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Recent debate papers in Child and Adolescent Mental Health (Debate CAMH, May 2022) advocate a more widespread and appropriate use by CAMH clinicians of borderline personality disorder diagnoses. This paper makes the case against the widespread use of other types of PD diagnosis in children and young people. Nevertheless, it would be of interest to establish to what extent adult PDs have their roots in early neurodevelopmental anomalies, and ascertainment of personality traits can help clarify children's response to environmental or traumatic stresses in those presenting with problems such as at the interface between physical and mental health.

Background The paediatric population is known to be at high risk for psychiatric problems. Paediatric liaison child/adolescent mental health services (PL-CAMHS) have been developed to help increase recognition and management of psychiatric morbidity in the paediatric setting. This report describes clinical activity by a psychological medicine PL-CAMHS and considers specificity by comparing this with community/general CAMHS activity. Method Clinical information was obtained on consecutive patients seen by a PL-CAMHS in a UK tertiary specialist hospital. Where feasible this was compared with published data on national/community CAMHS work. Results Data was obtained on 800 patients (mean age 11.9, SD 3.8). Most referrals came from a variety of paediatric teams, nearly two-thirds were for psychosomatic problems or difficulties adjusting to physical illness. The majority had an ICD-10 psychiatric diagnosis (mostly adjustment, mood and anxiety, and somatoform disorders); problems were often complex and in about half, family difficulties were also noted; one-third had received prior mental health treatment. Virtually all children were seen by the PL service within a month of referral and only 2% of families failed to attend for assessment. Some level of clinical improvement was noted for the majority. There were indications of differences from national/community CAMHS work in referral source, take up rates and psychiatric diagnoses. Conclusions Paediatric liaison child and adolescent mental health services users commonly have characteristic psychiatric problems, interventions appear potentially effective and the work is specific and complementary of community CAMHS. Thus PL-CAMHS make a distinct contribution to the provision of truly comprehensive CAMHS.

Background: The Primary Mental Health Worker (PMHW) interface role was introduced in England 13 years ago. This study evaluated the development of the role. Method: 415 English PMHWs (64% of workforce) completed a survey about the services they provide, management organisation, training and development, and job satisfaction. Results: PMHWs perceive their role to involve successful collaboration with primary care staff, offering improved access to mental health services, and being supported by a generally good infrastructure; although training opportunities remain an area of need. Conclusions: The workforce development policy appears, from the PMHWs' perspective, to be successful although training opportunities need consideration. Key Practitioner Message: • PMHWs work with a range of staff groups in primary care and have diversified the location of mental health services for children and young people by seeing a proportion of clients in their homes or at school • A considerable proportion of PMHWs continue to perceive a need with regard to their training opportunities, while the majority are satisfied with the clinical supervision they receive • From the perspective of the postholders, the PMHW role appears to be effective at helping close the service gap between primary care and specialist mental health services although further research needs to evaluate the clinical and cost effectiveness of the role.

Background: The role of primary mental health worker (PMHW) in CAMHS was established in 1995 although comparatively little research has explored the attributes required to successfully undertake this role. Method: Qualitative interviews with PMHWs and staff working in primary care were conducted and thematic analysis was performed. Results: In addition to clinical skills and mental health knowledge all respondents consistently emphasised the importance of inter-personal attributes such as general accessibility, flexibility, and self-motivation. Conclusions: Both professional competencies and inter-personal skills are perceived as important characteristics for PMHWs. It therefore seems appropriate for these to be made more explicit in competency frameworks.

Background: Although psychiatric morbidity is common amongst paediatric patients, little is known about the availability of CAMH paediatric liaison services. Method: We surveyed all Trusts with specialist CAMH services and paediatric units in Greater London, enquiring about the nature of liaison that CAMHS provide. Results: We found that although liaison paediatric work was common, dedicated paediatric liaison services were provided by only a minority of specialist multidisciplinary CAMHS. Their work involved most aspects of child psychopathology, and included emergencies and children with joint physical and psychiatric problems. About 2/3 of paediatricians were satisfied with CAMHS liaison services, but virtually all desired to see them developed further. There were few indications of co-ordination between specialist multidisciplinary CAMHS and other paediatric psychosocial support services.

Background: We document the extent, nature and predictors of interface work between secondary Child and Adolescent Mental Health (CAMHS) and primary services, through structured questionnaires sent to all Trusts with CAMHS in England (returned by 124/150 or 83%). Results: Two-thirds of CAMHS reported training and education to primary care services, about one-third a structured consultation service, one-fifth reported undertaking outpatient clinics in primary care settings and joint casework. One-third had developed primary mental health worker posts. Multiple regression analysis identified firstly specialist clinics within CAMHS, and secondly CAMHS size, as the strongest predictors of interface work across agencies. Interface work thus grows with more developed, larger CAMHS.

HoNOSCA is a timely newcomer to the field of Child and Adolescent Mental Health Services (CAMHS) research. In its short life it has already been thoroughly and successfully evaluated. Its user-friendliness has made it acceptable and even popular in routine clinical practice. It was central to clinical data gathering for the recent national survey of CAMH provision in the UK (Audit Commission, 1999). What are the reasons for its popularity? What are its limitations? And what about possible future uses?