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Background: To study clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their Child and Adolescent Mental Health Service (CAMHS) and its association with mental health indicators, transition recommendations and mental health service (MHS) use. Methods: 763 CAMHS users from eight European countries were assessed using multi-informant and standardised assessment tools at baseline and nine months follow-up. Separate ANCOVA's and pairwise comparisons were conducted to assess whether clinicians' and parents' awareness of young people's suicidal behaviour were associated with mental health indicators, clinician's recommendations to continue treatment and MHS use at nine months follow-up. Results: 53.5 % of clinicians and 56.9 % of parents were unaware of young people's self-reported suicidal behaviour at baseline. Compared to those whose clinicians/parents were aware, unawareness was associated with a 72–80 % lower proportion of being recommended to continue treatment. Self-reported mental health problems at baseline were comparable for young people whose clinicians and parents were aware and unaware of suicidal behaviour. Clinicians' and parents' unawareness were not associated with MHS use at follow-up. Limitations: Aspects of suicidal behaviour, such as suicide ideation, -plans and -attempts, could not be distinguished. Few young people transitioned to Adult Mental Health Services (AMHS), therefore power to study factors associated with AMHS use was limited. Conclusion: Clinicians and parents are often unaware of suicidal behaviour, which decreases the likelihood of a recommendation to continue treatment, but does not seem to affect young people's MHS use or their mental health problems.

Background: The configuration of having separate mental health services by age, namely child and adolescent mental health services (CAMHS) and adult mental health services (AMHS), might be a barrier to continuity of care that adversely affects young people's mental health. However, no studies have investigated whether discontinuity of care in the transition period affects mental health. We aimed to discern the type of care young people receive after reaching the upper age limit of their CAMHS and examine differences in outcomes at 24-month follow-up between young people receiving different types of care. Methods: To assess mental health in young people from 39 CAMHS in eight European countries (Belgium, Croatia, France, Germany, Italy, Ireland, the Netherlands, and the UK), we did a longitudinal cohort study. Eligible young people were CAMHS users up to 1 year younger than the upper age limit of their CAMHS or up to 3 months older, if they were still in CAMHS. Information on mental health service use, mental health problems (ie, using the Health of the Nation Outcome Scale for Children and Adolescents, Youth Self-Report and Adult Self-Report, DSM-5, and ICD-10), and sociodemographic characteristics were collected using self-reported, parent-reported, and clinician-reported interviews and questionnaires. Mixed models were applied to assess relationships between baseline characteristics, mental health service use, and outcomes. Findings: The MILESTONE cohort included 763 young people. The participants were 60·0% female (n=458) and 40·0% male (n=305), 90·3% White (n=578), and had a mean age of 17·5 years (range 15·2–19·6 years). Over the 24-month follow-up period, 48 young people (6·3%) actively withdrew from the study. For young people, the higher their scores on the Health of the Nation Outcome Scale for Children and Adolescents (p=0·0009) and Youth Self-Report and Adult Self-Report (p=0·046), and who had a clinical classification of severe mental illness (p=0·0033), had suicidal thoughts or behaviours or self-harm (p=0·034), used psychotropic medication (p=0·0014), and had a self-reported or parent-reported need for continued treatment (p

Purpose Young people transitioning from child to adult mental health services are frequently also known to social services, but the role of such services in this study and their interplay with mental healthcare system lacks evidence in the European panorama. This study aims to gather information on the characteristics and the involvement of social services supporting young people approaching transition. Design/methodology/approach A survey of 16 European Union countries was conducted. Country respondents, representing social services’ point of view, completed an ad hoc questionnaire. Information sought included details on social service availability and the characteristics of their interplay with mental health services. Findings Service availability ranges from a low of 3/100,000 social workers working with young people of transition age in Spain to a high 500/100,000 social workers in Poland, with heterogeneous involvement in youth health care. Community-based residential facilities and services for youth under custodial measures were the most commonly type of social service involved. In 80% of the surveyed countries, youth protection from abuse/neglect is overall regulated by national protocols or written agreements between mental health and social services, with the exception of Czech Republic and Greece, where poor or no protocols apply. Lack of connection between child and adult mental health services has been identified as the major obstacles to transition (93.8%), together with insufficient involvement of stakeholders throughout the process. Research limitations/implications Marked heterogeneity across countries may suggest weaknesses in youth mental health policy-making at the European level. Greater inclusion of relevant stakeholders is needed to inform the development and implementation of person-centered health-care models. Disconnection between child and adult mental health services is widely recognized in the social services arena as the major barrier faced by young service users in transition; this “outside” perspective provides further support for an urgent re-configuration of services and the need to address unaligned working practices and service cultures. Originality/value This is the first survey gathering information on social service provision at the time of mental health services transition at a European level; its findings may help to inform services to offer a better coordinated social health care for young people with mental health disorders.

The transition from child and adolescent to adult mental health services for young people with mental health problems is of international concern. Despite the high prevalence of mental disorders during adolescence and their tendency to continue during adulthood, the majority of young people do not experience continuity of care. The aim of this review paper is to unravel the complexity of transitional mental healthcare to clinicians, policy makers and mental health service managers, and to address challenges to a smooth transition process at all levels. ispartof: BJPSYCH BULLETIN vol:44 issue:4 pages:163-168 ispartof: location:England status: published

ObjectiveYoung people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16–18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person’s readiness for transition, and their outcomes at the transfer boundary.DesignMILESTONE prospective study.SettingEight European Union (EU) countries participating in the EU-funded MILESTONE study.ParticipantsThe first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people.ResultsThe development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported.ConclusionThe TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person.Trial registration numberISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.

Purpose The purpose of this paper is to address a knowledge gap on advocacy outcomes from mental health service users’ perspective, and the implications for evaluating advocacy impact. The studies discussed highlight challenges for measuring the outcomes of advocacy, but underline the importance of doing so, and of involving service users alongside other stakeholders in co-designing evaluation systems. Design/methodology/approach The paper uses findings from three qualitative studies of independent advocacy involving focus groups and interviews with: 30 African and African Caribbean men who were mental health service users; 90 “qualifying patients” in a study of Independent Mental Health Advocate services; and nine young women in children and adolescent mental health services (CAMHS). Findings A comparative analysis and synthesis of findings from three studies identifies four common dimensions: how mental health advocacy is conceptualised and understood; how service users define advocacy outcomes; wider impacts; and, user involvement in evaluating advocacy outcomes. Advocacy outcomes were conceptualised as increasing involvement, changing care and treatment and supporting personal development. There was evidence of advocacy acting to empower mental health service users, and of broader impacts on service regimes and policies. However, there was limited evidence of transformational impact. Evaluating advocacy outcomes is increasingly seen as important. Originality/value Few researchers have focused primarily on the perspectives of people using independent mental health advocacy, or on the experience of “advocacy as empowerment”, and none have done so across diverse groups. This analysis adds insight into the impact of independent advocacy. Data from empirical studies attest to the important role independent advocacy plays in modern mental health systems.

Background Local government public sector children’s services working with vulnerable children in England are faced with challenging cases involving potentially harmful digital/online risks. All services have a duty to safeguard. Educators and key professionals in children’s services such as in social care, mental health, youth justice, voluntary sector advice centres or policing may be involved. Yet little is known about how these services identify, assess, refer and respond to such cases. Aim This study aims to explore how local services working with children and young people, including social care, health and the police, address cases with digital components among children and adolescents and how equipped they are to do so. Methods Using semi-structured interviews, this study interviewed 14 participants within 10 services such as mental health, social care, youth justice, teenage pregnancy prevention, voluntary sector online youth counselling, school nursing and children’s education inspection and safeguarding services. Interviews were transcribed and thematically analysed. Results A narrowly focused awareness of online risk was noticed among all participants, reflecting an emphasis on a singular target (e.g. Child Sexual Exploitation - CSE). This led frontline staff to omit exploration of wider online risks or antecedents of grooming. The outcome therefore was a lack of data on harms other than CSE or sharing of explicit images, and limited knowledge of a wider range of fast changing risks to children, which could inform prevention. Assessment tools seemed generic and focus heavily on CSE or social media; some omitted online risk unless safeguarding issues were raised. Furthermore, multi-agency collaboration was hampered by simplistic or no referral mechanisms for evidence involving online risks. Finally, it was also apparent that there is a lack of structured and mandatory training programmes around online risk and children and young people’s digital lives. Conclusion Online risks need careful consideration within children’s services’ cases and to be more systematically embedded within practice. The findings are crucial in guiding services towards modernising their methods, advancing their training and assessment tools to enhance multi-agency collaboration in cases involving vulnerable children.

Background Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. Methods A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Results Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. Conclusions There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. Electronic supplementary material The online version of this article (10.1186/s12910-018-0276-3) contains supplementary material, which is available to authorized users.

Background: Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014–19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals.Methods: Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians.Discussion: Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers.Trial registration: "MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

Background One in ten children in Britain have been identified as experiencing a diagnosable mental health disorder. School-based humanistic counselling (SBHC) may help young people identify, address, and overcome psychological distress. Data from four pilot trials suggest that SBHC may be clinically effective. However, a fully powered randomised controlled trial (RCT) is needed to provide a robust test of its effectiveness, to assess its cost-effectiveness, and to determine the process of change. Methods/design The Effectiveness and Cost-effectiveness Trial of Humanistic Counselling in Schools (ETHOS) is a two-arm, parallel-group RCT comparing the clinical and cost-effectiveness of SBHC with Pastoral Care as Usual (PCAU) in school settings. Eligibility criteria for young people include being between 13 and 16 years of age and experiencing moderate to severe levels of emotional distress. Participants are randomised to receive either SBHC or PCAU. SBHC is delivered in up to 10 weekly, individual sessions in their school with a qualified, experienced counsellor who has also received training using a clinical practice manual. Adherence to the SBHC model is assessed by a sub-team of auditors and in clinical supervision. PCAU consists of the schools’ pre-existing systems for supporting the emotional health and well-being of students. The primary outcomes are psychological distress measured using the Young Person’s Clinical Outcomes in Routine Evaluation (YP-CORE) and costs evaluated using the Client Service Receipt Inventory (CSRI). Secondary outcomes include psychological difficulties, levels of depression, anxiety and self-esteem, well-being, school engagement, educational outcomes and achievement of personal goals. Qualitative interviews with participants, parents and school staff will look to identify the mechanisms of change in SBHC. Researchers administering the measures are blind to allocation. The trial requires n = 306 participants (n = 153 in each group), with 90% power to detect a standardised mean difference (SMD) of 0.5. An intention-to-treat analysis will be undertaken. Discussion This RCT is powered to detect clinically meaningful differences, and will make a major contribution to the evidence base for mental health provision for adolescents. It will have implications for all stakeholders, including policy-makers, statutory advisory bodies for child welfare, head teachers, children and young people practitioners, child welfare and parenting organisations, and young people. Trial registration Controlled Trials International Standard Randomised Controlled Trial Number (ISRCTN) Registry, ID: ISRCTN10460622. Registered on 11 May 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2538-2) contains supplementary material, which is available to authorized users.

There is longstanding and widespread concern about the poor care offered to young people at the point of making a transition from mental health services for children and young people to services for adults. Research has highlighted that many experience sub-optimal care including poor planning, little information, limited choices and a sense of the whole process being rushed. A number of national UK government reviews have been convened over the last fifteen plus years that have raised poor mental health transitions from children and young people’s mental health services (CYPMHS) as an area requiring urgent attention; this includes Future in Mind. Promoting, protecting and improving our children and young people’s mental health (Department of Health and NHS England) which sets out the national vision for children and young people’s mental health in the UK. Young people report feeling excluded from important decisions about their care, that transition from CYPMHS is often rushed, poorly planned and that their wishes are disregarded. This article describes some of the policy background to this issue and the service improvement initiatives that have emerged in the UK in response including a new contractual indicator to try and incentivize service change. At the centre of this, the article presents the perspectives and transition experiences of a number of young people who are part of GIFT, Great Involvement Future Thinking, a partnership between a mental health consultants, researchers and trainers and young people who work as sessional workers and national advisors, drawn from across the UK, all with experience of using NHS mental health services. Three of these young people, Leanne, Amanda and Anna co-authored this article and provide vivid examples of the barriers many young people in transition can face, along with ideas as to what would improve mental health service transitions.

Advocacy services for vulnerable children and young people began to be provided in the 1980s (Willow, 2013) and have grown as legislation and guidance expanded the range and remit of services (Wood and Selwyn, 2013). Research has followed the development of policy and services, but until recently has not examined the impact and outcomes of advocacy in any depth. In this article we draw on findings from a study of the outcomes and impact of independent advocacy for children and young people to explore how the value of advocacy is understood by them and by advocates, social workers and other professionals, and to consider what differences advocacy can make to the lives of children and young people (Thomas et al., 2016). Our findings indicate that the outcomes of advocacy in children and young people’s lives can be significant and wide-ranging, including both direct effects on the child or young person and wider impact on services. This complex picture has implications for how best to capture and report the outcomes of advocacy, which we explore in the latter part of the article with the aid of a proposed new conceptual framework.

Background:Young people’s transition from child and adolescent (CAMHS) to adult mental health services (AMHS).Objectives:To systematically review evidence on the effectiveness of different models of CAMHS–AMHS transitional care, service user and staff perspectives, and facilitators of/barriers to effective CAMHS–AMHS transition.Data sources:A systematic search in May 2012 of Medline, PsycINFO, CINAHL, EMBASE, AMED, Health Business Elite, HMIC, Cochrane Database, Web of Science and ASSIA; ancestral searches; and consultation with experts in the field.Study selection:Qualitative, quantitative and mixed-methods primary research on the CAMHS–AMHS health-care transition of young people (aged 16–21 years) with mental health problems.Data extraction:Two reviewers independently completed a standardised data extraction form and critically evaluated identified documents using a validated appraisal tool for empirical studies with varied methodologies.Results:A total of 19 studies of variable quality were identified. None were randomised or case-controlled trials. Studies incorporating service user/carer perspectives highlighted the need to tackle stigma and provide accessible, age-appropriate services. Parents/carers wanted more involvement with AMHS. Transitional care provision was considered patchy and often not prioritised within mental health services. There was no clear evidence of superior effectiveness of any particular model.Conclusions:High-quality evidence of transitional care models is lacking. Data broadly support the development of programmes that address the broader transitional care needs of ‘emerging adults’ and their mental health needs but further evaluation is necessary. Developing robust transitional mental health care will require the policy–practice gap to be addressed and development of accessible, acceptable, responsive, age-appropriate provision.

The original version of this article contained an error in Table 1. The correct table is presented below.

The importance of joint working between educational and child mental health professionals is well documented but there are numerous challenges and only limited training models. While the evidence base and training programmes for educationalists regarding child mental health is growing, training mental health professionals about education is more limited. This study presents the views of 36 child mental health and education professionals from four service localities in England regarding their experiences of joint working and perceptions of training, including a preliminary evaluation of a training programme designed to bridge this gap. The findings indicate that participants perceived that a degree of knowledge in education matters is important, and reported that this could be acquired through the development of relationships with educational professionals, setting up link posts and joint training; they also described challenges related to building experience and to resource constraints. Participants were ...

PurposeThe purpose of this paper is to evaluate the introduction of a voluntary sector pilot project to develop innovative mental health services for young people.Design/methodology/approachA combination of observation, interview and group discussion with service providers and users was used to build a picture of the relationships between context, mechanism and outcome.FindingsThe project was perceived as successful and beneficial in all three pilot sites, although there were differences of perception as to whether it complemented or challenged existing statutory services.Practical implicationsLearning about what adolescents and young adults with complex mental health needs find helpful may help to develop more appropriate and acceptable services. A mental health service for young people delivered by the voluntary sector offers the opportunity for radical service innovation. Synergy may be achieved as a result of statutory and voluntary sectors working together but the ethos of the voluntary service may challenge that of the statutory services.Originality/valueThe research is original in that it examines the process of introducing an innovative voluntary sector project into an existing traditional service framework.

Research has highlighted problems in accessing mental health services for people from minority ethnic groups. Much of this literature is focused on adults. The Minority Voices study aimed to identify and describe the perceptions and use of mental health services from the viewpoint of black and minority ethnic (BME) young people aged between 12 and 25 in England and Wales, and to examine initiatives designed to improve the access to, and acceptability of, services for these young people. It used a mixed methods approach, including a literature review, national service mapping, in‐depth interviews and focus groups in four sample areas and action research in preparing materials designed by BME young people. A number of issues that impede access to services, and that are specific to them, were identified and explored with young people from BME groups. These include concerns related to discrimination and racism, confidentiality, family and community pressures, uncertainty about any help they may receive, and marked fears of the stigma that surrounds mental health difficulties. Within services, a lack of capacity of targeted services and of cultural competence were highlighted. The research concluded that there is a need to improve awareness of mental health and information about services among BME communities, and for child and adolescent mental health services (CAMHS) to work with these communities to explore ways in which acceptable and appropriate mental health expertise can be made more readily available through both informal and mainstream provision.

There is currently considerable interest in consulting with young people and involving them in the development and delivery of mental health services - both at the local and national level. This is a welcome development since, as various studies have highlighted, young people can offer both valuable insights into the services they receive and suggestions for what they want from services. In 2003, YoungMinds, a national charity that works to promote children’s mental health, completed a two-year, in-depth qualitative study focused on a sample of in-patient units drawn from across England and Wales. Such units, found at Tier 4 (the most severe or complex problems) within Child and Adolescent Mental Health Services (CAMHS) provide highly specialist care and treatment to some of the most seriously ill and vulnerable children and young people. A key aim of the study was to give a ‘voice’ to these young people in order to help in-patient services develop their provision in ways that are possibly more ‘young-person friendly’. Alongside this, information from staff working both within in-patient units and the community was gathered, to provide an important contrasting perspective and to build up understanding of the current pressures and challenges that face service providers in this area. In total, data was gathered from 107 young people, 35 parents and 169 staff. Information from a number of other services was also compiled to provide case study illustrations of some new models of in-patient care now emerging. Multi-centre Research Ethics Committee approval was gained for the study, with considerable attention being paid to the design of clear ‘young person’ friendly information sheets, consent forms and questionnaires. Much attention was also paid to explaining how information would be used and confidentiality respected. The study findings reveal a picture of considerable change - of improvements but also continuing service gaps. Most importantly, there was a high level of consistency amongst young people as to the areas of greatest concern and many highly realistic, practical suggestions and requests for how in-patient provision for young people should be improved. This article outlines some of the issues raised by young people and in particular highlights the importance of information sharing and of in-patient units being properly staffed. The need for inter-agency links and coordination between in-patient and community based mental health services is also emphasised.

In humans 6-sulphatoxy melatonin (SaMT) is the principal metabolite of endogenous and exogenous melatonin. 5-sulphatoxy N-acetyl-serotonin (SNAS) is a minor metabolite of exogenous melatonin, but it has not been established whether the levels of endogenous SNAS in plasma derives principally from endogenous melatonin. We have developed the first radioimmunoassay (RIA) for SNAS and used it (together with RIAs for melatonin and SaMT) to determine whether endogenous SNAS derives from endogenous melatonin or from platelet serotonin. Our results show a) the values of endogenous SNAS, unlike endogenous SaMT, increased with blood collection procedures that increased the values of serotonin, b) the values of endogenous SNAS in urine or in platelet-poor plasma were approximately the same as those of endogenous SaMT, but, unlike SaMT, did not show a diurnal rhythm, and c) we confirmed that SNAS was a minor metabolite of orally ingested melatonin. Thus, our conclusion is that SNAS is a minor metabolite of exogenous melatonin, but is not a significant metabolite of endogenous melatonin. In all probability, endogenous SNAS is principally the metabolite of platelet serotonin.

We have purified the major metabolite of melatonin, 6-sulphatoxymelatonin, from urine and compared it to its synthetic counterpart. For preparation of the biological material, oral melatonin was administered to human volunteers and their urine extracted onto Amberlite XAD-2 resin to remove urea; the glucuronide metabolites of melatonin were removed by silica chromatography; and 6-sulphatoxymelatonin was separated from N-acetyl serotonin sulphate, the other sulphate metabolite of melatonin, by preparative thin-layer chromatography. Synthetic 6-sulphatoxymelatonin was produced by reacting 6-hydroxymelatonin with chlorosulphonic acid in dimethylformamide; the reaction mixture was purified on Florisil and preparative thin-layer chromatography was used to remove indolic by-products of the reaction. Elemental and X-ray microanalysis of the biological and synthetic products showed that classical methods used for their purification introduced inorganic impurities, such as silicon- and chlorine- containing compounds, which were not detectable by thin-layer chromatography, infrared spectroscopy, nuclear magnetic resonance spectroscopy, or gas chromatography-mass spectrometry. We introduced further purification steps to remove these inorganic impurities, monitoring the process using elemental and X-ray microanalysis. Extensive characterization of the resulting purified products showed that the biological and synthetic compounds were identical.

Recent policies recommend effective joint working between health and education; however, the views of service users are underrepresented, particularly opinions of young children.The project was operational from 2005-2008 when interviews were conducted with parents and children. The children were attending CAMHS for mental health and educational difficulties.Results indicated that they had a positive view of multiagency working. They consider that joint working is limited by a number of problems and make recommendations for improvement.Findings indicate that more effective communication between agencies is needed and this should be provided for parents in an accessible language. This has implications for training professionals together.

The improved joint working between child and adolescent mental health services (CAMHS) and schools is a policy priority. Although there have been a range of school-based initiatives and studies on teachers’ awareness of mental health issues, there has been limited evidence on the training needs of CAMHS practitioners. The aim of this study was to explore how much CAMHS staff know about educational issues and how confident they feel working collaboratively with education colleagues. Ninety-six staff from four specialist CAMHS completed a questionnaire with 40 items on perceptions of knowledge, practice and attitudes towards educational issues and services, and three case vignettes. Despite the fact that participants reported frequent contact with children with education-related needs and with education services, they also highlighted concerns about their level of training and skills in this regard. Perceptions of knowledge and attitudes significantly predicted response to case vignettes. Previous training and experience were associated with knowledge, but did not predict case vignettes scores. The results suggest that training of CAMHS staff should be integral to all services in helping improve their understanding of school and education systems, improve clinical skills in detecting education-related mental health problems, and develop strategies in increasing joint working.

We report an HPLC assay for melatonin that incorporates automated injection, methanol/water mobile phase, and fluorescence detection. Plasma samples were extracted by solid and liquid phases. Recovery was > 70% for 1-10 mL of plasma extracted, approximately 40 pg-250 ng of melatonin. Samples were dried and reconstituted in 100 mL/L methanol. Injections were 25 microL or 150 microL, depending on sample concentration, and the melatonin peak was eluted in 380 mL/L methanol. The detection limit of the assay was 6 pg on the column, allowing a practical sensitivity in plasma of 11 pmol/L for 8-mL samples and 34 pmol/L for 2-mL samples. More than 100 plasma samples from volunteers and patients were assayed and the results compared with an established RIA. The mean daytime concentration of melatonin was 20.7 pmol/L (SEM = 1.2) and 18.5 pmol/L (SEM = 1.6) for HPLC and RIA, respectively, and the mean nighttime concentration was 82.4 pmol/L (SEM = 6.5) and 82.2 (SEM = 7.3), respectively.

The increased production of cortisol by the fetal adrenal gland at term acts as the trigger for parturition in some species. The fetal pituitary controls fetal adrenal function. However, ACTH is only one of a family of closely related peptides which derive from a common precursor and we have shown that although ACTH is the dominant form in the adult pituitary, the expression of the "family trees' is altered in the fetus. In the sheep, it is large-molecular-weight precursors and, in the primate, the smaller peptides such as alpha-MSH, CLIP, beta-MSH and beta-endorphin that predominate in fetal life and which may be responsible for fetal adrenal function. It is still unclear what causes the developmental change in the ACTH "family tree'. Since it may result from a change in pituitary function - from the peptides of the pars intermedia, in the fetus, to those of pars anterior, in the adult - we have studied these two lobes separately in pituitaries taken from adult and fetal sheep and monkeys. Our preliminary results suggest that the change may occur in the neurointermediate lobe in the primate, but that in the sheep the developmental changes occur in the anterior lobe.