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Professor Simon Gowers, University of Liverpool Section of Adolescent Psychiatry, Academic Unit, 79 Liverpool Road, Chester CH2 1AW UK Although the majority of children with mental health problems are treated in community services, a comprehensive child and adolescent mental health service (CAMHS) needs access to highly specialised provision including in-patient facilities. A lack of monitoring has led to a situation in which little is known about the precise number, distribution and function of these services, hence the Department of Health's decision to commission the National In-patient Child and Adolescent Psychiatry Study (NICAPS). There are several variables to consider: the epidemiology of mental health problems in children and adolescents, comparisons with other developed countries, the views of referring CAMHS, and evidence of inappropriate admissions elsewhere. If we take 7.1% as a conservative estimate of the prevalence of mental health problems in this population, this would suggest that 1 in 1000 children with a mental health problem could be admitted to an in-patient unit at any time.

STUDY OBJECTIVE--The aim was to assess the relationship between social deprivation, as measured by the Jarman under-privileged area score (UPA score), and psychiatric admission rates and length of stay within an inner London borough. DESIGN--The study was a retrospective survey of psychiatric admission rates for electoral wards in the London borough of Islington in relation to Jarman UPA scores and subscores. SETTING--Islington Health Authority psychiatric admission wards at the Whittington and Friern Hospitals. PATIENTS--All admissions during the year of 1985 were studied (n = 778). MAIN RESULTS--No correlation was found between the total Jarman UPA score and either admission rates or length of stay. There was, however, a correlation between the Jarman UPA subscore for ethnic minorities and admission rates (r = 0.409, p less than 0.05), and between the Jarman UPA subscore for lone parents and length of stay (r = 0.390, p less than 0.05). CONCLUSIONS--The Jarman UPA score at electoral ward level is not related to psychiatric morbidity, and should not therefore be used for planning local service provision.

Questions concerning the safety of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression in children led us to compare and contrast published and unpublished data on the risks and benefits of these drugs. We did a meta-analysis of data from randomised controlled trials that evaluated an SSRI versus placebo in participants aged 5–18 years and that were published in a peer-reviewed journal or were unpublished and included in a review by the Committee on Safety of Medicines. The following outcomes were included: remission, response to treatment, depressive symptom scores, serious adverse events, suicide-related behaviours, and discontinuation of treatment because of adverse events. Data for two published trials suggest that fluoxetine has a favourable risk-benefit profile, and unpublished data lend support to this finding. Published results from one trial of paroxetine and two trials of sertraline suggest equivocal or weak positive risk-benefit profiles. However, in both cases, addition of unpublished data indicates that risks outweigh benefits. Data from unpublished trials of citalopram and venlafaxine show unfavourable risk-benefit profiles. Published data suggest a favourable risk-benefit profile for some SSRIs; however, addition of unpublished data indicates that risks could outweigh benefits of these drugs (except fluoxetine) to treat depression in children and young people. Clinical guideline development and clinical decisions about treatment are largely dependent on an evidence base published in peer-reviewed journals. Non-publication of trials, for whatever reason, or the omission of important data from published trials, can lead to erroneous recommendations for treatment. Greater openness and transparency with respect to all intervention studies is needed.