CAMHS learning disability service referral criteria


  • Positive symptoms – Paranoia, delusional beliefs, abnormal perceptions (hallucinations on all sensory modalities)
  • Negative, symptoms – deterioration in self-care and daily personal, social and family functioning
  • Disinhibited behavior, over activity, risk taking, with pressure of speech and agitation
  • Severe depression with psychomotor retardation, social withdrawal, suicidal ideation
  • See Appendix 10

Mood Disorders

  • We provide a service to young people whose primary presenting problem is a mood disorder. This includes those presenting with moderate to severe depression as well as those young people who present with complex diagnostic issues involving mood and bipolar disorders.

Eating Disorders

  • Anorexia -Anorexia Nervosa is an eating disorder characterised by excessive food restriction and an irrational fear of weight gain and distorted body image.  It typically involves excessive weight loss
  • Bulimia – Engaging in binge and purge behavior
  • Eating Disorders – Other difficulties around food and eating

Significantly impairing Anxiety Disorders of a diagnosable level (e.g. OCD, PTSD)

  • Severe or debilitating Anxiety panic attacks
  • Separation anxiety which severely impacts on the child’s functioning
  • Phobias including phobic anxiety


  • Physical symptoms – poor sleep / appetite / libido
  • Cognitive symptoms – negative thoughts about self / others / world
  • Suicidal ideation – level of intent, current thought, etc
  • Co-morbidity – depression often occurs concurrently with other presenting mental health problems

Post Traumatic Stress Disorder

  • Symptoms occurring more than 3 months after a recognised traumatic event
  • Intrusion and avoidance of thoughts and memories about the trauma
  • Hyper-vigilance, hyper-arousal and emotional numbing

Obsessive Compulsive Disorder

  • Obsessions and / or compulsions with functional impairment

Attention Deficit Hyperactivity Disorder (ADHD) & Autistic Spectrum Disorder (ASD) and Tourettes

  • For initial assessment and diagnosis, follow the local multi-agency protocol
  • Complex ADHD cases with co-morbidity should be referred to Specialist CAMHS
  • Tourettes Syndrome with complex motor and vocal tics, particularly with co-morbidity with OCD and rage

Deliberate Self Harm

  • most commonly skin-cutting but might include burning, scratching, banging or hitting body parts, interfering with wound healing, hair-pulling (trichotillomania) and the ingestion of toxic substances or objects
  • may be associated with suicidal ideation and intent  and/or a pattern of emotional disregulation, interpersonal difficulty and maladaptive coping strategies

Under 5’s

  • Age –Children from 0 to 5 year olds including infants
  • Presenting symptoms This is not an exhaustive list but the following examples are a guideline of appropriate referrals 
  • Behavioural: sleeping, eating difficulties, toileting, aggression, selective mutism etc.
  • Emotional/social: attachment/bonding difficulties, trauma, abuse, quality of family relationship, carers mental health issues, birth trauma / separation anxiety
  • There needs to be some evidence or indication that the presenting difficulties have not been alleviated by Tier 2 Interventions.

Complex Trauma

Complex trauma occurs when an individual is exposed to multiple traumatic events with an impact on immediate and long-term outcomes. Complex trauma is sometimes described as Developmental Trauma when:

  • It occurs through childhood with early onset
  • Is chronic and prolonged
  • Within the family, (interpersonal)
  • Impacts on development

Developmental trauma is sometimes called complex PTSD, but this label is not satisfactory because children can experience developmental trauma and not fulfil the criteria for a diagnosis of PTSD.

CAMHS tier 2/3 criteria for young people with learning disabilities

CRITERION 1: Level of learning disability




MILD learning disabilities

MODERATE learning disabilities

SEVERE/PROFOUND learning disabilities



Expressive language


Often delayed - but usually able to use everyday speech and hold conversations

Delayed and limited – typically acquire the use of only simple phrases/manual signs

Few words only or speech absent




Often delayed – explanations may need to be simplified to aid understanding

Delayed and limited – typically to understanding simple phrases or requests

Very limited understanding if any





Fully independent in majority of areas (eating, washing, dressing, continence etc)

Some supervision required in majority of areas

Constant supervision/support always required in all areas


Difficulties with reading, writing and arithmetic common

Limited - may develop basic literacy and numeracy skills

Severely limited – focus is often on acquiring other skills


No delay in development

Delayed but usually full mobility is achieved

Often severely limited (and sensory impairments common)




Social immaturity common (more impaired if co-morbid ASD)

Limited – but often acquire the basic social skills necessary for interaction

Restricted (and ASD common)


Usually in mainstream school

Usually in special school

Always in special school

Overall support needs

Limited – intermittent and focused support usually needed (e.g. at times of transition) 

Extensive – regular, long-term support needed in at least some environments

Pervasive – constant, high-intensity support needed across all environments

Mental health needs

Needs and presentation similar to children without learning disabilities

Diagnosis often dependent on third-party reports or observing changes in behaviour

Difficulty diagnosing – severe and chronic  behavioural difficulties common

A comparison of terminology


MILD learning disabilities

MODERATE learning disabilities

SEVERE/PROFOUND learning disabilities


Mild developmental delay

Moderate developmental delay

Severe/profound developmental delay


Moderate learning difficulties

Severe learning difficulties


CRITERION 2: Level of need

Tier 3

Tier 2






Such as verbal/physical aggression, self-injury and sexually inappropriate behaviour providing that such behaviours:


  • Are of sufficient frequency, severity or chronicity to require specialist assessment and intervention
  • Impact significantly on the quality of life of the person/others OR present a significant risk to the health and/or safety of the person and/or others
  • Are persistent
  • Are pervasive (occur in a range of situations)



Such as verbal/physical aggression and significantly impaired sleep/eating providing that such behaviours:


  • Are of sufficient frequency, severity or chronicity to require assessment and intervention
  • Impact on the quality of life of the person/others OR present a risk to the health and/or safety of the person and/or others
  • Are persistent
  • Do not only occur at school

CRITERION 3: Previous Interventions

Behavioural/parenting interventions have already been tried by services such as early help, early intervention family support, health sisitor/school nurse, or through courses such as Triple P Stepping Stones.

Any referral must meet all 3 criteria to be accepted by CAMHS learning disability service