The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care

The Framework has been developed to assist all agencies with planning and delivering integrated approaches to children and young people's mental health.


Art Therapy: Art therapy offers an opportunity to explore intense or painful thoughts and feelings in a supportive environment. It involves use of a wide variety of art materials, for example paints, clay and batik, to create a visual representation of thought and feelings. Art therapy can be an individual activity but is often used very successfully in group situations.

Child and Adolescent Mental Health Services ( CAMHS): Child and adolescent mental health services ( CAMHS) is sometimes used to embrace the range of services across agencies that contribute to the mental health and care of children and young people. These are sometimes referred to as universal or Tier 1 services and include those services whose primary function is not mental health care, such as general practice, schools and social services. The term is also used to describe specialist CAMHS, which mainly comprise professionals who have specific training in children's and young people's mental health, and which provide specialist mental health assessment and treatment. Specialist CAMHS are sometimes referred to as Tier 2, 3 or 4 services. They include generic multi-discipline teams, single professional teams, targeted teams ( e.g. for looked after children and young people), "outposters" ( i.e. people who are CAMH-trained and employed, but who work in non- CAMHS settings), and specialist care teams ( e.g. day patient, inpatient, intensive outreach).

The following table is adapted from the English National Service Framework 88 and describes the different tiers of CAMHS which are sometimes referred to. These were first published in Together We Stand89 and have been misinterpreted by some to represent a hierarchical model of service relationships. However, the English National Service Framework notes that " in reality, there will be some children and young people that may require services from a number, or even all of the tiers, at the same time".

Tier 1: A primary level of service provided within universal services and including mental health promotion, general advice and identification of mental health problems early in their development.

Professionals providing the service include:

  • GPs
  • Public Health Nurses (Health Visitors and School Nurses)
  • Teachers
  • Social workers
  • Voluntary agencies

Tier 2: A level of service provided by uni-professional groups which relate to each other through a network rather than a team. Functions include assessment, care and treatment for children and young people, and consultation and advice to professionals in Tier 1.

  • Practitioners with special interest
  • Clinical child psychologists
  • Paediatricians (especially community)
  • Educational psychologists
  • Child and adolescent psychiatrists
  • Community nurses/nurse specialists
  • Social workers
  • Voluntary agencies

Tier 3: A specialised service for more severe, complex or persistent mental health problems. Assessment and treatment is the core function.

  • Child and adolescent psychiatrists
  • Clinical child psychologists
  • Nurses (community and inpatient)
  • Child psychotherapists

Tier 4: Essential tertiary level services such as day units, highly specialised outpatient teams and inpatient units. Assessment and treatment is the core function.

  • Occupational therapists
  • Speech and language therapists
  • Art, music and drama therapists
  • Social workers
  • Voluntary agencies

Child Health Commissioner: The representative within each NHS Board with responsibility for ensuring that appropriate health services are in place to meet the needs of the local population of children and young people. See

Choose Life: The national suicide prevention programme for Scotland, and part of the National Programme for Improving Mental Health & Wellbeing - .

Clinical Psychologist: These staff most often work in the NHS, providing psychological support. They diagnose and evaluate mental and emotional disorders, and use tools such as psychotherapy and hypnosis to treat affected patients. They conduct interviews and psychological tests, and may conduct complex treatment programmes, sometimes in conjunction with physicians or other specialists.

Community Learning and Development: Community learning and development ( CLD) is learning and social development work with individuals and groups in their communities using a range of formal and informal methods. A common defining feature is that programmes and activities are developed in dialogue with communities and participants. The main aim is to help individuals and communities tackle real issues and grasp opportunities in their lives through community action and community-based learning 90.

Counselling: A process whereby one person helps another using a style of listening which is non-judgmental, non-directive, of a reflective nature, and which encourages clients to work through their issues.

Drama Therapy: An active approach that aims to help a person use drama as part of the recovery process. It can give a person an opportunity for reflection and to tell his or her story to help solve a problem and achieve a catharsis.

Educational Psychologist: Educational psychologists are employed by education authorities, who have a duty 91 to provide a psychological service. Educational psychologists work at three main levels: the individual child or family, the school or establishment, and the local authority. At each of these levels, educational psychologists have five core functions: consultation, assessment, intervention, training and research. They work with children and young people in both mainstream and special sectors across the spectrum of education, behaviour and development issues. They often co-ordinate the work of a multi-disciplinary team around the needs of an individual child.

Emotional Literacy: Being able to recognise what you are feeling so that it doesn't interfere with thinking. It becomes another dimension to draw upon when making decisions or encountering situations.

Family Centres: These can vary in terms of service provision, but generally, they will encompass the core aims of improving child health, particularly in relation to special needs and disability, promoting good parenting and better parent-child relationships through programmes of family support and Community Learning for all ages.

Family Therapy: A form of psychotherapy in which the interrelationships of family members are examined in group sessions in order to identify and alleviate problems of one or more family members.

Health Promotion: The Ottawa Charter 92 defines health promotion as "the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing".

There are 5 elements to promoting health:

  • Build healthy public policy
  • Create supportive environments
  • Strengthen community action
  • Develop personal skills
  • Reorient health services

Health Promotion Staff: Staff employed specifically to support the process of promoting health, usually employed by the NHS.

Healthy Living Centres: Lottery-funded centres that are usually based in more economically deprived communities. They provide access to classes and activities that encourage and help local people to lead healthy lifestyles.

Integrated Care Pathways ( ICPs): A multi-disciplinary outline of anticipated care, placed in an appropriate timeframe, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to positive outcomes. ICPs are important because they help to reduce unnecessary variations in patient care and outcomes. They support the development of care partnerships and empower patients and their carers.

LAC Nurses: Nurses who work specifically with children and young people who are looked after and accommodated. Usually employed by the NHS, these staff attend to the health needs of the whole child. Not all areas have LAC Nurses.

Managed Care Networks: Groups of staff who adopt a partnership approach, reflecting the need for greater integration of services and better joint working between the statutory and voluntary organisations and with service users and carers. Networks allow a joint approach to the redesign of services, linking together all the points at which services, care and support are delivered.

Mental Disorder: When mental health problems are persistent, severe or complex, and interfere with a person's day-to-day functioning, they are often defined as mental disorders. In some severe cases, the term psychiatric or mental illness is used. The SNAP report notes that the practice of making use of diagnostic labels has risks attached, particularly in terms of stigma.

Mental Health: The SNAP report acknowledges that there is no single accepted definition for mental health. It explores a number of concepts and adopts the following description, from the 1997 International Workshop on Mental Health Promotion, to emphasise that mental health is both personal and social: "Mental health is the capacity of each and all of us to feel, think and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual wellbeing that respects the importance of culture, equity, social justice, interconnections and personal dignity"93.

Mental Health Problems:Together We Stand94 describes mental health problems as "difficulties and/or disabilities in the realm of personal relationships, psychological development, the capacity for play and learning and in distress and maladaptive behaviour. They are relatively common, and may or may not be persistent".

Mental Health Promotion: This involves any action to enhance the mental wellbeing of individuals, families, organisations and communities. Mental health promotion is essentially concerned with:

  • How individuals, families, organisations and communities think and feel
  • The factors which influence how we think and feel, individually and collectively
  • The impact that this has on overall health and wellbeing

Everyone has mental health needs, whether or not they have a diagnosis of mental illness. Mental health promotion programmes that target the whole community will also include and benefit people with mental health problems.

Mental Welfare Commission ( MWC): An independent organisation set up by the Scottish Parliament with the responsibility for protecting the welfare of people with mental disorder (including learning disabilities and dementia) in Scotland. The work of the MWC includes visiting people in hospital and in the community, investigating cases of deficiency in care or treatment and providing information and advice. See .

Music Therapy: There are different approaches to the use of music in therapy. Depending on the needs of the client and the orientation of the therapist, different aspects of the work may be emphasised. Fundamental to all approaches, however, is the development of a relationship between the client and therapist. Music-making forms the basis for communication in this relationship. As a general rule, both client and therapist take an active part in the sessions by playing, singing and listening. The therapist does not teach the client to sing or play an instrument. Rather, clients are encouraged to use accessible percussion and other instruments and their own voices to explore the world of sound and to create a musical language of their own. By responding musically, the therapist is able to support and encourage this process. Much of the music is improvised, thus enhancing the individual nature of each relationship. Through whatever form the therapy takes, the therapist aims to facilitate positive changes in behaviour and emotional wellbeing. He or she also aims to help the client develop an increased sense of self-awareness, and thereby to enhance his or her quality of life. The process may take place in individual or group sessions.

National Care Standards: In order to raise the level of care in Scotland and ensure that service users receive the same quality of care no matter where they live, Scottish Ministers have developed national care standards for a wide range of care services. The standards have been created from the service user's point of view and are designed to explain what can be expected from care services.

They also help service users to raise concerns or make a complaint. The standards are based on the following six principles:

  • Dignity
  • Privacy
  • Choice
  • Safety
  • Realising potential
  • Equality and diversity

The Care Commission regulates and inspects all care services in Scotland using the National Care Standards to ensure that service users receive the same standard of care wherever they live in Scotland. See

Play Therapy: Uses a variety of play and creative arts techniques to alleviate chronic, mild and moderate psychological and emotional conditions in children that are causing behavioural problems and/or are preventing children from realising their potential. The play therapist works in an integrated way using a wide range of play and creative arts techniques, mostly responding to the child's wishes. This distinguishes the play therapist from more specialised therapists (art, music, drama, etc.) and from those using therapeutic play skills. The play therapist forms a short to medium term therapeutic relationship and often works systemically taking into account and perhaps dealing with the social environment of the clients (peers, siblings, family, school, etc.). Clinical supervision is essential. Play therapy may be non-directive (where the child decides what to do in a session, within safe boundaries), directive (where the therapist leads the way) or a mixture of the two.

Primary Care Team: The initial contact for many people when they develop a health problem is with a member of the primary care team, usually their GP. Many other health professionals work as part of this frontline team - nurses, health visitors, dentists, opticians, pharmacists and a range of specialist therapists. NHS 24 and NHS walk-in-centres are also primary care services.

Primary Mental Health Workers: Sometimes also called "Mental Health Link Workers". Throughout this document, reference is made to "Primary Mental Health Workers ( PMHWs)". This role was described in Together We Stand95 and was recommended as a way of improving the relationship, communication and collaboration between specialist mental health services ( CAMHS) and the wider network of services working with children, e.g. schools, youth and community services, primary care, etc.. Primary Mental Health Workers tend to operate in Tiers 1 and 2. In some parts of the UK, including Scotland, this has led to the establishment of PMHW posts. In other areas, the role has been developed, but delivered in a variety of ways. In some cases, workers are employed specifically to deliver primary mental health work, whilst in others, this work is achieved though an extension of pre-existing professional roles. The CAMH Workforce Group will offer further advice about this.

Personal & Social Education ( PSE): In Personal and Social Education ( PSE), the learning and teaching focus is on the qualities, skills, knowledge and understanding needed for pupils to:

  • Function effectively as individuals and learners
  • Form considerate and supportive relationships
  • Interact effectively with the natural and social environment
  • Make the transition to adult and working life
  • Operate effectively within the community

The quality of a school's PSE programme is a major factor in the promotion of fairness, citizenship and health. It follows that health promotion will be an integral part of a school's PSE programme. Opportunities will arise within this programme for pupils to:

  • Develop self-awareness and self-esteem
  • Recognise their individuality
  • Explore their own and others' attitudes and values
  • Develop personal and interpersonal skills
  • Increase their knowledge and understanding of a variety of lifestyles and health issues

Pupils should be permitted to explore feelings and emotions, reflect on past experiences, and discuss topical issues relevant to their situation and stage of development.

Psychotherapeutic Support: The treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems, with the goal being relief of symptoms, changes in behaviour leading to improved social and vocational functioning, and personality growth.

Public Health Nurses: In 2001, Nursing for Health96 recommended that a new discipline of public health nursing should be developed, bringing together health visiting and school nursing into a single discipline with a shared educational programme and a common focus on addressing the health needs of identified communities. The term "public health nurse" encompasses both health visiting and school nursing and, in time, is expected to replace the titles "Health Visitor" and "School Nurse".

Resilience: A resilient child can resist adversity, cope with uncertainty and recover more successfully from traumatic events or episodes 97.

Scottish Institute for Human Relations ( SIHR): The Scottish Institute of Human Relations exists to promote a deeper understanding of human relations and to develop this understanding in key areas of national life. SIHR provides both services and training. See .

See Me: Part of the National Programme for Improving Mental Health & Wellbeing, see me was launched in October 2002 to challenge stigma and discrimination around mental ill-health in Scotland. The campaign combines an award-winning national publicity programme with local and national anti-stigma action developed in partnership with like-minded groups and individuals across all sectors of Scottish life. Individuals who have experienced stigma are involved in many aspects of the campaign, including those prepared to talk to the media about the impact stigma has had on their lives. See .

Social Competence: Social competence is possessing and using the ability to integrate thinking, feeling and behaviour to achieve social tasks and outcomes valued in the host context and culture. In a school setting, these tasks and outcomes would include accessing the school curriculum successfully, meeting associated personal, social and emotional needs, and developing transferable skills and attitudes of value beyond school.

Social Service Staff: All staff employed in the social service workforce.

Social Workers: Professionally qualified staff who are registered to practice with the Scottish Social Services Council.

Social Work Services: Services provided or commissioned by local authorities to meet identified social needs of the communities they serve.

Sure Start Workers: Sure Start Scotland 98 provides targeted support for families with very young children (aged 0-3 years). It aims to:

  • Improve children's social and emotional development
  • Improve children's health
  • Improve children's ability to learn
  • Strengthen families and communities

Services are developed around existing provision and on the basis of the identified needs of each family. Funding for Sure Start is channelled through local authorities, but they are expected to work in partnership with other local service providers, including health services and the voluntary sector, to devise local solutions to meet identified local need.

Throughcare and Aftercare: "Throughcare" is the preparation of young people for leaving care, and "aftercare" is support for their first few years of independence.

Youth Work: Youth work takes place in a variety of community settings and uses a variety of approaches to engage young people. It supports young people to realise their potential and to address life's challenges critically and creatively; it takes account of all strands of diversity. Some of those engaged in youth work are employed by statutory or voluntary agencies, whilst others are volunteers. YouthLink Scotland has developed a statement describing the nature and purpose of youth work 99.

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