{"id":194328,"date":"2023-03-03T11:01:18","date_gmt":"2023-03-03T11:01:18","guid":{"rendered":"https:\/\/oxfordhealth.nhs.uk\/camhs\/?page_id=194328"},"modified":"2025-03-17T12:28:29","modified_gmt":"2025-03-17T12:28:29","slug":"confidentiality","status":"publish","type":"page","link":"https:\/\/oxfordhealth.nhs.uk\/camhs\/carers\/family-ambassadors\/confidentiality\/","title":{"rendered":"Managing tier 4 admission"},"content":{"rendered":"<h2>What is CAMHS tier 4?<\/h2>\n<div class=\"ohft-box gray\">\n<p>Child and Adolescent Mental Health Services (CAMHS) support young people experiencing poor mental health and are organised in a tiered system.<\/p>\n<ul style=\"list-style-type: square\">\n<li><strong>Tier 1<\/strong> &#8211; provides early intervention through schools, GPs, health visitors.<\/li>\n<li><strong>Tier 2<\/strong> &#8211; provides early help and targeted services, including some CAMHS services e.g. counselling.<\/li>\n<li><strong>Tier 3<\/strong> &#8211; provides specialist CAMHS services in the community, including eating disorder services.<\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/camhs\/t4\/\" target=\"_blank\" rel=\"noopener\"><strong>Tier 4<\/strong><\/a> &#8211; is highly specialised day and inpatient units, where young people with more severe mental health problems can be assessed and treated.\u00a0 This can be voluntary, or as a person who have been detained under the Mental Health Act.<\/li>\n<\/ul>\n<\/div>\n<h2>CAMHS Tier 4 Services<\/h2>\n<p>CAMHS Tier 4 Services include care that is inpatient, intensive outpatient or day care treatment, which reflects a level of need equivalent to inpatient care.<\/p>\n<div class=\"ohft-box gray\">\n<ul>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/highfieldunit\/\" target=\"_blank\" rel=\"noopener\">Highfield Unit inpatient services<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/camhs\/swindon\/inpatient\/\" target=\"_blank\" rel=\"noopener\">Marlborough House inpatient and day care services<\/a><\/li>\n<li>Meadow Unit Psychiatric Intensive Care Unit (PICU)<\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/13\/2024\/08\/HOSPITAL-AT-HOME-INFORMATION-LEAFLET.pdf\">Hospital at Home for Eating Disorders (H@H for ED)<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/camhs\/t4\/hospitalhome\/\" target=\"_blank\" rel=\"noopener\">Hospital at Home Learning Disabilities and Autism service (H@H LDA)<\/a><\/li>\n<li><a href=\"https:\/\/cypf.berkshirehealthcare.nhs.uk\/our-services\/children-and-adolescent-mental-health-services-camhs\/phoenix-unit-tier-4-alternative-to-admission-service\/\" target=\"_blank\" rel=\"noopener\">Phoenix Day Alternative to Admission service<\/a><\/li>\n<\/ul>\n<\/div>\n<h2>Travel Expenses<\/h2>\n<div class=\"ohft-box gray\">\n<p>Managing travel costs can be a worry for some families.\u00a0 We have posted some information on this here under &#8216;<a href=\"https:\/\/oxfordhealth.nhs.uk\/camhs\/carers\/family-ambassadors\/is-your-child-entitled-to-benefits\/\" target=\"_blank\" rel=\"noopener\">Help with travel costs<\/a>&#8216;.<\/p>\n<\/div>\n<h2>Helpful info for your child&#8217;s inpatient stay<\/h2>\n<p>#GettingThrough guides were created by and for families in collaboration with NHS England. They offer useful information for families when their child or young person (CYP) has been admitted to a CAMHS Tier 4 inpatient unit. The #GettingThrough guides can be accessed below.<\/p>\n<div class=\"ohft-box gray\">\n<p><a href=\"https:\/\/www.england.nhs.uk\/publication\/gettingthrough\/\" target=\"_blank\" rel=\"noopener\">#GettingThrough guides<\/a> there are five guides in total.<\/p>\n<ul>\n<li>Getting through meetings during an inpatient stay<\/li>\n<li>Getting through family life during an inpatient stay<\/li>\n<li>Getting through communication during an inpatient stay<\/li>\n<li>Getting through the first few days: staff guidance<\/li>\n<li>Getting through the first few days: patient booklet<\/li>\n<\/ul>\n<p>First Do No Harm have also written a fantastic <a href=\"https:\/\/www.first-do-no-harm.com\/for-current-patients-families\" target=\"_blank\" rel=\"noopener\">step by step guide<\/a> to ensure you are actively involved in your young persons care, when they are admitted to a mental health unit.<\/p>\n<\/div>\n<h2>Advice for supporting your child&#8217;s mental health<\/h2>\n<div class=\"ohft-box gray\">\n<p><a href=\"https:\/\/thismayhelp.me\/\" target=\"_blank\" rel=\"noopener\">This May Help<\/a> offers some practical advice and short videos to help in supporting your young person with mental health needs.\u00a0 This includes some topics such as school avoidance, self-harm, eating disorders and de-escalating anger.\u00a0 There are also downloadable advice pages that you can print off.<\/p>\n<\/div>\n<h2>Guides to help understand CAMHS T4 processes<\/h2>\n<div class=\"ohft-box gray\">\n<ul>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/13\/2024\/08\/CAMHS-Family-Survival-Guide.pdf\">CAMHS Tier 4 A Family Survival Guide<\/a> a comprehensive reference guide written and edited by experienced parents.<\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/13\/2024\/08\/Education-Survival-Guide.pdf\" target=\"_blank\" rel=\"noopener\">SEND Education Family Survival Guide<\/a> help for parents to understand the SEND system.<\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/13\/2024\/08\/Avoiding-Crisis-A-Survival-Guide.pdf\" target=\"_blank\" rel=\"noopener\">Crisis Prevention A Family Survival Guide<\/a> support for families to understand and access local education, health and care services to avoid a potential crisis.<\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/camhs\/about\/glossary\/\" target=\"_blank\" rel=\"noopener\">Jargon Buster<\/a> guide to common acronyms in Children and Adolescent Mental Health Services.<\/li>\n<li><a href=\"https:\/\/www.nhs.uk\/conditions\/social-care-and-support-guide\/help-from-social-services-and-charities\/care-for-people-with-mental-health-problems-care-programme-approach\/\" target=\"_blank\" rel=\"noopener\">Information about the Care Programme Approach (CPA)<\/a> NHS guide to explain how the care programme approach works.<\/li>\n<li><a href=\"https:\/\/www.rethink.org\/advice-and-information\/living-with-mental-illness\/treatment-and-support\/care-programme-approach-cpa\/\" target=\"_blank\" rel=\"noopener\">Rethink Mental Illness, Care Programme Approach (CPA)<\/a> at the bottom of the page is a factsheet that you can download.<\/li>\n<\/ul>\n<\/div>\n<h2>Human rights and legal rights<\/h2>\n<p>Below are some links explaining what your child\u2019s rights are when they are in a mental heath unit.<\/p>\n<div class=\"ohft-box gray\">\n<ul>\n<li><a href=\"https:\/\/www.bihr.org.uk\/our-work\/our-programmes\/transforming-organisations\/camhs\" target=\"_blank\" rel=\"noopener\">Human Rights in CAMHS | British Institute of Human Rights<\/a> (bihr.org.uk) explaining young people\u2019s rights in inpatient mental health units and human rights law<\/li>\n<li><a href=\"https:\/\/www.mind.org.uk\/for-young-people\/your-rights\/\" target=\"_blank\" rel=\"noopener\">Information for 11-18 year olds: your rights<\/a> (Mind) understanding legal rights for 11 \u2013 18 year olds with mental health difficulties<\/li>\n<li><a href=\"https:\/\/childlawadvice.org.uk\/information-pages\/child-in-need-services\/\" target=\"_blank\" rel=\"noopener\">Requesting a Child &amp; Family Assessment under Section 17 of the Children Act 1989<\/a> &#8211; your right to a child and family assessment to assess the needs of the child (and also the carer).<\/li>\n<\/ul>\n<\/div>\n<h2>The Mental Health Act and being sectioned<\/h2>\n<p>If you are &#8216;sectioned&#8217;, this means that you are kept in hospital under the Mental Health Act.\u00a0 \u00a0There are different types of sections, each with different rules to keep you in hospital.\u00a0 You can find out more about your rights when you are sectioned below.<\/p>\n<div class=\"ohft-box gray\">\n<ul>\n<li>It can be very helpful to know about your rights as a \u2018nearest relative\u2019.\u00a0 Nearest relative is a legal term used in the Mental Health Act.\u00a0 A factsheet can be located here:\u00a0<a href=\"https:\/\/www.rethink.org\/advice-and-information\/rights-restrictions\/mental-health-laws\/nearest-relative-under-the-mental-health-act\/\">https:\/\/www.rethink.org\/advice-and-information\/rights-restrictions\/mental-health-laws\/nearest-relative-under-the-mental-health-act\/<\/a><\/li>\n<li><a href=\"https:\/\/www.mind.org.uk\/information-support\/legal-rights\/mental-health-act-1983\/about-the-mha-1983\/\" target=\"_blank\" rel=\"noopener\">The Mental Health Act<\/a> explains the Mental Health Act, being sectioned and your child&#8217;s rights.<\/li>\n<li><a href=\"https:\/\/www.mind.org.uk\/information-support\/legal-rights\/sectioning\/my-rights\/#CanIRefuseTreatment\" target=\"_blank\" rel=\"noopener\">My rights if I&#8217;ve been sectioned<\/a> from Mind.<\/li>\n<li>Mental Health Act and your child <a href=\"https:\/\/www.mind.org.uk\/information-support\/legal-rights\/leaving-hospital\/section-117-aftercare\/\" target=\"_blank\" rel=\"noopener\">Explain Section 117 of the Mental Health Act, \u2018Section 117 Aftercare\u2019<\/a><\/li>\n<\/ul>\n<\/div>\n<h2>About Care, Education and Treatment Reviews (CETRs)<\/h2>\n<p>Care, Education and Treatment Reviews (CETRs) are for young people with learning disabilities or autism and mental health issues who have been admitted to a CAMHS Tier 4 inpatient unit, or for those at risk of admission.\u00a0 Their purpose is to ensure that young people are only admitted if absolutely necessary and for the minimum amount of time possible, and to ensure they have good care at the right time and in the right place.<\/p>\n<div class=\"ohft-box gray\">\n<ul>\n<li><a href=\"https:\/\/www.england.nhs.uk\/long-read\/dynamic-support-register-and-care-education-and-treatment-review-policy-and-guide-plain-english-version\/#the-dynamic-support-register\" target=\"_blank\" rel=\"noopener\">The Dynamic support register (DSR) and Care, Education and Treatment Reviews (CETRs)<\/a> for young people with learning disabilities or autism who are in hospital, or at risk of going to hospital.\u00a0 See below for more information about CETRs.<\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/13\/2024\/09\/CTR-Survival-Guide-Aug-2017-1.pdf\">Care &amp; Treatment Review, A Family Survival Guide<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/13\/2024\/05\/My-Care-Education-and-Treatment-Review-Planner-and-Consent.docx\">My Care Education and Treatment Review Planner and Consent<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/13\/2024\/05\/Easy-Read-My-Care-Education-and-Treatment-Review-Planner-and-Consent.docx\">Easy-Read &#8211; My Care Education and Treatment Review Planner and Consent<\/a><\/li>\n<li><a href=\"https:\/\/www.england.nhs.uk\/learning-disabilities\/care\/ctr\/care-education-and-treatment-reviews\/\" target=\"_blank\" rel=\"noopener\">NHS England Care Education &amp; Treatment Reviews (CETRs)<\/a> to meet the needs of young people with learning disabilities and autism.<\/li>\n<li><a href=\"https:\/\/www.england.nhs.uk\/learning-disabilities\/care\/children-young-people\/keyworkers\/\" target=\"_blank\" rel=\"noopener\">Children &amp; Young People Keyworkers<\/a> young people with a learning disability and\/or who are autistic with the most complex needs will have a designated keyworker.<\/li>\n<\/ul>\n<\/div>\n<h2>Your right to a social care assessment<\/h2>\n<div class=\"ohft-box gray\">\n<ul>\n<li><a href=\"https:\/\/childlawadvice.org.uk\/information-pages\/child-in-need-services\/\" target=\"_blank\" rel=\"noopener\">Requesting a Child &amp; Family Assessment under Section 17 of the Children Act 1989<\/a> &#8211; the assessment aims to gather information and assess the needs of the child (and also the carer).<\/li>\n<\/ul>\n<\/div>\n<p><em>For more CAMHS parent information, please check out\u00a0<\/em><a href=\"https:\/\/oxfordhealth.nhs.uk\/camhs\/self-care\/\"><em>Good Advice<\/em><\/a><em>\u00a0and the\u00a0<\/em><a href=\"https:\/\/oxfordhealth.nhs.uk\/camhs\/carers\/\"><em>Parent and Carers<\/em><\/a><em>\u00a0resources.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is CAMHS tier 4? CAMHS Tier 4 Services CAMHS Tier 4 Services include care that is inpatient, intensive outpatient or day care treatment, which reflects a level of need equivalent to inpatient care. Travel Expenses Helpful info for your child&#8217;s inpatient stay #GettingThrough guides were created by and for families in collaboration with NHS [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":194326,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"template-selfhelp.php","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-194328","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/oxfordhealth.nhs.uk\/camhs\/wp-json\/wp\/v2\/pages\/194328","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/oxfordhealth.nhs.uk\/camhs\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/oxfordhealth.nhs.uk\/camhs\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/camhs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/camhs\/wp-json\/wp\/v2\/comments?post=194328"}],"version-history":[{"count":90,"href":"https:\/\/oxfordhealth.nhs.uk\/camhs\/wp-json\/wp\/v2\/pages\/194328\/revisions"}],"predecessor-version":[{"id":196419,"href":"https:\/\/oxfordhealth.nhs.uk\/camhs\/wp-json\/wp\/v2\/pages\/194328\/revisions\/196419"}],"up":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/camhs\/wp-json\/wp\/v2\/pages\/194326"}],"wp:attachment":[{"href":"https:\/\/oxfordhealth.nhs.uk\/camhs\/wp-json\/wp\/v2\/media?parent=194328"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}