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Gordana Milavić, Clinical Director, Child and Adolescent Mental Health Services (CAMHS), The South London and Maudsley NHS Foundation Trust and Lead Clinician, National and Specialist Services, CAMHS Directorate, CAMHS, Michael Rutter Centre, Maudsley Hospital, London, UK
There are many similarities between the psychiatric intensive care of adults and the management of children and young people who present with serious mental health problems. However, there are equally a number of differences stemming from the biological, developmental and social aspects pertinent to childhood and adolescence.
In everyday clinical practice young people presenting with severe and complex psychiatric disorders requiring inpatient treatment receive that treatment in a variety of settings. At best they are treated in adolescent inpatient units or the few adolescent intensive care or forensic units, but an increasing number of young people go on to receive treatment in adult mental health units including Psychiatric Intensive Care Units (PICUs). This happens mainly because of a lack of specialist inpatient resources in the Child and Adolescent Mental Health Service (CAMHS) sector.
This chapter will focus on the key components and functions of CAMHS with particular reference to the group of young people with serious psychiatric and/or behavioural disorders who pose a high risk to themselves or others and are likely to require admission to adult PICUs.
CAMHS service structure
Child and Adolescent Mental Health Services can be managed by Primary Care Trusts, Mental Health Trusts or in some cases acute hospital services as part of paediatric services. Children's Trusts are a more recent development in which social services, education and health come together jointly to commission and to provide comprehensive children's services including CAMHS.