What are the current recommendations for screening and managing mental health issues in children and adolescents in primary care?

Screening and Identification: Healthcare professionals in primary care should be trained to detect symptoms of depression and assess children and young people at risk of depression, including asking directly about alcohol and drug use, bullying, abuse, self-harm, and suicidal ideas, with opportunities for private discussion offered to young people. Risk profiling should be routinely conducted and recorded, considering social, educational, family context, and comorbidities. Language and cultural competence are important, with interpreters used when necessary and professionals trained in cultural competence to aid diagnosis and treatment in minority ethnic groups. Primary care should identify mental health problems early and offer general advice and mental health promotion and prevention ¹,².

Management in Primary Care (Tier 1): Mild depression without comorbidity, or children exposed to a single undesirable life event without other risk factors, can be managed in primary care. Supportive, collaborative relationships with the child/young person and their family/carers are essential, with shared decision-making and informed consent before treatment initiation. Self-help materials and strategies may be recommended only as part of a supported and planned care package. Psychological therapies should be delivered by therapists trained in child and adolescent mental health. When bullying is a factor, primary care should collaborate with schools and CAMHS to develop anti-bullying strategies. Monitoring of clinical progress may include self-report tools like the Mood and Feelings Questionnaire ¹,².

Referral and Stepped Care Approach: Children and young people with moderate to severe depression, signs of recurrence, unexplained self-neglect, active suicidal ideas/plans, or if requested by the young person/family, should be referred to CAMHS tiers 2 or above for assessment and treatment. Early referral is advised if depression or self-harm is evident. CAMHS operates a four-tier system with increasing specialization, from primary care and community services (tier 1) to highly specialized inpatient units (tier 4). Primary mental health workers or CAMHS link workers in schools can facilitate communication and collaborative care planning between tiers ¹,².

Additional Considerations: Before treatment, assess the social network and formulate factors contributing to depression, working in partnership with the social and professional network. Family mental health issues (e.g., parental depression or substance misuse) should be considered as they may impact treatment success. Most children and young people should be treated on an outpatient or community basis. Outcome measures should be routinely used and recorded to monitor treatment effectiveness and service planning ¹.