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'Referral advice' recommendation details

Depression in children and young people

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG28 A child or young person who has been exposed to a recent undesirable life event, such as bereavement, parental divorce or separation or a severely disappointing experience and is identified to be at high risk of depression (the presence of two or more other risk factors for depression), should be offered the opportunity to talk over their recent negative experiences with a professional in tier 1 and assessed for depression. Early referral should be considered if there is evidence of depression and/or self-harm. When a child or young person is exposed to a recent undesirable life event, such as bereavement, parental divorce or separation or a severely disappointing experience, and where one or more family members (parents or children) have multiple-risk histories for depression, they should be offered the opportunity to talk over their recent negative experiences with a professional in tier 1 and assessed for depression. Early referral should be considered if there is evidence of depression and/or self-harm. Time frame not specified
CG28 After up to 4 weeks of watchful waiting, children and young people with continuing mild depression should be offered a course of non-directive supportive therapy, group cognitive behavioural therapy (CBT) or guided selfhelp. Ideally this should be offered by appropriately trained professionals in tier 1 (primary care, schools, social services and the voluntary sector) but may require a referral to tier 2 Child and Adolescent Mental Health Services (CAMHS) depending on local resources. If this is ineffective within 2 to 3 months, they should be referred for assessment by a tier 2 or 3 Child and Adolescent Mental Health Services (CAMHS) team. Antidepressant medication should not be used in the initial treatment of mild depression. Following a period of up to 4 weeks of watchful waiting, all children and young people with continuing mild depression and without significant comorbid problems or signs of suicidal ideation should be offered individual non-directive supportive therapy, group Cognitive Behavioural Therapy (CBT) or guided self-help for a limited period (approximately 2 to 3 months). This could be provided by appropriately trained professionals in primary care, schools, social services and the voluntary sector or in tier 2 Child and Adolescent Mental Health Services (CAMHS). Children and young people with mild depression who do not respond after 2 to 3 months to non-directive supportive therapy, group Cognitive Behavioural Therapy (CBT) or guided self-help should be referred for review by a tier 2 or 3 Child and Adolescent Mental Health Services (CAMHS) team. Time frame not specified
CG28 Factors in patients with depression that favour referral to mental health professionalsinclude: poor or incomplete response to two interventions, recurrent episode within 1 year of previous one, patient or relatives request referral, self-neglect. Factors that favour urgent referral to a psychiatrist: actively suicidal ideas or plans, psychotic symptoms, severe agitation accompanying severe (seven or more) symptoms or severe self-neglect. Urgent
CG28 All children and young people with moderate to severe depression should be assessed by Child and Adolescent Mental Health Services (CAMHS) tier 2 or 3 professionals and offered a specific psychological therapy as a first-line treatment. Children and young people presenting with moderate to severe depression should be reviewed by a Child and Adolescent Mental Health Services (CAMHS) tier 2 or 3 team. Time frame not specified
CG28 For children and young people, the following factors should be used by healthcare professionals as indications that management can remain at tier 1: - exposure to a single undesirable event in the absence of other risk factors for depression - exposure to a recent undesirable life event in the presence of two or more other risk factors with no evidence of depression and/or self-harm - exposure to a recent undesirable life event, where one or more family members (parents or children) have multiple-risk histories for depression, providing that there is no evidence of depression and/or self-harm in the child or young person - mild depression without comorbidity. For children and young people, the following factors should be used by healthcare professionals as criteria for referral to tier 2 or 3 Child and Adolescent Mental Health Services (CAMHS): - depression with two or more other risk factors for depression - depression where one or more family members (parents or children) have multiple-risk histories for depression - mild depression in those who have not responded to interventions in tier 1 after 2?3 months - moderate or severe depression (including psychotic depression) - signs of a recurrence of depression in those who have recovered from previous moderate or severe depression - unexplained self-neglect of at least 1 month's duration that could be harmful to their physical health - active suicidal ideas or plans - referral requested by a young person or their parent(s) or carer(s). For children and young people, the following factors should be used by healthcare professionals as criteria for referral to tier 4 services: - high recurrent risk of acts of self-harm or suicide - significant ongoing self-neglect (such as poor personal hygiene or significant reduction in eating that could be harmful to their physical health) - requirement for intensity of assessment/treatment and/or level of supervision that is not available in tier 2 or 3. Time frame not specified

This page was last updated: 22 August 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.