ABSTRACT Transitioning between mental health services is a vulnerable process that can challenge treatment outcomes. This study explores the experience of moving from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) from the perspective of young people with anorexia nervosa. Qualitative interviews were conducted with three women undergoing this transition, focusing on their motivation, ambivalence and the changing role of the family. The data were analysed using interpretative phenomenological analysis. Four themes emerged: Sudden shift of responsibility; relational needs unmet during transitioning; the changing role of the family; and transitioning to treatment with peers. The findings highlight two novel aspects of this process: the lasting impact of family‐based treatment on parental involvement and the dual role of peer treatment as both maintaining and motivating. Trial Registration: ClinicalTrials.gov identifier: NCT05956366

Discharge planning should be considered for all individuals attending mental health services from the first visit and should involve the individual, whenever possible. However, despite this ideal and evidence for planned discharge, many services still carry out this process in silos, away from the individual it impacts most. This paper aims to reflect on Will's experience of discharge during his time with Child and Adolescent Mental Health Services (CAMHS) in order to demonstrate the importance of discharge planning in such services. This is a first person narrative weaved with input from the academic literature in order to examine discharge planning within CAMHS. As demonstrated through this lived experience piece, when discharge is planned efficiently and with the person involved throughout, then the overall experience of the service and of the discharge process, particularly in CAMHS, is a positive one. However, as noted in this narrative, unfortunately, this ideal is often not met, and despite the good that is achieved from accessing services, discharge when unplanned and not considered in the unique context of the person can lead to a return to unwellness. In essence, this narrative advocates for a recovery-oriented, person-centred approach to discharge planning and execution in CAMHS so that a person, like Will, can live a life of their choosing, free from unwellness.

Globally, there is increasing need to address the burden of mental illness on populations, including youth, and increasing recognition of the role of social determinants on mental health. The study of resilience, as an ecological process of individual and community resource mobilisation in the face of adversity, is a promising lens through which to understand culturally and contextually relevant factors that enhance or inhibit mental wellbeing. This paper reports on a validation of a reduced, 2-factor, 17-item form of the child and youth resilience measure (CYRM-28) on a population of youth in Aotearoa (New Zealand) who were involved in multiple service systems, including child and adolescent mental health services. It builds on previous work which validated the full 28-item scale. It responds to needs articulated by researchers and service providers for a shortened version of the CYRM-28 that reduces assessment burdens on youth and clinicians. The reduced form may be helpful in mental health settings to quickly understand the resilience resources around vulnerable youth and support interventions that build on strengths and directly address areas where resources are missing.

Child and Adolescent Mental Health Services (CAMHS) are specialist, publicly funded services that play a vital role in supporting young people with moderate to severe mental health needs. In Ireland, and internationally, CAMHS face enduring systemic pressures, including underinvestment, workforce shortages, and long waits for assessment and intervention. Caregivers are central to service engagement, acting as advocates and coordinators of care, yet their perspectives remain underrepresented in the literature. Understanding caregiver experiences is essential to improving quality, strengthening therapeutic relationships, and shaping meaningful reform.To explore the lived experiences of caregivers engaging with CAMHS in Ireland and to examine the relational, systemic, and structural factors shaping these experiences.Reflexive thematic analysis (RTA) was used to analyse semi-structured interviews and focus groups. A qualitative study design was employed, with participants purposively sampled following a national caregiver survey. Data collection and analysis were iterative and reflexive across all stages.Twenty-two caregivers participated, generating six interrelated themes: (1) When CAMHS Works: Feeling Seen, Heard, and Supported, (2) Barriers to Communication and Trust: Caregiver-Clinician Disconnects, (3) Fragmented and Standardised Care: Impacts on Continuity and Engagement, (4) Limited Access and Inadequate Crisis Response, (5) Workforce and Infrastructure Deficits, and (6) Neuroinclusion Gaps: Barriers for Autistic and Neurodivergent Young People. These findings illustrate how structural and relational challenges shape caregiver experiences and inform priorities for CAMHS reform.Caregivers described fragmented care, poor communication, and limited neuroinclusion, exacerbated by staff shortages, service fragmentation, and inconsistent support. Positive examples were rare but highlighted the value of relational, family-centred practice. The findings underscore the need for structural reform alongside a cultural shift toward more inclusive, family-centred and neurodiversity-informed CAMHS, in line with international calls for accessible, high-quality youth mental health services.

Borderline personality disorder (BPD) is a severe mental health condition typically identified in adolescence. We aim to investigate the factor structure, internal consistency, item analysis, convergent validity, and diagnostic accuracy of the Greek version of the Borderline Personality Features Scale for Children-11 (BPFSC-11). A sample of 112 early adolescents aged 11 to 14 years was recruited from an outpatient community child and adolescent mental health service. Confirmatory Factor Analysis was used to explore the fit of the unidimensional model to our sample. Reliability was assessed using the omega coefficient, and regression analysis was employed to evaluate convergent validity with the dysregulation profile of psychopathology, as measured by the Youth Self Report (YSR). Item analysis was assessed via Item Response Theory, while criterion validity was evaluated against clinical evaluation using the ROC curve. We found that BPFS-11 did not fit the data well, while a 9-item version provided a good fit (RMSEA = 0.058, CFI = 0.986, TLI = 0.982). Reliability was strong (ω = 0.81). Convergent validity was demonstrated, as adolescents with high scores on the dysregulation profile of the YSR had statistically significantly higher summed scores on the BPFS. The ROC curve analysis suggested high diagnostic accuracy (AUC=0.86). Sensitivity at the optimum cut-off point of 26 was found to be 0.88, while specificity was 0.75. Our study presents evidence for the reliability and validity of the BPFS and provides a cut-off point for its use in outpatient clinical settings to timely identify adolescents with high borderline personality traits.

The prevalence of mental ill health is increasing in young people worldwide, with rising referrals to child and adolescent mental health services (CAMHS). The numbers and proportions of the youth population who present to CAMHS, however, including how those figures are changing over time, are unclear. Understanding trends in mental health service contacts for young people over time is crucial mental health surveillance data. Our aim was to calculate both the lifetime and annual prevalence of CAMHS contact in Wales for young people up to age 18 years. Using linked Welsh administrative healthcare records, we calculated the annual prevalence of CAMHS contacts between 2004 and 2023. We also calculated the lifetime prevalence of CAMHS contacts for sequential annual birth cohorts born between 1991 and 2005 and followed to age 18 (between 2009 and 2023). In 2004, 0.8% (n = 4665) of the total child and adolescent population were in contact with CAMHS. By 2022, this had risen nearly five-fold to 3.9% (n = 19 870) of the total child and adolescent population. Among the 1991 birth cohort who turned 18 in 2009, 5.8% had contact with CAMHS at some stage in childhood or adolescence. For individuals born in 2005 who turned 18 in 2023, this figure had risen to 20.2%. The number of the young people in contact with CAMHS has increased dramatically over the past 15 years, from 1 in 17 young people who turned 18 in 2009 to 1 in 5 young people who turned 18 in 2023.

There has been a wealth of research on psychotic experiences (PEs) in children and adolescents, highlighting their prevalence and clinical characteristics. However, the prevalence of PEs has not been systematically evaluated in youth mental health services. We aimed to conduct a systematic review and meta-analysis of the prevalence of PEs in child and adolescent mental health services. Five electronic databases were searched from inception to March 2024 for literature relevant to childhood or adolescent PEs and mental health service use. Data on the prevalence of PEs from all relevant papers was extracted. The literature search, data extraction, and quality review were conducted independently by two reviewers. A random effects model was used to calculate a meta-analytic estimate of PE prevalence across studies and results were stratified by associated distress and PE measurement. We produced a narrative summary of research on clinical outcomes associated with the presence of PEs. Eighteen studies were identified, involving 6126 individuals in total. The pooled prevalence of PEs in mental health services was 54% (95% CI: 39%-68%). The prevalence of PEs with associated distress was 45% (95% CI: 30%-60%). The prevalence of PEs based on interview studies was 36% (95% CI: 26%-46%). PEs are very common in children and adolescents presenting to mental health services. Future research should evaluate for specific PE features that predict clinical and functional outcomes, as well as research to investigate how PEs may act as a marker of response to treatment within clinical services.

Attending child and adolescent mental health services is a risk factor for developing bipolar and psychotic disorders in adulthood.

Child and Adolescent Mental Health Services (CAMHS) face mounting pressures due to increased demand, emotional complexity, and systemic strain. Improving outcomes for young people must go hand-in-hand with supporting the workforce that delivers care. This study describes a service innovation project that applied the COM-B model (Capability, Opportunity, Motivation – Behaviour) alongside behavioural systems mapping to identify barriers and enablers to change in a multidisciplinary CAMHS setting. Through the development of a systems map and structured focus group analysis, staff highlighted key feedback loops contributing to burnout, disengagement, and limited organisational responsiveness. COM-B provided a structured lens to interpret these dynamics and co-produce feasible, context-specific service improvements. This method, adapted from research culture transformation work, offers a novel and transferable approach for service development in mental health settings.

Many autistic young people and/or those with attention deficit hyperactivity disorder (ADHD) have co-occurring mental health conditions. These individuals can experience significant challenges when transitioning from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). However, barriers and enablers to the transition from CAMHS to AMHS are poorly understood for this population. This scoping review sought to synthesise the available evidence on barriers and enablers to the transition from CAMHS to AMHS for autistic young people and/or those with ADHD. Arksey and O'Malley's six-step framework for scoping reviews was used to map out the evidence available and report the findings with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines (PRISMA-ScR). Electronic databases of Medline, PsycINFO, CINAHL, Scopus and ProQuest Central were searched for relevant studies published in English with no date limitations. The review included studies that focused on young people with a primary diagnosis of autism spectrum disorder (ASD) and/or ADHD (population) and their care transition barriers and/or enablers (concept) from CAMHS to AMHS (context). A socioecological framework informed data extraction and narrative synthesis of data on barriers and enablers to transition. This review identified 1677 studies, of which 66 proceeded to full-text screening, and 10 were included. Most studies focused on institutional-level transition barriers, including poor communication between CAMHS and AMHS and lack of clarity about their role in the transition process. Involvement of the neurodivergent young person in decision-making processes about their mental health care and clinicians who tailored their approaches to the needs of the neurodivergent young person emerged as key enablers of a positive transition experience. Studies largely failed to examine community and policy-related barriers to mental health care transitions. Most studies examined the perspectives of providers or carers, with only five representing the perspectives of neurodivergent people. Young people who are autistic and/or have ADHD experience many barriers to their transition from CAMHS to AMHS; however, few studies have examined barriers and enablers to the service transition process.

SUMMARY Children with social communication difficulties or an autism diagnosis and co-occurring mental health needs can struggle to access and engage in psychological treatment. This can have a negative effect on well-being and recovery. A service improvement pilot study investigated the impact of a values-focused intervention on the well-being of this patient group. Here, an anonymised clinical case demonstrates the key phases of the intervention. Reflections highlight the importance of a flexible and person-centred approach for these young people.

OP 14: Health Services 3, B302 (FCSH), September 3, 2025, 17:00 - 18:00BackgroundMigration is a complex social determinant of health, with profound impacts on the mental well-being of children and adolescents. Globally, migrant populations face increased vulnerability to mental health issues due to factors such as family separation, cultural dissonance, socioeconomic instability, and trauma. In Portugal, where migration rates have surged, migrant children and adolescents often encounter systemic barriers that hinder equitable access to healthcare. Despite this challenge, little is known about the experiences of migrant families within the Portuguese mental health system.ObjectivesThis study explores the perceptions and experiences of migrant families regarding access and use of mental health services for children and adolescents in Portugal, highlighting barriers, facilitators, patterns of service utilization, and sources of support.MethodsA qualitative, exploratory approach was employed through five focus groups comprising 30 participants from diverse cultural backgrounds. Participants were recruited via non-governmental organisations (NGOs). Discussions were audio-recorded, transcribed, and examined using thematic analysis.ResultsMigrant families reported significant barriers to accessing mental health services, including bureaucratic delays in obtaining healthcare user numbers, economic constraints, geographic challenges, and language barriers. Emergency departments often served as the primary entry point to mental healthcare due to difficulties in accessing primary care. Formal support from NGOs and schools, informal community networks, and the use of translation apps were identified as key facilitators. Participants also emphasized the need for culturally sensitive healthcare practices and clearer information about the Portuguese healthcare system.ConclusionsSystemic barriers hinder equitable access to mental health services for migrant children and adolescents in Portugal. Addressing bureaucratic obstacles, promoting cultural sensitivity, and integrating community-based support mechanisms are crucial for improving healthcare access and outcomes for migrant populations. Policy interventions should focus on enhancing primary care responsiveness and fostering collaboration with NGOs and schools to create a more inclusive and equitable healthcare system.

ABSTRACT Objectives Adolescents transitioning from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) may face challenges in accurately identifying and reporting their mental health symptoms, often leading to discrepancies between clinician and patient evaluations. Using data from the MILESTONE project, this study aims to assess clinician‐adolescent concordance over 24 months and identify domains of psychopathology with the highest disparities. Methods Participants were assessed at baseline, 9, 15, and 24 months using the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) scale and were categorized in four diagnostic groups. Hierarchical cluster analysis identified symptom‐based subgroups of patients based on clinician and patient‐rated HoNOSCA scores. Concordance was evaluated through multilevel linear regression models, while Bland–Altman plots examined agreement between scores across time points. Results Two clusters of patients were identified: one characterized by lower severity and greater prevalence, the other by higher complexity and fewer individuals. Clinician–patient concordance increased over time, rising from 77% to 83% by the second time point and stabilizing. Concordance varied across diagnostic categories, with anxiety showing the highest agreement and ADHD the lowest. Conclusions Improved communication, psychoeducation, and tailored interventions may facilitate greater patient–clinician alignment, thereby supporting more favorable outcomes during this critical developmental period. Trial Registration: ISRCTN83240263; NCT03013595

Objective: This study aims to examine the impact of the COVID-19 pandemic on inpatient treatment processes in child and adolescent psychiatry by comparing three distinct periods: pre-pandemic, during the pandemic, and post-pandemic. Methods: Clinical data of a total of 768 patients who were hospitalized in the child and adolescent psychiatry inpatient unit of a university hospital between April 1, 2018, and January 31, 2024, were retrospectively reviewed. Sociodemographic variables (age, sex) and clinical variables (diagnosis, length of stay, number of admissions, history of suicide attempts, presence of comorbid diagnoses) were compared across three time periods. Results: During the pandemic period, a statistically significant increase was observed in the hospitalization rates of patients diagnosed with neurodevelopmental disorders, particularly attention-deficit/hyperactivity disorder (p < 0.05). Although hospitalization rates for patients diagnosed with depressive disorder, post-traumatic stress disorder, bipolar disorder, obsessive-compulsive disorder, substance use disorder, and anxiety disorders increased during the pandemic period, these increases were not statistically significant. The mean age of patients increased during the pandemic period, and the rate of comorbid diagnoses was markedly higher compared to previous periods. Additionally, the length of hospital stay was significantly shorter during the pandemic and post-pandemic periods (p < 0.05). Conclusion: The COVID-19 pandemic adversely affected the mental health of children and adolescents, particularly increasing the need for inpatient treatment among individuals with neurodevelopmental disorders. The findings highlight the necessity of maintaining the sustainability of child and adolescent mental health services world wide even under extraordinary circumstances such as a pandemic. Therefore, strengthening child mental health services and developing supportive policies targeted at vulnerable groups are crucial for preparedness in future similar crises.

The COVID-19 pandemic has significantly impacted the mental health of children and families. This study sought to further explore the relationship between the pandemic (accounting for age and sex) and children's mental health outcomes, parenting quality, and service complexity. Data consisted of interRAI Child and Youth Mental Health Assessments from 5,067 children and youth between the age of 4-18-years-old. Surprisingly, our findings revealed the pandemic was not a significant predictor of parenting quality and children's mental health. Significantly lower levels of service complexity during the first few months of the pandemic were observed. Compared to younger males, older female children were more likely to experience internalizing symptoms and less likely to display externalizing symptoms. Older children (vs. younger children) were more likely to receive low parenting quality and experience service complexity. Clinical implications, limitations, and future directions are discussed.

BackgroundAdult presentations for attention-deficit/hyperactivity disorder (ADHD) are perceived to be rising, placing pressure on services. General practitioners (GPs) are often the first point of contact and frequently collaborate with specialty care in ongoing management. We explored GP perspectives on drivers of demand and barriers to safe, coordinated care within the National Health Service (NHS).MethodsWe aimed to investigate GP perspectives on diagnosis and management of adult ADHD. We conducted a qualitative study with analysis initially drawing on grounded theory principles (inductive coding, constant comparison, and iterative refinement of topic guides), whilst later using the framework method to provide a systematic structure for analysis. Semi-structured video interviews were completed with 10 GPs and two psychiatrists from NHS Tayside (Scotland) from February to April 2022. Participants were purposively sampled by GP age, experience, practice size, and deprivation level. Transcripts were independently coded by two or more researchers, and a consensus analytical matrix was developed to identify themes across demographics and professional groups.ResultsParticipants reported increased adult presentations for suspected ADHD, often prompted by self-identification, peer influence, or media exposure. Deprivation was viewed as the demographic factor with the greatest impact on need, whereas age and sex had modest effects. GPs described limited training and reliance on rating scales to support referral, alongside long waits and fragmented communication with psychiatry. Shared-care arrangements were inconsistently operationalised: most GPs expected psychiatrists to provide follow-up monitoring, while psychiatrists expected GPs to conduct physical health monitoring. Transition from child and adolescent mental health services (CAMHS) to adult services was a recurrent vulnerability, with young adults frequently “lost to follow-up.” Patients commonly sought private assessment to bypass delays, raising concerns about variable quality and equity. GPs perceived medication benefits as largely subjective but generally positive, while expressing unease about under-monitoring and potential misuse.ConclusionsGPs perceived rising adult ADHD demand driven by social awareness and self-identification, occurring within strained services and unclear monitoring responsibilities. Clarifying roles within shared care, strengthening CAMHS-to-adult transitions, and expanding multidisciplinary capacity may reduce waits, improve safety, and support equitable access to evidence-informed care.

The recovery concept has been widely integrated into mental health policy, services, and research. However, its applicability across diverse contexts and populations remains a subject of ongoing critique. This paper discusses key issues pertaining to the suitability of implementing the recovery approach in child and youth mental health services, including adult-centric foundations of the recovery concept; limited multi-stakeholder participatory research; privileging individualistic ideologies; differences in developmental stages; differences in illness trajectory, mental health experiences, and service provider interactions; and different systems of care and social environments. The paper concludes with recommendations for future research.

This paper focuses on the topic of marital conflict and how it can be conceptualized and processed in the child’s mind through a psychoanalytic intervention carried out in public services, that is, child and family mental health and social welfare services operating within the Italian public healthcare system. As is often the case in the Italian context, in public mental health services for children and their families, interventions are typically reserved for patients with multiple diagnoses, leaving at-risk cases—those requiring clinical attention—on long waiting lists. Such situations of family conflict and emotional distress observed in public child and family services, however, could benefit from psychoanalytically-informed interventions capable of preventing future maladjustment. After providing a theoretical and clinical framework of the concept of co-parenting—understood as a psychic space offered to the child to accompany them through the phases of mental growth—I will highlight the most meaningful elements from a year-long weekly psychoanalytic psychotherapy with a seven-year-old boy. I believe this child allowed his mind to begin thinking again (Bion, 1962) and to emotionally reinvest in the surrounding world, reintroducing a virtuous cycle into family life that enabled more adequate care for each member’s emotional experiences.

Background: While the positive relationship between mental health and physical activity (PA) is well established, numerous barriers are reported. This study analyzed PA levels and associated barriers in young people attending a national child and adolescent mental health service using a quantitatively driven mixed methods design. Methods: From contacted patient families (n = 1284) meeting inclusion criteria, 23.67% (n = 304; age 12 to 18 years) completed a questionnaire (quantitative component/supplementary qualitative component). Statistical tests and thematic analysis were used to interpret data. Results: 57.24% (n = 174) of participants practiced PA/sport. Those in a sporting discipline did more PA overall, and males were almost twice as likely (OR = 1.98) to do PA/sports than females. PA levels were significantly different across mental disorder groups (highest in personality disorders and related traits, and lowest in disruptive behavioral or dissocial disorders). Participants supported the positive association between mental health and athletic performance, including the use of exercise prescriptions. Barriers to PA included excessive screentime, reduced mental health support/awareness, lack of appropriate facilities, financial difficulties, etc. Conclusion: Further research is needed. However, such results will serve to inform the development of the first documented sport mental health clinic for young people.

BackgroundDialectical Behavior Therapy – Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) is a 30-week program adapted from the comprehensive DBT protocol for adolescents, to be delivered in schools, by school staff. This novel approach takes a preventative position wherein adolescents (aged 11–18) are taught social and emotional skills from DBT to equip them to navigate challenging situations with the premise that this may prevent the development of more severe psychological difficulties. Few studies exist evaluating the “real world delivery” of STEPS-A, and less so outside the United States of America. This protocol outlines the planned evaluation of the effectiveness of the STEPS-A program, as delivered by Marinoto Child and Adolescent Mental Health Service (Health New Zealand|Te Whatu Ora - Waitematā) in Aotearoa New Zealand.MethodThis research will use a mixed-methods approach. Specifically, the evaluation of the program will be based on: (i) completed psychometrics pre- and post- program completion, (ii) perceived acceptability as expressed by participants, their families and the schools running the STEPS-A program during semi-structured interviews and focus groups, and (iii) the feasibility of the STEPS-A program in terms of the ability of participating schools to deliver it in an ongoing manner and (iv) any adaptations required to run the program in New Zealand in a culturally responsive manner. The proposed protocol has been peer reviewed by two independent academics and approved by a national health and disability ethics committee. A power analysis has also indicated that the estimated number of program participants will likely yield a sample that will be adequately powered for data analysis.DiscussionThis research will evaluate the effectiveness, acceptability and feasibility of the STEPS-A program. Findings will highlight the challenges of implementation in a public health system and the suitability for use with an indigenous population.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40359-025-02694-0.