Thank you to Griffiths, Brown and Kirkbride for their thoughtful comments on my recent editorial, which highlighted the opportunities within specialist child and adolescent mental health services (CAMHS) for the prediction and prevention of bipolar and schizophrenia-spectrum disorders.^{Reference Kelleher1}

We recently showed, in a total population sample of people born in Finland in 1987, that 54% of individuals diagnosed with schizophrenia and 52% of individuals diagnosed with bipolar affective disorder had, at some point in childhood, attended specialist CAMHS.^{Reference Lång, Ramsay, Yates, Veijola, Gyllenberg and Clarke2} This highlights incredible opportunities for earlier intervention and even prevention of severe mental illness within CAMHS, which should spur researchers, clinicians and policy makers to action.

These findings demonstrate that if you build and resource CAMHS, not only will you create opportunities to address the current mental health problems facing young people, you will also create enormous opportunities for the prediction (and ultimately prevention) of many of the most severe, disabling (and costly) mental illnesses of adulthood, including schizophrenia and bipolar disorder.^{Reference Lång, Ramsay, Yates, Veijola, Gyllenberg and Clarke2} That's a very exciting prospect – and an opportunity that we, as a clinical and research community, should grasp.

Griffiths and colleagues point to research that showed that children from Black and minority ethnic backgrounds were less likely to access CAMHS than their White British peers.^{Reference Vostanis, Svirydzenka, Dugard, Singh and Dogra3} They rightly call for equitable access to CAMHS for minoritised and marginalised groups so that they can equally benefit from the opportunities for psychosis prevention to which I hope this research will ultimately lead. At the same time, there is clearly an ethical imperative for clinicians and researchers to attend to the high level of risk for schizophrenia and bipolar disorder that we have identified within existing CAMHS services without delay.

As Griffiths and colleagues suggest, given the huge personal, family and economic costs associated with psychotic disorders, our findings make the risks (and lost opportunities) of structural, systemic and cultural barriers to specialist mental healthcare access even clearer.