Introduction

The need to develop a comprehensive range of services for young people requiring highly specialised mental healthcare and treatment has been a UK policy objective since the early 1990s. It is nearly a decade since the National Service Framework (NSF) for Children, Young People and Maternity Services stated that young people must be able to access Tier 4 child and adolescent mental health services (CAMHS). The NSF defined these as intensive outpatient services; assertive outreach teams; inpatient residential and secure provision; or other highly specialised assessment, consultation and intervention services (Department of Health 2004). A decade on and despite clear policy declarations, highly specialised mental health services for children and young people have been neglected in many areas of the UK and in some areas have not developed at all.