Handle Demand

How to manage what is coming in…


Relentless demand for our services is often the most stressful aspect of CAMHS work. Much time can be spent managing the flood, with little time to draw breath. In our experience many services have tried to reduce demand by increasing threshold criteria and refining priority criteria. Whilst useful, this can consume a lot of team time deciding if referrals meet the criteria and, if done in isolation, rarely results in a good service for families who then fall through service gaps.

A quality system for Handling Demand requires a multi-agency strategy combined with choice for users. This means being clear about what specialist CAMHS and partner agencies do best, ensuring smooth pathways between them, integrating services, and facilitating families to make informed choices.

Understanding your demand is essential. Without this you cannot match your capacity or plan. Most of us mistakenly think our demand equates to referral numbers. In reality it is the amount of clinical time required to manage those referrals that chose to use our service and varies according to what type of clinical service they receive. The amount of clinical time used for individual psychodynamic psychotherapy and solution focused brief therapy are often not the same

Demand Example

Anywhere CAMHS receives 800 referrals per year. Due to their 6-month waiting list only 60% actually book in. Each referral on average receives / needs 9 direct clinical hours until discharge.

60% x 800 = 480 cases 9 hours x 480 = 4320 hours are needed to manage this demand.

Notice how this would change if each family took, on average: 5 hours each (2400 clinical hours) or 12 hours (5760 hours)

In fact, local audit in Herts. suggests that the correlation between the number of sessions per family (what you do) and the waiting list size is four times stronger than the number of referrals per therapist (what you’re asked to do).


Implementing this Habit will also help you with the following High Impact Changes for Mental Health as well as with:

High Impact Change 2.

Improve flow of service users and carers across health and social care by improving access to screening and assessment

High Impact Change 4.

Manage variation in access to all mental health services

High Impact Change 8.

Improve service user flow by removing queues

and Flow Management

This section is suitable for both inpatient and outpatient services.

The 9 areas in the Handle Demand section are the first 9 items of our self-evaluation tool: the 7 –Habits Assessment Tool [7-HAT]…