RJ

Call 01704 387 159 or 07706 607 390 | Open a Google Map for directions

Here are some questions young people have asked us. If you don’t find an answer to your question here, please call us on 0151 293 3662 and we will be happy to have a chat with you.

How can we access CAMHS?

If you are worried about your child’s emotional and mental health, you can seek a referral from any professional connected with your child (e.g. GP, Social Worker, Health Visitor, School Nurse or Teacher). You can now also self-refer your child to CAMHS by getting in touch with our team.

Every weekday we have a team of experienced mental health professionals who look at the referrals that we receive. Their task is to decide whether it looks from the information as if CAMHS is the right service to help, they then decide whether the referral should be treated as urgent or routine. Urgent appointments are seen within two weeks and routine appointments are seen as soon as possible (and within the maximum wait time of 18 weeks).

What to expect at your first appointment?

Your first appointment is called a ‘Choice’ appointment. We call it this because we hope to give children, young people and families and carers as much choice as possible in the plans that are made to start helping.

You will meet with an experienced member of our team who will work with you to develop an initial shared understanding of the difficulties. We will be asking you what you are worried about, what you have already tried and what you would like to change. We will help you to think about whether our service or other services are best placed to help. We will also be considering risk, what you might be able to do for yourselves and what the intervention options are. Ultimately, your ‘Choice’ appointment(s) should help bring you to a point where you can make an informed decision about what is needed.

Your ‘Choice’ Clinician will then direct you to the most appropriate part of our service if we think that CAMHS interventions are likely to be helpful and effective. In most cases, the next person you meet will be your ‘Partnership’ Clinician who will oversee any on-going care.

What happens next?

We hope that between your ‘Choice’ and ‘Partnership’ appointments that the advice you have been given and the changes you begin to make will have been helpful. There are several aims of the first ‘Partnership’ session. Firstly, there will be a chance to revisit your goals and see if these have changed at all. We will also begin a more in depth assessment to reach a shared understanding and develop a plan of action and support.

Your ‘Partnership’ Clinician will have a set of core clinical skills, mental health training, experience and expertise. However, you are experts in your own family and your own experiences and we will work in partnership with you to offer as many or as few sessions as are needed to move towards your goals. On average, seven or eight sessions appear to be enough to achieve some meaningful change; however, decisions about on-going care or discharge will be made at regular review appointments. The care that you receive will also be discussed within a Multi-disciplinary team.

Sometimes, your ‘Partnership’ Clinician will want to introduce another therapist to you or your child. This would be to add a specific assessment or therapy skill to your bespoke package of intervention. This might be about providing a short piece of intensive work/assessment or a longer term piece of work at an enhanced level.

In general, the care that your family and your child would fall in to the following areas:

• Consultation and Multi-Agency Work
• Extended Assessment
• Individual Therapeutic Interventions
• Family Interventions
• Group Based Interventions
• Training

How do we measure change?

We are committed to delivering high quality, evidence-based and effective support. From the beginning of your involvement with us we will be monitoring the impact of any interventions. You will be asked to fill in some questionnaires that will be repeated throughout the time that we spend with you and your family. The questionnaires will help us to determine the severity of difficulties and will also help us to monitor change over time. We will also ask you to feed back to us about your experience of our service.

Everyone who works in Alder Hey CAMHS has chosen to join the service to help, support and enable children, young people and families to make the most out of their lives. We are all committed to easing suffering and distress and promoting well-being, building on strengths and engagement with life.

Whilst we all have different backgrounds and training and may understand mental health in slightly different ways, we work in teams where we are able to discuss and share our views and come up with understandings and interventions that will be most helpful for you.

Each CAMHS practitioner will offer you confidentiality (except in situations where you or someone else may be in danger). We will also be open and honest with you.

If you ever have any compliments or complaints about your therapist or the care that you receive, please let us know by talking to us or by contacting Alder Hey’s Patient and Family Support Team.

Here are the types of practitioners you might meet in your CAMHS journey.

Applied Behaviour Therapist

Applied behaviour analysis – also known as ABA – is a systematic way of observing someone’s behaviour, identifying desirable changes in that behaviour and then using the most appropriate methods to make those changes.

An ABA therapist may use a variety of techniques to change someone’s behaviour. For example, the therapist may try to improve a child’s communication and social skills by demonstrating more effective ways to interact with other children and then rewarding them when they demonstrate the improved behaviours. The therapist will then analyse how well that approach has worked and, if necessary, make changes to the intervention to improve the child’s behaviour next time around.

Applied behaviour analysis has been used to support a wide range of people, including children and adults on the autism spectrum, as well as individuals with other disabilities.

Art Therapist

Art Therapists have an understanding of art and creativity and how this relates to peoples mental health and emotional well-being. Art Therapists seek to provide a trusting and facilitating environment in which children and young people are able to safely express themselves in a variety of ways.

They help their clients find an outlet for often complex and confusing emotions, which they may not necessarily be able to express verbally. They also foster self-awareness and confidence. Part of an Art Therapist’s role is to devise distinct ways of working with clients in different environments. This may include providing a safe environment and a variety of art materials to those who do not feel able to talk, allowing the art itself to become a valuable means of communication.

In group work, an art therapist will encourage members to relate to each other via the art they produce. The images and their meanings for the group will need to be worked through which can take some time.

Clinical Psychologist

A Clinical Psychologist is a practitioner who has trained over several years to be able to work with people with a variety of different difficulties. They will have studied at to doctoral level and typically will have gained experience of working with: children, young people and families; people with learning disabilities; adults and older adults. Clinical Psychologists then decide where they would like to specialize and gain extra experience and training in their chosen field. A Clinical Psychologist’s overall aim is to understand and reduce psychological distress and enhance and promote psychological well-being.

They work with a full range of people with mental or physical health problems and have specific skills in conducting cognitive assessments (tests and puzzles to work out how the brain is functioning)

Clinical psychologists work largely in health and social care settings, and will often work alongside other professionals in their multi-disciplinary teams and in other agencies.

A Clinical Psychologist will typically undertake a clinical assessment, using a variety of methods including, psychometric tests & questionnaires, face to face discussions and direct observation of behaviour. From assessment a Clinical Psychologist will help you to develop a bespoke ‘formulation’; that is a shared understanding of what the presenting difficulties are and what may be keeping them going. Assessment and formulation inform what interventions are likely to be helpful. Clinical Psychologists are trained to use a wide range of psychological interventions. Often these are talking therapies.

Cognitive Behavioural Therapist

A clinician who has trained to become a Cognitive Behavioural Therapist will be skilled in helping you to understand the links between your thoughts, your feelings and what you do. They will work hard with you to develop your skills in being able to manage your thoughts and feelings and changing your behaviour.

CBT cannot remove your problems, but it can help you deal with them in a more positive way. A CBT Therapist will help you to identify how your thoughts, feelings and behaviours can trap you in a vicious cycle. They will then help you crack this cycle by breaking down overwhelming problems into smaller parts and showing you how to change these negative patterns to improve the way you feel.

Unlike some other talking treatments, CBT deals mainly with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis. After working out what you can change, your therapist will ask you to practice these changes in your daily life and you will discuss how you got on during the next session. The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your daily life.

Family Therapist

Family Therapy – or to give it its full title, Family and Systemic Psychotherapy – helps people in a close relationship help each other.

Family Therapists are trained to Masters Level and may have trained in other professions before becoming Family Therapists. They generally seek to enable family members, couples and others who care about each other to express and explore difficult thoughts and emotions safely, to understand each other’s experiences and views, appreciate each other’s needs, build on strengths and make useful changes in their relationships and their lives. Individuals can find Family Therapy helpful, as an opportunity to reflect on important relationships and find ways forward.

Research shows Family Therapy is useful for children, young people and adults experiencing a very wide range of difficulties and experiences.

Family Therapy aims to be:

• Inclusive and considerate of the needs of each member of the family and/or other key relationships (systems) in people’s lives
• Recognise and build on peoples’ strengths and relational resources
• Work in partnership ‘with’ families and others, not ‘on’ them
• Sensitive to diverse family forms and relationships, beliefs and cultures
• Enable people to talk, together or individually, often about difficult or distressing issues, in ways that respect their experiences, invite engagement and support recovery

Key Workers

CAMHS Key Workers liaise with external agencies including health, education, social care and the voluntary sector and act as a named key worker to children, young people and families accessing Alder Hey CAMH services.

Some of their duties include:

• Working directly with children, young people and families, supporting the implementation of therapeutic interventions / care plans formulated by the case manager.
• Working in the community, including home visits and through agreed activities to positively improve a young person’s social and emotional development.
• Working flexibly in order to maximise opportunities for engagement of children, young people and families
• Working in a variety of settings including schools, to allow direct observation and also to support therapeutic interventions.
• Working to identify appropriate leisure activities for young people and develop a local knowledge of youth groups and alternative voluntary projects young people can link with.
• Supporting young people to participate in the shaping of CAMHS

Learning Disability Nurse

Learning Disability Nurses are concerned with influencing behaviours and lifestyles to enable a vulnerable group of people to achieve optimum health and to live in an inclusive society as equal citizens, where rights are respected. Learning Disability nurses have the knowledge, skills, attitudes and abilities to work in partnership with people of all ages who have learning disabilities, their families and their carers, to help individuals to develop individually and fulfil their potential in all aspects of their lives irrespective of their disabilities. They work closely with a range of other disciplines in a variety of residential, day and outreach service settings, adapting the level of support they provide according to complex needs’.

Mental Health Nurse

Mental Health Nurses are very skilled at planning and providing support to people across a range of settings. They will typically have trained in some general nursing skills and then chosen to further train in understanding and providing interventions to people with emotional health difficulties.

Mental Health Nurses typically work as part of a team of professionals and also work independently with young people and families. They use a bio-psycho-social model of understanding what is going on for young people and they are also trained in understanding and sometimes administering medication.

Mental health Nurses are particularly good at building relationships with, listening to and talking with young people and families so that they can develop, agree and review intervention plans and support packages.

Occupational Therapist

Occupational therapists work with people of all ages to help them overcome the effects of disability caused by physical or psychological illness, ageing or accident.

Occupational therapists work in hospital and various community settings. They may visit clients and their carers at home to monitor their progress. When a course of therapy is completed, the therapist will analyse how effective it has been.

Play Therapist

Play Therapists receive extensive training in subjects such as child development and attachment (the bonding process). They are also trained to use play, a child’s natural form of expression, as a means for understanding and communicating with children about feelings, thoughts and behaviour.

A Play Therapist will begin by listening to your concerns about your child and family. They will review their history and find out about the stresses the family have been through so that they can help your child make sense of it. They may ask to seek information from school and other significant adults. An assessment is made of your child’s strengths as well as their difficulties.

Your child’s Play Therapist will talk with you about what to tell your child about their Play Therapy and how to anticipate and answer your child’s questions. They may work as part of a team of other professionals or independently and may suggest a referral for other professional intervention as part of the support package you are offered. This might include support for you.

Play Therapists sometimes work with parents in the playroom with their child. Some specially trained Filial Play Therapists may train parents in how use child-centered play and other techniques to find different ways to relate to children.

Psychiatrist

A psychiatrist is a medically-qualified practitioner who will have spent a few years training as a doctor at university. He or she will then have worked as a doctor in general medicine and surgery, before choosing to work in helping people with mental health problems. After a few years working with people of different ages, a child and adolescent psychiatrist chooses to specialise in working with young people and their carers and families, with the special needs of children in mind. After a number of years doing this they become a specialist.

What are a psychiatrist’s special skills? All psychiatrists will learn how to:

• Assess a person’s state of mind
• Use the “bio psycho-social” model of understanding. This emphasises the importance of a person’s past experiences, family, culture, surroundings and work as well as any medical and physical features.
• Diagnose a mental illness
• Use a range of psychological treatments
• Use a range of medications
• Help a person recover

As well as these ‘core’ skills, a psychiatrist will work with other non-medical colleagues to ensure that a patient gets the best and safest possible care.

Psychodynamic Psychotherapists

A Child and Adolescent Psychotherapist can help a child or adolescent to understand themselves through their relationship together. The problems identified in this relationship shed light on those in other relationships in the child’s life, whether in the past or present. During a therapeutic session, young children may be encouraged to play, while older children may be asked to draw or paint and teenagers to talk about their feelings. Through the relationship with the therapist in a consistent setting, the child or adolescent may begin to know and to feel able to express their most troubling thoughts and feelings.

The extensive training of Child Psychotherapists uniquely enables them to work with these very disturbing thoughts and help the child make sense of their experience and develop their own individuality and potential. Confused, frightened, hurt, angry or painful feelings can gradually be put into words rather than actions. As a result the child can begin to express their emotions in a way that is more helpful to them.

For the wider network the Child Psychotherapist will also be able to represent the child’s experience in relation to his/her family, placement, special educational needs and therapeutic needs.

More information can be found on the NSCAP website.

Social Worker

Social workers form relationships with people and assist them to live more successfully within their local communities by helping them find solutions to their problems.

Social work involves engaging not only with clients themselves but their families and friends as well as working closely with other organisations including the police, local authority departments, schools and youth services.

Social Workers who are working within CAMHS have chosen to specialize in emotional wellbeing and how to use their social work skills and other therapeutic skills to enhance people’s lives.

Youth Worker

Youth workers help facilitate personal, social and educational growth in young people to help them reach their full potential in society.

At its core, Youth Work is about the relationship and conversations built up between a youth worker and a young person.

Youth Workers work with young people in a variety of settings such as:

• youth centres;
• schools;
• colleges;
• faith-based groups.

Youth Work could also be street based due to its outreach nature.

Youth workers’ roles vary greatly, but in addition to working with young people face-to-face, typical activities involve:

• managing and delivering youth and community projects and resources;
• assessing the needs of young people, and planning and delivering programmes related to areas such as health, fitness, smoking, drugs, gangs, violence, relationships and bullying;
• befriending and supporting individuals in various settings, including outreach work;
• mentoring, coaching and supporting individuals to facilitate personal, social and educational growth in young people as well as encouraging greater social inclusion;
• working in partnership with professionals from other organisations that support young people such as social care, health, police, education, youth offending teams and local authorities;
• attending and contributing to multi-agency meetings that bring together practitioners from different sectors as part of a team around the family (TAF) approach;
• working with parents and community groups to win support for improved provision and acting as an advocate for young people’s interests.

Other types of psychotherapy

There are several different types of psychotherapy that have been proven to be effective and are offered by the NHS. Some of these are described below. However, if your CAMHS practitioner thinks that another therapy approach might be helpful, they should explain to you what it is and how it works.

• Cognitive Analytical Therapy (CAT) – helps us to look at patterns of relating, and the effect these patterns are having on how we feel, our problems and our relationships. It brings together ideas from other therapies such as CBT and psychoanalytic psychotherapy into one. It is an active therapy that helps you to take part in the process of change in your own way. Read more at ACAT.
• Interpersonal Psychotherapy (IPT) – looks at the way difficulties can be triggered and maintained by events involving relationships with others. It helps you to cope with the feelings involved as well as working out coping strategies.
• Humanistic Therapies – this included counselling approaches which encourage you to think about yourself more positively and aim to improve your self-awareness. Therapists will offer you a non-judgemental space and be guided by what you want to talk about.

Comprehensive Child and Adolescent Mental Health provision in Liverpool and Sefton is provided through an array of services that are commissioned across multiple agencies and professional disciplines.

Whilst these services do work together, efficiency and effectiveness is maximised by ensuring children and young people access the most appropriate type of service to meet their presenting difficulties at that particular time.

Types of problems CAMHS can help with include violent or angry behavior, depression, eating difficulties, low self-esteem, anxiety, obsessions or compulsions, sleep problems, self-harming and the effects of abuse or traumatic events. CAMHS can also diagnose and treat mental health problems such as bipolar disorder and schizophrenia.

If you are looking for an assessment and/or diagnosis of ASD, ADHD or other developmental conditions, we are not the service you are looking for and referrals should be made to Community Paediatricians for oversight (see exclusion criteria below)

We take referrals for any professional working with children. However, it is essential that referrals are consented to either by the person who holds parental responsibility and/or the young person where they have capacity to consent.

All referral requests must be made in writing to:

Single Point of Access (SPA)

LIVERPOOL FRESH CAMHS

Alder Hey Children's NHS Foundation Trust

Fresh Building

Alder Hey Hospital

Alder Road

L12 2AP

Tel: 0151 293 3659

Fax: 0151 293 3698 (safehaven fax)
Email: camhs.referrals@alderhey.nhs.uk (safehaven email)

Please feel free to call the SPA duty team on 0151 293 3662 with any enquiries or to discuss a referral.

• Download a Single Point of Access CAMHS Referral Form

Referral criteria for further assessment

The Child / Young Person must be:

• Registered with a GP in Liverpool or Sefton.
• Aged 0 – 18years at the time of referral
  • If over the age of 16 years, emergency, unplanned or crisis care is provided by Merseycare (see exclusion criteria)
• Presenting with signs indicative of, or on-going symptoms of mental health difficulties that
  • impacts upon their developmental functioning
  • or is likely to result in significant risk to themselves or others

And

• A less intensive intervention (e.g. school based parenting groups, guided self-help) or Adult Mental health service for 16-18 year olds (e.g. Inclusion Matters, ) is unlikely to suffice

And

• Valid, informed consent has been obtained from the Young Person where applicable, or person(s) with Parental Responsibility
• Any current safeguarding issues must have been referred to Social Care

And

• Evidence and/or guidance would suggest that an intervention from the Specialist CAMH service would ameliorate the presenting risk and support the return of the young person to acceptable levels of functioning.

Exclusion Criteria

We will not accept referrals where the child or young person is:

• Is over 16 years of age and requires emergency, unplanned or crisis care
  • Referral goes to Merseycare Access Team
• Has not, or refuses to give consent to intervention
  • Consider if serious enough to warrant assessment of capacity/assessment under the Mental Health Act
  • Consider working with the child’s network

We do not accept referrals where the referral is a request for assessment/management of:

• Attention Deficit Hyperactivity Disorder
  • Consider Community Paediatrics/ADHD Foundation
• Autistic Spectrum Disorder
  • Consider ASD Pathway
• Substance misuse
  • Consider Young Addaction / OKUK (Mersey Youth Association)
• Forensic risk
  • YOS prevention team/FACT
  • Must be referred and managed by Social Care
• Primarily issues of parental mental health / illness
  • Refer to GP with recommendation for IAPT / Adult Mental Health

Specialist CAMHs welcome requests for consultation in relation to the above areas, where professionals would benefit from additional support/advice.

Choice and Partnership approach

Alder Hey CAMHS operates the Choice and Partnership Approach (CAPA) CAPA is a clinical model that has been implemented in by many CAMHS services throughout the UK, North America and Australasia.

It is a service transformation model that is a combination of collaboration and participatory practice with users of the service. Its broad aims are to enhance effectiveness, leadership, skills modelling and demand and capacity management.

For more details please visit the CAPA website.

Quality & Clinical Governance

Clinical quality and effectiveness is regularly monitored through the use of routine outcome measures. Measures are given to children/young people and parents/carers at the initial Choice appointment, first Partnership, review and on case closure. The measures have been selected to capture changes in symptomatology, problem description and functioning, therapeutic alliance (via session-by-session measures) and experience of service.

Useful links

• Minded

YoungMinds are working with NHS England and NEL Commissioning Support Unit to help increase the voices of parents, carers and young people around young people’s mental health services.

They have created surveys to hear about the opportunities that currently exist for young people, parents and carers to get involved in mental health services, and what would help to build young people’s and parents’ participation across the young people’s mental health system.

• Take the survey for young people
• Take the survey for parents and carers
• Take the survey for health professionals

Sometimes we use odd words or phrases. Whilst we will try hard to make sure that what we say is in plainlanguage; however, sometimes we forget and you might come across abbreviations. Feel free to ask us toexplain when we do this. However, here is a list of common terms that we might use:

• ABA – Applied Behaviour Analysis
• ADD – Attention Deficit Disorder
• ASD – Autism Spectrum Disorder
• ADHD – Attention Deficient and Hyperactivity Disorder
• BPD – Borderline Personality Disorder
• CAMHS – Child and Adolescent Mental Health Services
• CAPA – Choice and Partnership Approach
• CAT - Cognitive Analytic Therapy
• CCA – Continuing Care Assessment
• CMHT – Community Mental Health Team
• CLDT – Community Learning Disability Team
• CPA – Care Programme Approach
• CYP – Children and Young people
• DNA – Did Not Attend
• DSH – Deliberate Self Harm
• EMDR – Eye Movement Desensitisation & Reprocessing Therapy
• EIP - Early Intervention in Psychosis
• EP – Educational Psychologist
• GAD – Generalised Anxiety Disorder
• IAPT - Improving access to Psychological Therapies
• LAC – Looked after Child
• LD – Learning Disability
• MHA – Mental Health Act
• MHP – Mental Health Practitioner
• MLD - Moderate Learning Disability
• MDT – Multi Disciplinary Team
• OCD – Obsessive Compulsive Disorder
• ODD – Oppositional Defiance Disorder
• OT – Occupational Therapist
• PCP – Person Centred Plan
• PD – Personality Disorder
• PMH – Primary Mental Health
• PTSD – Post-Traumatic Stress Disorder
• ROMS – Routine Outcome Measures
• SFPT – Solution Focussed Brief therapy
• SLD – Severe Learning Disability
• SPA – Single Point of Access
• SSRI – Selective Serotonin Reuptake inhibitors
• YP – Young Person

As many as 1 in 6 young people will struggle with anxiety difficulties as some point in their life.

There are lots of words to describe anxiety (e.g. worry, fear, stress or panic). Anxiety is a normal part of life andmost people feel anxious about certain life situations. However, sometimes anxiety can continue for a long time ormight be so strong that it starts to interfere with how you live your life and do everyday things. This is when anxietyis a problem and when you might need to come to see CAMHS.

Having an anxiety problem might mean that you feel frightened, panicked and nervous a lot of the time. It mightmean that you have trouble sleeping, eating and concentrating. When anxiety is a problem it can make you feeldown, tired and/or irritable. You might also experience physical feelings such as feeling your heart beating strangely,having a dry mouth, having body aches and pains and you might feel shaky. You also are likely to notice that you areavoiding situations.

Anxiety difficulties could be due to your life experiences, your family history, experiences of trauma or something todo with your genes and personality.

At CAMHS we will work hard with you to help you to understand and manageyour anxiety in a more helpful way so that you can get back to living your life in the way that you want to. We haveclinicians trained in ways to treat anxiety problems.

Anxiety based problems include (but are not limited to):

• Generalised Anxiety Disorder
• Obsessive Compulsive Disorder
• Panic AttacksPhobias (including Social Phobia)
• Post-Traumatic Stress Disorder

More useful information about anxiety from

• Royal College of Psychiatrists
• Young Minds
• National Institute for Health and Care (NICE)

Autism Spectrum Disorder (ASD) is a condition that affects social interaction, communication, interests andbehaviour. It includes Asperger syndrome and childhood autism. In itself, ASD is not a mental health problem.However, sometimes people with ASD experience mental health problems as a result of their social andcommunication difficulties.

Some people also use the term autism spectrum condition or ‘neurodiverse’ (as opposed to people without autismbeing ‘neurotypical’).

The main features of ASD typically start to develop in childhood, although the impact of these may not be apparentuntil there is a significant change in the person’s life, such as a change of school.In the UK, it's estimated that about one in every 100 people has ASD.

Signs and symptoms

ASD can cause a wide range of symptoms, which are often grouped into two main categories:

• Problems with social interaction and communication – including problems understanding and beingaware of other people's emotions and feelings; it can also include delayed language development and aninability to start conversations or take part in them properly.
• Restricted and repetitive patterns of thought, interests and physical behaviours – including makingrepetitive physical movements, such as hand tapping or twisting, and becoming upset if set routines aredisrupted.

About half of those with ASD also have varying levels of learning difficulties. However, with appropriate supportmany people can be helped to become independent.

There is no 'cure' for ASD, but a wide range of treatments – including education and behaviour support – can helppeople to manage their condition. Read more about available treatments.

All of us have our ups and downs and situations in our lives can make us feel sad, down or upset. However, someyoung people can feel sad, lonely, down, upset, stressed, withdrawn and flat for long periods of time. When thisstarts to interfere with your day to day living it is known as depression.

When a person is depressed they may find it hard to do things that they previously enjoyed. They might find thattheir sleeping and eating patterns change. They might feel exhausted, miserable, lonely, upset and irritable and find that they criticise themselves and feel hopeless. In some cases people who are depressed use self-harm to managetheir feelings.

Many people suffer from depression at some point (2% of under 12’s, 5% of teenagers and 10% of adults).Depression can be caused by lots of things such as your life experiences, family history, bullying, feeling like you havelack of support or it may even run in your family and genes.

At CAMHS we have clinicians who are trained and have experience of helping children and young people understandand overcome depression.

More information

• Royal College of Psychiatrists
• Young Minds
• National Guidelines (NICE)

Eating Disorders are a very serious set of conditions and if you think that you may have an eating disorder it isimportant that you seek help as soon as you can. Your GP will be able to check your physical health and refer you tous.

Anorexia Nervosa

Anorexia is a serious eating disorder that affects roughly 1 in 100 young people per year. Anorexia is characterizedby people worrying a lot and being preoccupied with their weight and their body. Typically, people with anorexia arevery frightened about putting on weight and go to extreme lengths to lose weight, even if they are already classed asunderweight. Anorexia raises strong feelings for all those who are touched by it: the individuals, their families,friends, relatives and other adults in their lives.

A young person with anorexia may have a lot going on in their life that they cannot control: taking control of theireating is one way of getting a sense of control in their life. They may judge themselves very harshly and believe theyare fat even if other people tell them that they are thin.

Eating problems like anorexia are not just about food, they are about feelings too. We do not know what causessomeone to develop an eating disorder and it is likely that a number of factors contribute such as:

• Control - losing weight can make us feel good and in control
• Longstanding unhappiness which may show itself through eating
• Puberty - anorexia reverses some of the physical changes of puberty. You can see it as putting off some ofthe challenges of becoming an adult
• Family - saying “no” to food may be the only way you can express your feelings
• Depression - binges may start off as a way of coping with unhappiness
• Low self-esteem
• Social pressure - Western culture, particularly the media, idealizes being thin
• Genes may play a part.

Symptoms of anorexia include: losing a lot of weight quickly, eating less and less food, thinking about the caloriecontent of food, feeling panicky about eating food with other people or having a big meal; feeling moody or irritablebecause of the lack of food; feeling cold; feeling depressed and unable to concentrate. Girls’ periods may stop andboys may stop having erections.

Anorexia is a serious eating disorder and the longer terms consequences can be severe such as developing weak orbrittle bones and affecting the ability to have children. Ultimately, if left untreated, anorexia can result in death andalthough it is often very difficult for an individual with anorexia to accept help, it is very important that help is soughtas soon as possible.

Bulimia Nervosa

Bulimia is an eating disorder that shares much in common with anorexia but typically involves patterns of eating thatincludes binges and attempts to ‘purge’.

Again, Bulimia is not all about food, it is about feelings too and people with bulimia may experience a number ofsymptoms such as: poor sleep, poor concentration, depression, loss of interest, preoccupation with their body andfood, tiredness and irritability. People who are inducing vomiting may:

• Eventually lose the enamel on their teeth
• Get a swollen face
• Have palpitations
• Feel weak and tired
• Experience huge weight swings
• Get kidney damage
• Have seizures
• Be unable to get pregnant

When young people come to us with an Eating Disorder we work hard to understands the underlying issues andprovide access to a multidisciplinary team to start to make healthy changes.

More information

• Royal College of Psychiatrists
• Young Minds - Anorexia
• Young Minds - Bulimia
• National Guidelines (NICE)

The Department of Health in England (DH 2001) in their ‘Valuing People’ document define a learning disability as ‘a significantly reduced ability to understand new or complex information, to learn new skills (impairedintelligence) along with a reduced ability to cope independently (impaired social functioning). The onset ofdisability is considered to have started before adulthood, with a lasting effect on development’.

For the purposes of service delivery the terms "mild", "moderate", "severe and profound" learning disabilities aresometimes used to categorise or label children and young people. This appears to suggest distinct categories forlearning disability but in reality these do not adequately describe the range of impairments or disabilities this groupof children may have may have or the support they may require.

Children and young people who have moderate, severe, or profound learning disabilities may also experience mentalhealth problems and/or challenging behaviour. This can include:

• Anxiety
• Anger and aggression
• Low mood, sadness
• Agitated, unsettled or disruptive behaviours
• Self-harm
• Psychosis

At CAMHS, we have a range of professionals including Psychiatrists, Learning Disability Nurses and Psychologists whohave extensive training and experience of working with children, young people and families who are affected byLearning Disabilities. We work in a number of ways to support young people with their difficulties. This includesconsultation with professionals and services, and direct work with young people and their families. We meetchildren and families in community settings such as their home, school, respite and in clinic.

We all have habits and ways that we like to do things. We often hear people say that they have OCD when theymean they like to have things done in a certain way. However, OCD is a serious anxiety disorder that affects the waypeople think, the way people feel and the way people act.

People with OCD experience (often intrusive) obsessionsand feel compelled or have urges to perform certain actions or rituals. Typically, the symptoms of OCD get in theway of everyday living. About one in 50 people experience OCD.

Obsessions may be experienced as horrible thoughts or preoccupations and worries that seem irrational or over thetop. Compulsions may include excessive washing, checking, counting or repeating actions. The compulsions may beused as a way to stop the obsessions from entering the mind, to decrease anxiety or to prevent terrible things fromhappening.

At CAMHS we work hard alongside you to get to a shared understanding of what is going on and develop a plan thatwill help you to manage the OCD in a different, more helpful way.

More information

• Royal College of Psychiatrists
• Young Minds
• National Guidelines (NICE)

Sometimes young people are exposed to or experience situations or events that are traumatic, life threatening,horrific and terrifying. When this happens, sometimes young people go on to develop symptoms of PTSD.

The symptoms of PTSD are in three main categories:

Flashbacks or nightmares

You keep remembering the traumatic event even when you don’t want to and get flashbacks or nightmares.Essentially, you keep reliving the event(s).

Avoidance and numbing

You might feel too terrified to relive the event or think about it so you might try to keep yourself busy and keep yourmind occupied. You might avoid the places and people that remind you of the trauma, and try not to talk about it.You may deal with the pain of your feelings by trying to feel nothing at all – by becoming emotionally numb.

Being on guard and unable to relax

You may feel anxious all the time and feel unable to let your guard down. We call this ‘hypervigilance’ and‘hyperarousal’. You might feel jumpy and irritable and find it hard to sleep.

Young people may experience PTSD immediately after a traumatic event or it may start weeks, months or yearslater. Most people who have experienced a traumatic event would experience symptoms of PTSD for the first fewweeks after and many people go on to recover naturally given time, understanding and support. Around one in 3people who experience trauma will develop PTSD.

Complex PTSD

Young people who have experienced severe neglect or abuse may develop complex PTSD. This looks and feels muchlike the description above but includes further symptoms and experiences such as intense guilt, shame, an overlysensitive fight/flight response, impaired impulse control, feeling numb and finding it difficult to trust and connect topeople.

At CAMHS, we will work hard to understand the causes of any PTSD and help you to begin to recover usinginterventions that are evidence based.

More information

• Royal College of Psychiatrists
• Young Minds
• National Guidelines (NICE)

Psychosis is term that we use to describe a set of symptoms that interfere with a person’s ability to think clearly andtell the difference between what is real and what is not. Psychosis also affects how people behave. Psychosis isusually an indication of serious mental health problems and if you are experiencing symptoms of psychosis it is a signthat you need support.

People who develop psychosis often have their first psychotic experiences in their teens or early twenties and it isimportant to get help as soon as possible as there are interventions that can be very helpful in enabling people to goon to lead the life they wish to live.

Early signs of psychosis include:

• Withdrawal and loss of interest in usual activities
• Loss of energy or motivation
• Problems with memory and concentration
• Problems with work or study
• Lack of emotional response or inappropriate emotional display
• Changes or problems with sleep or appetite
• Unusual ideas or behaviour
• Feeling changed in some way

People with psychosis may experience distressing symptoms such as:

• Hallucinations - hearing voices no-one else hears, seeing things that aren't there, or feeling, smelling ortasting unusual sensations with no obvious cause
• Believing others can influence their thoughts, or they can influence the thoughts of others or control events
• Believing they are being watched, followed or persecuted by others or that their life is in danger
• Feeling their thoughts have sped up or slowed down
• Thinking or talking in a confused way

Psychosis is not a condition in and of itself. It is a set of symptoms that can be triggered by other conditions such asschizophrenia, bipolar disorder (manic-depression), drug misuse (there appears to be a particularly strong linkbetween psychosis and cannabis use) and severe stress.

Treatments for psychosis include talking therapies such as CBT, social support and use of medication.

More information

• Royal College of Psychiatrists
• Young Minds
• National Guidelines (NICE)

Self Harm can bring up really difficult feelings for lots of people but it is more common than you might think. Asmany as one in ten people self harm at some point in their life.

Self-Harm is a term used to describe when someone inflicts pain or damage on themselves in some way. This mayinclude cutting, scratching, burning, biting, head-banging, tying ligatures and ingesting substances and takingoverdoses. It is usually a sign that someone is trying to come with overwhelming feelings.

It seems that sometimes people’s difficulties build up to the point where they feel unmanageable and young peopleoften describe a sense of release related to self-harming. It is often used as a way of coping. People self-harm for avariety of reasons and each episode of self-harm isn’t always for the same reason. Common reasons for self-harminginclude (but are not limited to):

• Relieving tension
• Communicating distress
• Gaining a sense of control
• To feel something
• To make emotional pain physical
• To punish themselves

Sometimes, but not always, self-harm can be used as an attempt to commit suicide. Often people who self-harm areexperiencing mental health problems although self-harm in itself is not a mental illness. Nevertheless, the key toaddressing and managing self-harm is often to get help with underlying issues. Self-harm can be dangerous andpeople who self-harm sometimes risk killing themselves accidentally. If you are self-harming it is important that youseek help as soon as possible.

At CAMHS we will work hard to understand what the underlying issues are and work with you to help you to managein a more helpful and less damaging way. In the meantime, this self-help booklet might help.

You might also find talking to Childline helpful by calling 0800 1111.

More information

• Royal College of Psychiatrists
• Young Minds
• National Guidelines (NICE)