Child and adolescent mental health in general practice

A GP looks after people at all life stages. Children are cared for both as patients and as family members of patients.

Every GP should have the skills to consult with a child or young person, and their families or carers, in a way which makes them feel heard and validated, seeks to identify their concerns and expectations, and communicate in a way that is understandable and accessible. All GPs should be able to recognise mental health problems in children and young people (CYP), and manage, refer and/or signpost appropriately.

The RCGP Curriculum details the core knowledge and skills expected of all GPs. These are covered both under the Mental Health Clinical Topic Guide and the Children and Young People Life Stages Topic Guide.  

The Mental Health of Children and Young People in England 2023 report found that 20.3% of eight to 16-year-olds had a probable mental disorder in 2023. Among 17 to 19-year-olds, the proportion was 23.3%. Health services were the second most common source of help and advice for parents of children with a probable mental disorder, and for the 17 to 19-year-olds, and the third most common (after education services and friends or family) for the eight to 16-year-old cohort of children.

A GPwER’s management of the patient extends beyond the medical model, and as a GP they bring important additional skills in practising holistically and dealing with complexity and uncertainty to these roles. The ageless skillset of a GP is particularly beneficial in managing the transition between services for children and young people, and adult services. GPs are embedded in their communities and are familiar with the strengths and challenges that affect the population at all ages, thus able to contextualise difficulties, drawing on their knowledge and experience of local issues. Furthermore, GPs are integral in adopting a system approach to healthcare. Extensive experience working with a variety of agencies, including those who may not usually be related to CAMH services, enables them to bring an additional perspective and explore treatment options by capitalising on system-wide relationships they have developed.

A GP looks after people at all life stages. Children are cared for both as patients and as family members of patients. The age of population eligible for CAMH services will vary by area. Some may only see up to the age of 18, others have bespoke transition services starting earlier, and others work with an older cohort, often up to the age of 25. The practice of a GPwER CAMH will need to be developed in line with the group(s) they are working with.

Establishing the role of GPwER CAMH will serve to support early intervention and prevention of severe and enduring mental illness, and improve access to comprehensive, tailored and informed healthcare in both the primary care setting and in higher tiers of complexity.

The extended role of a GPwER CAMH involves an advanced approach to the recognition, assessment, diagnosis, treatment, and ongoing care of CYP with mental health problems. This expanded role enables GPs to provide more comprehensive and tailored support to individuals and their families by various means, including delivery of brief, evidence-based psychological interventions and pharmacological treatments.

Key areas of delivery

• Early detection and advanced recognition of CYP with mental health problems
• Recognition of factors that contribute to poor mental health, such as adverse childhood experiences (ACEs), and the context in which the child or young person’s difficulties exist, such as their family, life experiences, education and physical health.
• Development of a holistic formulation, through a comprehensive assessment, to identify the needs of the child/young person and those around the child or young person.
• Providing a more comprehensive and tailored support to individuals and their families by various means, including delivery of brief, evidence-based psychological interventions and pharmacological treatments.
• Participation in the development of a multi-disciplinary approach to address the needs of the child or young person and the family or carers.
• Interventions to improve the mental health of the child or young person.

• Gathers comprehensive medical and behavioural histories to better understand the individual's symptoms and challenges, including physical manifestations of mental health conditions.
• Understands the neurodevelopmental stages of childhood and recognises the ranges of normal variation, to avoid inappropriate diagnostic morbidity.
• Explores the presence of, and influence of, childhood trauma and adversity, intergenerational experiences (including epigenetics), the toxic stress response and its consequences, and the strengths which offer protection against adversity.
• Identifies and elicits key risks for poor mental health in CYP, and signposts to, or engages, resources to help address these.
• Considers risk at each interaction, including development of a risk formulation in line with NICE Guideline 225, when indicated, and creates safety plans.
• Develops personalised, evidence-based treatment plans that may include a combination of behavioural interventions, psychoeducation, psychological interventions, and medication management.
• Works closely with the individual, their family and other relevant individuals to tailor the treatment plan to their specific needs, preferences, and circumstances.
• Views the child in the context of their family and life circumstances and considers interventions which may benefit at a wider level, as well as for the individual.
• Prescribes and manages medications, acting within their competence, in collaboration with the individual and specialist if needed, monitoring their effectiveness and addressing any side effects.
• Adjusts medication based on regular assessments of the individual's response and progress.
• Provides lifestyle recommendations to help manage symptoms effectively, including advice on diet, sleep, exercise, drugs and alcohol.
• Understands the range of psychological therapies available for CYP, how to access them, and appreciates the most appropriate types of interventions for the difficulties affecting the CYP.
• Works in an integrated way with direct liaison and a collaborative approach with other specialities, such as paediatrics, learning disabilities, ADHD, autism, substance misuse and gender identity services.
• Co-ordinates with other professionals related to the delivery of safe mental health care, including seeking advice from, or making referrals to, physical health specialists where the CYP’s condition requires it.
• Acts as a central co-ordinator of care, liaising with specialists such as psychologists, psychiatrists, occupational therapists and educators to ensure a holistic approach.
• Conducts regular follow-up appointments to assess the individual's progress, adjusts the treatment plan as needed, and addresses any concerns or questions.
• Monitors the impact of ADHD on academic, occupational, and social functioning, providing guidance to enhance overall wellbeing and performance.
• Responds to queries and/or concerns from the CYP’s general practice in a timely and supportive fashion, offering advice and education where appropriate.
• Exercises a high level of professional curiosity and exhibits high level awareness of safeguarding issues, including liaison with relevant agencies and appropriate information sharing when risks are suspected or identified.
• Appreciates the benefits and risks associated with contact details and information technology in communication and delivery of healthcare, including specific issues related to proxy access to medical records.
• Uses knowledge of healthcare delivery to inform and develop systems which improve accessibility.
• Promotes, encourages, and supports research in general practice about the mental health of children and young people.

Mental health conditions in children and young people frequently co-exist with other problems. Therefore, although not expected to be a specialist in the area, key competences are required in the areas of neurodivergence and substance misuse.

• Recognises the possibility of, and enquires about, comorbid neurodiversity and substance misuse, including considering whether either may better account for the difficulties the CYP is experiencing.
• Has an awareness of the continually changing landscape in the misuse of drugs and alcohol, recognising that the prevalence and types of substances involved evolves over time.
• Recognises the potential psychotropic and psychological effects of alcohol and substances on the developing brain, as well as the possibility of altering presentations of mental health conditions and interactions with medications.
• Appreciates the relationships between genetic predisposition, epigenetics and childhood adversity/trauma, and how they may impact the CYP.
• Delivers brief interventions for drug and alcohol misuse and facilitates specialist input.
• Exercises strategies to minimise harm, including education and risk reduction advice.
• Understands the broad difficulties affecting children and young people with autistic spectrum disorders and takes a whole-family approach in support and onward referral.
• Recognises, and enquires about, the key symptoms of ADHD – inattention, hyperactivity and impulsivity – and recognises that the pattern of difficulties varies between individuals, whilst noting broad differences in presentation between genders, with the aim of minimising missed diagnoses.
• Has a working knowledge of ADHD medications, with a particular focus on interactions with medications used within their practice as a GPwER.
• Takes into account neurodiversity and makes adaptations where possible to facilitate assessment and develop collaborative treatment plans.
• Does not allow the presence of neurodivergence or alcohol/substance misuse to preclude treatment for a mental health condition. Works collaboratively with these services to deliver holistic and co-ordinated care.