Psychosocial treatments are central to effective delivery of Child and Adolescent Mental Health Services (CAMHS), with a strong evidence base for a range of interventions targeting many of the common and complex mental health presentations in children and young people. Practitioner knowledge of the range of psychosocial interventions offered by CAMHS is fundamental to making informed, shared decisions with children, young people and families about their care. In addition knowledge of how psychosocial interventions need to be adapted to meet the needs of diverse populations is central to ensuring equity of access.Demand for services will continue to increase, along with increasing complexity and severity for many children and young people, and services must ensure that they continue to offer a range of psychosocial interventions, tailored to individual need and choice, delivered by a well-trained workforce, with effective means to demonstrate outcomes. Transformation models such as THRIVE will be instrumental in ensuring that access to psychosocial intervention is broadened beyond existing services, supporting others in community and education settings to offer earlier intervention, greater choice and diversity and ensure that CAMHS is able to deliver specialist treatments to those who can benefit the most.

Early-onset psychosis (EOP) is a severe mental disorder with a significant impact on affected children, young people and their families. Its assessment and diagnosis may be challenging, treatment approaches may not always lead to full remission of symptoms, and it is frequently associated with recurrent episodes and long-term disability. A comprehensive evaluation of psychotic symptoms, co-morbidities, physical health and environmental risk factors is likely to contribute to the holistic understanding of the child or adolescent with psychosis and provide the best possible management framework. A systematic approach to treatment with antipsychotic medication and psychosocial interventions should incorporate regular reviews of its effectiveness and adverse effects. Early intervention seems to lead to optimal outcomes through reducing the duration of untreated psychosis and providing input during the critical period after its onset when treatment can be most effective. Further research aiming to advance our understanding of the complex aetiology of psychotic disorders, effectiveness of management strategies, and necessary service provision is urgently needed.

This chapter provides an overview of young people with mental health needs and the development of forensic mental health and youth justice services for young people. The provision of inpatient and community forensic child and adolescent mental health services is outlined in more detail, including referral criteria, characteristics of the young people who access the service and outcomes of the provision.

Assessment of mental health problems in children and young people (CYP) is an essential skill that requires a curious mind, a good knowledge of the subject and an ability to be empathic. Assessment should be structured with attention given to the developmental nature of the presenting difficulties and their impact on functioning. Similarly, understanding the impact of the child’s immediate environment on their mental health and integrating information from various sources is an important skill to be mastered. A thorough mental state examination of a CYP complimented by relevant physical examination is an integral component of a good assessment and creatively engaging a CYP in this process is crucial. A knowledge of psychometric profiles of various assessment and outcome measurement tools and the ability to skillfully use them in the assessment process is also important. The strength of child psychiatric assessments lies in multidisciplinary working. Specialist assessments by other professionals are valuable in arriving at a diagnosis or a formulation. The skill to sensitively feed this back to the CYP and their family, and engaging them in the next steps will help in a successful outcome. Ultimately, a good assessment ensures that the CYP and their families get the right help, at the right time from the right people.

Mood disorders are a leading cause of illness and disability in children and adolescents. Effective treatment is available, and early identification and intervention improves prognosis. This chapter provides a comprehensive summary of the epidemiology, aetiology and clinical features of depression and bipolar disorder in young people. We provide evidence-based recommendations for the prevention and treatment of mood disorders in children and adolescents, including psychological and pharmacological interventions, and novel and emerging treatment options. We present research on predictors of treatment outcome and prognosis of mood disorders in young people, and highlight areas for further research. This chapter will help clinicians identify and treat young people with mood disorders in a range of clinical settings.

This chapter reviews a broad spectrum in Child and Adolescent Mental Health; that of the anxiety disorders. The chapter briefly introduces the concept of attachment and touches on how attachment disorders, and attachment styles evolve. It focuses in on PTSD and C-PTSD, with a particular spotlight on C-PTSD as a new diagnostic concept, and considers its importance in understanding presentations of trauma and emotional dysregulation in children and young people. The chapter also investigates the epidemiology and course of anxiety disorders; and considers the differentiating features of the different presentations. We finish with an overview of interventions, including the rise of computerised approaches in treating the anxiety disorders in young people.

A survey found that 1 in 6 (16%) of children aged between 5 and 16 years has a probable mental illness. Furthermore, research has shown that most of these disorders have their origins in childhood, even if they are typically diagnosed in adulthood. Childhood represents a critical period of physical, cognitive, psychological, behavioural and social transformation. Identifying risk and protective factors that alter the typical developmental trajectory could have long-term educational, social, societal and economic implications. This chapter will address what is meant by the term risk factor and how these can be identified, provide examples of risk factors thought to be important in child and adolescent psychiatry. It concludes with some case vignettes to highlight the importance of taking a developmental biopsychosocial approach to identifying risk, considering predisposing, precipitating, perpetuating and protective factors.

Infancy is a time of great opportunity and hope. The mental health of infants is key to the health and wellbeing of society as a whole. Psychiatrists have an important role to play in this field of psychiatry, and knowledge in infant mental health is foundational to all specialties.This chapter describes the importance of infant mental health and explores the theoretical underpinnings of the specialty. The case for infant mental health services is discussed along with a needs-led approach to the provision of services. Clinical assessment and intervention are described broadly with examples of common intervention modalities.

This chapter provides an overview of neurodevelopmental disorders (NDDs) in children and young people. The definition and classification of NDDs is discussed, including key differences between ICD-10 and ICD-11 and the problematic use of language in diagnostic classifications, which is at odds with the social model of disability. Important stages of a multidisciplinary assessment of NDDs include a detailed developmental history, a psychosocial history, observation of the child, an assessment of the child’s communication and learning and supplementary rating scales. The role of professionals such as Community Paediatricians, Speech and Language Therapists, Occupational Therapists, teachers and Educational Psychologists is highlighted. Features of the main NDDs are outlined, including Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder, Specific Disorders of Development and Language and Tic disorders. Finally, an overview of treatment approaches and their evidence base is explored.

Eating disorders are complex conditions that pose significant challenges for diagnosis and treatment. Recent updates to diagnostic criteria in the DSM-5 and ICD-11 have refined our understanding of eating disorders, underscoring the need for early intervention to improve recovery outcomes. This chapter reviews these changes and their implications for clinical practice. We explore the increasing complexity of eating disorder presentations, particularly those involving neurodevelopmental and personality disorders, which require nuanced treatment approaches. Additionally, the chapter examines the impact of social media on eating behaviours, highlighting both the negative influences and the potential benefits of online resources. The rise of digital therapies, especially in response to the Covid-19 pandemic, is discussed as a key development in expanding access to care. The chapter also addresses the evolving clinical presentation of eating disorders, noting that conditions like binge eating disorder, other specified feeding or eating disorders, and avoidant restrictive food intake disorder are now more common. To meet the needs of young people, we advocate for improved community care, public health strategies and further research into effective treatments. This chapter emphasises the urgent need to enhance recognition and support for ED across health care systems and community settings.

The concept of prevention in health and welfare has long been recognised as crucial, yet its practical implementation remains complex. This chapter delves into the significance of prevention as a fundamental principle in addressing societal challenges and individual health outcomes. With a focus on the links between adversity, societal issues and health burdens, the economic rationale for preventive measures becomes apparent. Recent attention has been drawn to prevention and early intervention, particularly in light of the long-term consequences of early adversity on physical and mental health. Government initiatives in the UK, such as the establishment of Health and Wellbeing Boards and emphasis on prevention in health services, underscore the growing importance of prevention strategies. The impact of the Covid-19 pandemic has further highlighted the need for proactive prevention measures in health and welfare policies. This chapter explores the meaning of prevention, theoretical considerations, practical clinical strategies and the role of senior health professionals in promoting prevention in children’s mental health services.

Children and young people’s mental health services continue to remain a high priority for government and the NHS. Delivering good outcomes for young people will require coordinated action across health, education, third sector and local government departments and between national and local bodies. There are opportunities through increased investment and more collaborative commissioning and service delivery arrangements to deliver a systems wide approach to providing care for children and young people. The COVID-19 pandemic has affected everyone although children and young people have been disproportionately adversely affected, as they have had to adapt to extraordinary changes to the world around them. New models of care can stimulate effective collaboration between commissioners and providers to develop integrated, accessible services for all in community based settings. Expanding access through digital support can enable more people to receive effective care providing greater accessibility and choice. A focus on quality improvement can support staff and patients to improve care through effective use of data, with support from professional networks. However, all new models must be developed in partnership with experts-by-experience, carers, and community and voluntary organisations. Systemic investment in services and the staff who provide them is needed to meet the ambitions set by governments.