The Complex Needs Escalation and Support Tool (CNEST) is a needs stratification tool for young people up to age 25 with mental health difficulties.

The CNEST recognises the degree and complexity of a young person's unmet needs as they pertain to their mental health difficulties and helps practitioners allocate and mobilise appropriate resource to meet the mental health and care needs of young people. Meeting needs earlier reduces the likelihood of hospital admission, entry into care or custody.

Please note that CNEST is NOT a clinical risk assessment tool.

CNEST should only be used by practitioners who have completed CNEST training. Together with clinical risk assessments and formulation, it can contribute to multidisciplinary decision making and clinical prioritisation. It should be used in a dynamic way to reflect changes in a young person’s current situation.

CNEST can be helpful when used routinely and embedded into electronic records, by providing cohort level data on level and complexity of unmet need for young people with mental health difficulties. Within statutory services and across place based multi-agency systems, CNEST supports oversight and escalation so that resources can be allocated and mobilised appropriately.

CNEST training

CNEST Graphics.pngThe CNEST online training programme has been carefully designed to equip you and your teams with the essential skills needed to use the tool effectively and unlock its full potential. By completing the programme, you will be able to:

  • Use CNEST consistently and confidently
  • Strengthen multi‑agency discussions
  • Embed CNEST within existing pathways

CNEST training is suitable for: 

  • CYPMH practitioners
  • Social workers and Children’s services professionals
  • Educators
  • Commissioners
  • Integrated care system partners
  • Neurodevelopmental teams and keyworkers
  • Crisis and intensive support services
  • Tier 4 clinicians

If you would like to learn more about CNEST training, please visit the CNEST Training Section.

Did you know? 

  • 1 in 5 children and young people are experiencing mental health difficulties
  • 343,000 children and young people are waiting for mental health services, with 109,000 waiting over a year.
  • Presentations are becoming more complex, with rising levels of neurodevelopmental need, trauma, self‑harm, exploitation and crisis.

CNEST and the long term plan 

  •  A clinical risk assessment tool. CNEST does not replace clinical judgement or formal risk processes.
  •  A referral mechanism to Children and Young Peoples Mental Health Services (CYPMHS). It is important to note that completing CNEST does not automatically trigger a CYPMHS referral.
  •  A standalone solution. It is a needs‑stratification tool that highlights health and care needs; practitioners must still act on those needs.