If a child is in distress or showing troubling behaviour and their GP thinks they need to see a mental health service, you'd think that is what they would get.
It isn't as simple as that, as I reported yesterday. More than 7,000 young people a year are turned away by Scotland's Child and Adolescent Mental Health Services, despite many of them having been referred by their family doctor.
It's the same for other referrals. I can't count the number of times, in my role as a children's panel member, that I've been told by a social worker that a young person whose behaviour is causing serious concern, has been referred for help from Camhs.
And the number of times those same children have ultimately been turned down for help from Camhs.
That's not to be critical of the service. While significantly underfunded, especially in the face of rising demand, it is right that there should be a threshold.
NHS Scotland uses four tiers to identify a child in mental health need. Those at most risk of rapidly declining mental health or serious self harm are likely to have a consultant child and adolescent psychiatrist or clinical psychologist responsible for their care (tier four) and those in tier three will are also likely to have been diagnosed with one or more severe, complex and persistent disorders.
It doesn't help to overreact to problems or involve young people in medicalised treatment that they don't need.
It isn't uncommon, for instance, to see young people come before a children's hearing who are plainly isolated and depressed, or who are unhappy and troubled in a foster placement. Perhaps they are traumatised by memories of an early childhood of neglect and abuse. Maybe they are having regular contact with parents who are unable to suppress their own problems and put the child's interests first.
It will not help to label such young people, still less to medicate or medicalise those whose mental health problems might seem a more than rational reaction to some of the issues they have had to face.
But those at the lower end are suppose to get help from a primary care mental health worker – such as community psychiatric nurses, or other staff from art, music and drama therapists to social workers.
This, anecdotally, at least, is where the gaps are, according to Billy Watson, chief executive of the Scottish Association of Mental Health. The charity is gathering experiences from those – young people and families – who have had referrals to Camhs rejected. What was offered instead? Did they get it? Did it help?
Their condition may not be urgent at the point of referral. But if a GP refers them it suggests there is a problem. Unaddressed it is not hard to see that problems will escalate, so tackling these gaps is as important as addressing the pressures higher up the scale of mental health need.
The problem is that many don't.
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