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6.8 CAMHS Emergency Protocol and Escalation Arrangements

Contents

  1. Introduction
  2. Definitions
  3. Emergency Response
  4. Required Information
  5. Procedure for Daytime Emergencies on Children and Young People who are known and are Open Cases to Southwark CAMHS
  6. Emergencies on Children and Young People who are new to the Service or Cases currently closed to CAMHS
  7. Approval Mental Health Professional Service
  8. Seeking Consultation, Information or Guidance
  9. Escalation Arrangements
  10. Out of Hours Arrangements
  11. Relevant Contact Details

    Flowchart: Child Mental Health Emergency


1. Introduction

This document describes emergency mental health arrangements during daytime and out of normal working hours provided by Southwark Child and Adolescent Mental Health Services (CAMHS) for children and young people registered to a Southwark General Practitioner. It also includes arrangements for escalation when matters are unable to be resolved by practitioners involved. It should be noted that Southwark CAMHS caters for children and young people up to the age of 18 years old, and that at and above this age all mental health emergencies should be referred to Southwark Adult Mental Health Services. This protocol reflects our commitment to joint CAMHS and Social Work assessment and that social work staff will be part of the care planning following assessments.


2. Definitions

What is a mental health emergency?

It is difficult to be precise and exhaustive as to what constitutes a mental health emergency. Therefore before implementing the emergency procedures outlined below social workers should first discuss and obtain the agreement of their line manager.

The following are examples what might constitute an emergency but there are many factors to be considered as to whether there will be ‘an emergency response’ from CAMHS to the following:

  • Psychotic illness

    Psychosis is a complex illness and may present in various forms. A rapid psychiatric assessment will be required for treatment and consideration given to whether child/young person can be treated in the community or requires hospital admission
  • Serious Self Harm, Serious Suicide Threat/Attempt(s)

    Children and young people may cause such concerns that there are serious worries regarding their safety and therefore they may require urgent psychiatric assessment of their risk and any underlying mental illness that might be contributing to these behaviours.
  • Serious Aggressive and/or uncontrollable behaviours

    Aggressive or uncontrollable behaviours may or may not warrant urgent or any psychiatric intervention. This is very much dependent on whether there is an underlying mental illness or disorder that requires assessment and treatment. This is often difficult to determine and so may require further discussion so as to decide what the best course of action is in the particular circumstances.
  • A young person held in custody in a police station, or detained by court, where the police or court officers are requesting an urgent mental health assessment prior to disposal


3. Emergency Response

Once an emergency referral has been agreed and accepted by Southwark CAMHS, a CAMHS professional will see the child or young person as soon as is practical on the day of referral, or if the situation can be held for longer following agreement with the referrer and or family then no later than within twenty four hours.

When dealing with an emergency it may become apparent that a child or young person is unable or unwilling to attend a CAMHS or an accident and emergency hospital site for the psychiatric assessment. Arrangements may then need to be made by CAMHS to provide an assessment in the community depending on the circumstances and reasons for the emergency assessment. Depending on risk, the child or young person may be moved to a place of safety in order for the assessment to take place. Therefore at this stage, following discussions with the referrer, a plan should be formulated and agreed as to how the emergency psychiatric assessment can be conducted appropriately and safely. It may require the involvement of the Approved Mental Health Professional Service (AMPH), and arrangements for this are set out below. Contact with AMPH will be lead by CAMHS. If there are problems arranging an emergency community psychiatric assessment then the referrer can involve either the Service Development Manager, Child and Adolescent Mental Health Social Work Service or the Team Manager, National & Specialist Child Mental Health Social Work Team to discuss the concerns and reasons for an emergency community psychiatric assessment.


4. Required Information

In order to ensure that appropriate action is taken following a request for an emergency response from CAMHS the following information should be made available to the CAMHS worker dealing with the request:

  1. Full Name of Child/Young Person
  2. Date of Birth
  3. Current Address
  4. Legal status
  5. Who holds Parental Responsibility and their current whereabouts?
  6. Ethnic Origin/First Language
  7. Name of General Practitioner
  8. School attended
  9. Nature and duration of social work involvement
  10. An account of the mental health concerns that have led to this request for a CAMHS emergency response
  11. Name of the allocated social worker and their line manager

There is a mandatory expectation that the allocated social worker or equivalent will accompany the child or young person to the CAMHS emergency assessment in order that joint decisions can be made regarding the most appropriate outcome from the emergency CAMHS assessment.


5. Procedure for Daytime Emergencies on Children and Young People who are known and are Open Cases to Southwark CAMHS

When a child/family is currently being seen by Southwark CAMHS and an emergency arises, the social worker should in the first instance contact the CAMHS worker involved for advice. If the allocated worker is not available that day, then the social worker should request to speak to the senior person available in that team such as the Team Manager, Social Worker, Consultant Psychiatrist or Specialist Psychiatric Trainee.

If a child or young person has been seen by CAMHS within the last 12 months, but the case has been closed, the social worker should initially contact CAMHS for the area where the child was seen during the previous 12 months before implementing the procedures for unknown cases set out below.


6. Emergencies on Children and Young People who are new to the Service or Cases currently closed to CAMHS

For children aged under 12 years, contact should be made with the staff member on duty at the Belgrave Team. For young people aged 12 years - 18 years, contact should be made with the member of staff on duty at the Adolescent Service located at ‘The Bloomfield Centre’, Guy’s Hospital. (See Section 11 below for contact details). The duty staff will contact the appropriate service and have the details of the daytime on-call Southwark Consultant Psychiatrist.

The duty worker, depending on the nature of the emergency and the known risk, will discuss the safest and most efficient arrangement to assess the child or young person. It may be suggested that arrangements are made to escort and transport the young person to one of the above sites, or if necessary to the nearest A & E Department at King’s College Hospital, or A & E at St. Thomas’s Hospital.

There are circumstances, such as detention at a police station or at court, where a young person cannot be taken to a CAMHS site or hospital for assessment. There is a duty rota of the daytime on call Consultant Psychiatrists in Southwark CAMHS, which is held by the duty staff at the Belgrave and Bloomfield. It is then the responsibility of the duty worker to alert the on call CAMHS Consultant Psychiatrist on duty that day to make the necessary arrangement to have the young person assessed on site or to put in place suitable alternative arrangements. The Consultant Psychiatrist in such circumstances may also need to liaise with the Approved Mental Health Professional Service. The Social Services Duty Manager will be contacted and ensure that a Social Worker will attend so that a joint CAMHS and Social Work assessment is completed and planning is agreed.


7. Approved Mental Health Professional Service

If a child or young person is required to be assessed under the Mental Health Act 1983, there is an established procedure for assessing emergency referrals. Mental Health Act (MHA) assessments are coordinated through the Approved Mental Health Professional Service (AMHP). For details of the AMHP, contact York Clinic at Guys Hospital who carry the rota 020 7188 7038.

The Child and Adolescent Mental Health Social Work Team has a qualified AMHP who is able to provide advice and consultation on assessing young people who may have particular and complex mental health needs. If an AMHP assessment is required in the community then this can be discussed in the first instance, before referral, with the Team Manager, In-patients and National & Specialist Child Mental Health Social Work Team, who can offer advice and guidance regarding the appropriateness of using a Mental Health Act assessment service and will also advise as to which team should be responsible for the assessment.

MHA assessments on young people who may need admission to a children’s ward will need to be assessed by both a CAMHS Consultant Psychiatrist/ Specialist Psychiatric Trainee, second opinion doctor or GP as well as the AMHP.

After hours all MHA assessments are co-ordinated through the Children’s Out of Hours Service 020 7525 5000.

The Team Manager, In-Patients and National & Specialist Child Mental Health Social Work Team is based at ‘The Michael Rutter Centre’, Maudsley Hospital for which the contact details are set out below. If the Team Manager is unavailable then the social worker or his/her manager should contact the Service Development Manager, Child and Adolescent Mental Health Social Work Service.


8. Seeking Consultation, Information or Guidance

There may be circumstances where you are unsure as to whether the presentation of the child/young person constitutes a CAMHS emergency or you might be unsure as to how to access the most appropriate service within CAMHS for your client. You may also wish to receive some general advice regarding a mental health issue affecting the child or young person you are working with. In order to help with your decision-making you can contact one of the social workers attached to CAMHS teams listed below. They will be in a position to offer you advice and to point you in the right direction for further input. However, if the social worker is unavailable or you are unsure who to contact then you can always contact the Service Development Manager, or Team Manager, In-Patients and National & Specialist Child Mental Health Social Work Team who will be pleased to discuss your concerns and assist you with obtaining the appropriate CAMHS input.

CAMHS staff should be able to draw upon and use social work staff located within the Under-12 and Adolescent Services to assist in any emergency situation involving a referral from Southwark Children’s Services. If they are unavailable, the Service Development Manager or Team Manager, In-Patients and National & Specialist Child Mental Health Social Work Team should be contacted on 020 3049 8470 for assistance.


9. Escalation Arrangements

There may be situations where you have tried to access the relevant CAMHS and consider the response you have received as being unsatisfactory and you remain convinced that the child or young person is still in need of an urgent CAMHS input. In these circumstances, you must discuss the first response you have received with your line manager. With agreement from your line manager you should then contact either the Service Development Manager or the Team Manager In-Patients and N&S CAMHS. They will try to help resolve the situation.

However, if they are unable to do so, and share the view that urgent input is required then they will discuss this with the Business Unit Manager, Assessment and Safeguarding-020 7525 1927, and with the CAMHS Borough Manager and/or Clinical Lead for Southwark CAMHS-please see contact details.

Continued disagreements will be discussed between the Business Unit Manager, Southwark Children’s Social Services; Lead Clinician; and Lead Psychiatrists for CAMHS.


10. Out of Hours Arrangements

CAMHS operates on call out-of-hours services between the hours of 5pm and 9am during weekdays and throughout weekends and Bank Holiday periods. If there is a mental health emergency concerning a child or young person outside normal working hours then they will then be seen in the first instance by the on-site duty psychiatry Specialist Trainee. They will contact the specialist child psychiatry Specialist Trainee for further assessment if necessary. They can be contacted via the Maudsley Hospital or St. Thomas’s Hospital and asking to speak to the on duty Specialist Psychiatric Trainee for CAMHS. Although you can contact either Specialist Psychiatric Trainee it is probably best to discuss your concerns with the person located nearest to where the child resides.

It is likely that if you are dealing with an out of hours emergency regarding a Southwark child you should also be consulting with Southwark Children’s Out of Hours Service.


11. Relevant Contact Details

The Bloomfield Centre Adolescent Service

Guy’s Hospital (12-18 year olds)

Tel: 020 7188 0762

Fax: 0207188 0790

The Belgrave Child Psychiatry Department

King’s College Hospital (0-12 years old) (Emergencies or new cases only)

Tel: 020 3299 3219/3220

Fax: 020 3299 3221

Lister Primary Care Centre (Under 12’s CAMHS Services)

Tel: 020 3049 8470

Fax: 020 7701 8697

E-mail: Alexandra.holt@slam.nhs.uk (Alexandra Holt - Team Leader)

Maudsley Switchboard

(Out of hours CAMHS Specialist Psychiatric Trainee)

Tel: 020 3228 6000

St Thomas’ Hospital Switchboard

(Out of Hours CAMHS Specialist Trainee)

Tel: 0207 188 7188

Southwark CAMHS Neurodevelopmental Service

Sunshine House

Tel: 020 3049 8100

Fax: 020 -3049 8101

Carelink Service for Looked After Children

Dulwich Office, 47b East Dulwich Road    

Manager: Elizabeth Murphy

Tel: 020-7525 4436

Fax: 020- 7525 4449

The Snowsfields Adolescent Unit

Guy’s Hospital

E-mail: anna.schmidt @slam.nhs.uk (Anna Schmidt - Social Worker)

Tel: 020 71886117/6120

Fax: 020-7357-7951

The Bethlem Adolescent Unit

Bethlem Royal Hospital

Social Worker

Tel: 020 3228-4160

Fax: 020-3288 4511

The Bill Yule Adolescent Secure Unit

Bethlem Royal Hospital

Tel: 020-3228-3841

Fax: 020-3288-5011

In-Patients and National & Specialist Child Mental Health Social Work Team

The Michael Rutter Centre

E-mail: sarah.cannell @slam.nhs.uk (Sarah Cannell - Team Manager)

Tel: 020-3228-3881/2575

Fax: 020-3288-5011

Child and Adolescent Mental Health Social Work Service

Sunshine House

E-mail: roger.weissman@slam.nhs.uk (Roger Weissman- Service Development Manager)

Tel: 020-3049 8275

Mobile: 07957657721

Southwark CAMHS Service Manager (Locum)

Sunshine House

E-mail: sisa.madaka@slam.nhs.uk

Tel: 020 3049 8284

Fax: 020 -3049 8261

Southwark CAMHS Service Manager (Locum)

Bloomfield Centre

E-mail: helen.knight@slam.nhs.uk

Tel: 020 7188 0753

Fax: 020 7188 0754

Southwark CAMHS Clinical Lead

E-mail: elizabeth.murphy@slam.nhs.uk (Carelink)

Tel: 020-7525 4436

Fax: 020- 7525 4449

Southwark CAMHS Child & Adolescent Psychiatry Lead

Sunshine House,
27 Peckham Road,
London, SE5 8UH

E-mail: jeremy.turk@slam.nhs.uk (Jeremy Turk - Professor)

Tel: 020-3049-8268/9

Out of Hours Children’s Service
Tel: 020 7525 5000
Business Unit Manager

Assessment and Safeguarding

Southwark Social Services

Sumner House

Tel: 020 7525 1927


Flowchart: Child Mental Health Emergency

Click here to view Flowchart: Child Mental Health Emergency.

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