3.1 Current national service model
Child and adolescent mental health services (CAMHS) are commonly delivered according to a four-tier strategic framework (see Figure 4), with each of the tiers representing the potential support required for differing levels of need. This model has been widely adopted as the basis for planning, commissioning and delivering services, with localised variations in its application across the country. Most CAMHS services will be provided at Tiers 1 and 2; however, there is a misconception that individuals and services fall neatly within the tiers, with children and young people progressing through them as their condition is found to be more complex. In reality, many practitioners work across tiers, while children and young people may require services from more than one tier at the same time. In theory, this framework should be used conceptually to ensure a comprehensive range of services are commissioned to meet all the needs of children and young people within an area. In practice, the tiers are used to apply rigid service thresholds that can act as a barrier to access for children and young people in need.
Figure 4 – The CAMHS strategic framework (from the ICP Toolkit, Scotland)
 Department for Children, Schools and Families, CAMHS: Four-tier strategic framework. http://webarchive.nationalarchives.gov.uk/20100202100434/http:/dcsf.gov.uk/everychildmatters/healthandwellbeing/mentalhealthissues/camhs/fourtierstrategicframework/fourtierstrategicframework/