Depression (CAMHS)

Feelings of sadness are a normal part of childhood/adolescence and in most cases are temporary and often resolve on their own. Depression is characterised by disturbances of mood, sleeping, irritability, decrease in energy, social isolation, school performance is affected and thoughts of self-harm and suicidal ideation have been expressed.

Symptoms of depression or low mood in children often include:

Sadness, or a low mood that does not go away
Being irritable or grumpy all the time
A loss of interest in things they used to enjoy
Feeling tired and exhausted a lot of the time

Trouble sleeping or sleeping more than usual
Being unable to concentrate
Interacting less with friends and family
Being indecisive
Losing confidence
Eating less than usual or overeating
Having big changes in weight
Seeming unable to relax or being more lethargic than usual
Talking about feeling guilty or worthless
Feeling empty or unable to feel emotions (numb)
Having thoughts about suicide or self-harming
Self-harming, for example, cutting their skin, taking an overdose or behaving in ways that places them at risk.

Some children and young people (CYP) have problems with anxiety as well as depression. Some also have physical symptoms, such as headaches and stomach aches.

Tier 2 CAMHS – Tier 2 Teams – Child and Adolescent Mental Health Services

The CAMHS Tier 2 service comprises a team of mental health professionals called Primary Mental Health Workers (PMHW). One team covers East, Mid and West Lothian and another covers Edinburgh North and South.

CAMHS Tier 2 support CYPs mental health needs by offering an assessment through conversation with a CYP and their family/carer, followed by individualised signposting.

GPs can discuss referrals with a Tier 2 PMHW, who can advise whether a referral may require assessment by Tier 3 CAMHS.

CYP who show persistent or severe symptoms of depression or low mood, which interfere with daily function, should be referred to CAMHS.

We recommend GPs should meet and review a CYP prior to referral as often difficulties can resolve without intervention.

Specialist services should be involved:

URGENTLY if the person is actively suicidal or thought to have a psychosis
Where the child’s development or level of functioning has been seriously affected or there has been a sudden deterioration
Where it appears to be out of proportion to the family circumstances
Where there is a significant impact on the parent / carer / child relationship-please describe in referral.

Should the GP consider that an antidepressant is warranted, this requires referral to a CAMHS psychiatrist.

Parents, carers or trusted adults play an important role in supporting their child through experiences of low mood and depression. They help their child feel safe, heard and accepted, and support them to make sense of difficult emotions that can feel overwhelming. By staying connected, responding with warmth and patience, validating feelings, and gently encouraging everyday activities, parents and carers can help reduce withdrawal, build hope, and support recovery over time. Helpful ways for parents and carers to talk to their child or young person can be found in Resources and Links.

G.K & C.M – 6-10-26

Who can refer

GPs, school nurses, health visitors, teachers, social workers.

Who to refer to Tier 3 CAMHS

A referral to CAMHS can be considered,

URGENTLY if the person is actively suicidal or thought to have a psychosis
Where the child or young person development or level of functioning has been seriously affected or there has been a sudden deterioration
Where there are more than age-appropriate variations of mood
Where there is a significant change from previous levels of functioning, in the areas described above
Where it appears to be out of proportion to the family circumstances
Where there is a significant impact on the parent / carer / child relationship

Please describe this impact clearly in the referral.

Who not to refer

Children and young people whose changes in mood are age appropriate and return to previous level of functioning, are not sustained over time or pervasive across settings.

How to refer

Please:

Discuss referrals with Tier 2 PMHW, if it is not clear whether an assessment by Tier 2 or Tier 3 CAMHS is required.
Otherwise refer via SCI Gateway to CAMHS.

For children and young people who do not meet the criteria for CAMHS you may wish to direct them to locality based mental health information/resources – please see Resources and Links for details.

For children and young people who do not meet the criteria for CAMHS please consider locality based mental health information/resources:

Wellbeing – The City of Edinburgh Council (Edinburgh)
http://midspace.co.uk/ (Midlothian)
http://eastspace.org.uk/ (East Lothian)
http://www.westspace.org.uk/ (West Lothian)

Healthy reading scheme, available in some Lothian libraries.

NICE Guidelines:

Overview | Depression in children and young people: identification and management | Guidance | NICE

Helpful resources for parents and carers

Talking to your child about feelings – NHS

Individual sessions and a workbook for parents and carers, recorded by NHS Lothian CAMHS Clinical Psychology is available via this link, Low Mood and Depression

The recordings cover the following topics:

Understanding depression or low mood in children and young people,
Causes
Supports and treatments, including building relationships, getting back to basics, increasing activity, tackling negative thoughts, supporting a child experiencing suicidal thoughts and autistic young people with low mood or depression.

Self-care for parents and carers is important while supporting a child or young person in understanding and managing their mental health. Information can be found here:

Helpful websites for young people

Royal College of Psychiatrists have a range of resources written by mental health professionals and young people:

Young minds offer information on different mental health presentations, accessing support and what it may look like, and how to support a friend if they are struggling.