If you’re worried about your child, you'll need to speak to a professional to ask them to make a referral to us.

People who can refer a child or young person to us are those who work in:

  • Health – GPs, school nurses, paediatricians
  • Social care – social workers, ASSIST workers
  • Education  educational psychologists, special educational needs coordinators (SENCOs)
  • Youth justice – police, youth offending team
  • Youth workers – targeted youth teams such as Connexions.

You can now refer young people to the CAMHS service online.

It’s essential that you complete the form below with as much detail as possible, and that the person with parental responsibility consents to the referral unless there are exceptional circumstances.

A duty worker is available weekdays between 9am and 5pm to discuss potential referrals:

Consultation rather than direct assessment or intervention for cases can be provided where a mental health perspective will complement work already in progress, or where there's professional anxiety or uncertainty as to whether referral to specialist CAMHS is appropriate.

Eating disorders

Eating disorders are covered by a single team based in Ealing. We offer assessment and treatment to young people under 18 years who're registered with a GP in the boroughs of Ealing, Hammersmith and Fulham, and Hounslow, and who have anorexia nervosa or bulimia nervosa. We also accept self-referrals directly to CAMHS.

If you wish to discuss a referral, please call us on 020 8354 8160.

Ealing CAMHS Hammersmith & Fulham CAMHS Hounslow CAMHS

1 Armstrong Way
Southall
Middlesex
UB2 4SA

Tel: 020 8354 8160

E-mail:
wlm-tr.EalingCamhs@nhs.net

48 Glenthorne Road
Hammersmith
London
W6 0LS

Tel: 020 8483 1979

E-mail:
wlm-tr.hfcamhs@nhs.net

Heart of Hounslow Centre for Health
92 Bath Road
Hounslow
TW3 3EL

Tel: 020 8483 2050

E-mail:
wlm-tr.hounslowcamhs@nhs.net

We are required to register the full demographic details (including area of residency, GP details and NHS number) of all referrals. Please include this information in your referral otherwise we will need to return this form to you prior to triage.


CAMHS service Required
Date of Referral
PRIORITY (see separate guidance) Required

Child/Young Person (Patient) Details

Required
Required
Required
DOB Required
Required
Required
Address Required
Required
Required
Required
Required
Status Required
Required
Learning Disability Required
Physical Disability Required
Interpreter Required
Required
Required
GP Address if not referrer Required
Required
Required
School/College Address Required
Required
Special School Required

Parent/Carer/Guardian Details

Address
Address
Address if applicable
Learning Disability Required
Physical Disability Required
Interpreter Required

(give details e.g. parent/carer/Local Authority (LAC) include name and contact details if not already shown above)


Referrer Details

Address

Consent

If this section is not completed fully, the referral will be returned to you prior to triage

Has the child/young person/family had previous involvement with this or any other CAMHS Required
Do the parents/carer/guardians (who have parental responsibility) consent to this referral to CAMHS Required
Do the parents/carer/guardians (who have parental responsibility) consent to this referral to CAMHS being shared with another more appropriate NHS or Local Authority Service? This includes being sent to another Trust such as CNWL. Required
If no, are the parents/carer/guardians (who have parental responsibility) aware of this referral? Required
If the young person is 16 years and over, does the young person consent to this referral to CAMHS Required
If the young person is 16 years and over, does the young person consent to this referral to CAMHS being shared with another more appropriate NHS or Local Authority Service? This includes being sent to another Trust such as CNWL. Required
If the young person is 16 years and over, does the young person consent to this referral being shared with their parents/carer/guardians? Required
Are there any other matters such as culture, language, illness, religion or disability that we may need to consider when getting in touch. Required
Required

Reason for Referral

(Please specify why you think a CAMHS assessment is required and what you wish the service to do)

(Give details about onset, duration, frequency, severity)

(Neurodevelopmental disorders and other mental health conditions are pervasive across settings – home, school and community. Give details in relation to different settings)

(Give details of child development, family life, social life, learning/academic performance)

Is the family known to Children’s Social Services? Required
Does the child have an Education, Health & Care Plan (EHCP), Child Protection (CP) Plan, Child in Need (CIN) Plan? Required
Is the child/young person a Looked After Child (LAC) Required
Is the child/young person/family currently involved in Legal Proceedings relating to the child/young person? Required
Are you aware of any domestic violence or abuse issues in this family? Required
Are you aware of any drug or alcohol issues in this family? Required

(Give sufficient details to rule out organic conditions)

(Give details of school, universal/primary/secondary interventions)


Other Professionals Involved

(Give details of other agencies involved now or in the past with the child/young person and family)

Please provide the following for each agency:

  1. Agency Name
  2. Named Worker
  3. Address
  4. Tel No
Is the child/young person on a waiting list for a service? Required
Relevant reports attached Required
Required