Restricted accessResearch articleFirst published online 2026-4
Rapids Crisis Service for Children and Adolescents 2019–2024: 6-Year Changes in Crisis Service at Lambeth Children and Adolescent Mental Health Services in London,United Kingdom
The demand for children and adolescent mental health crisis services has risen dramatically in recent years, yet evidence on real-world implementation models remains limited. Rapids is a community-based crisis intervention service developed within Lambeth Children and Adolescent Mental Health Services (CAMHS) at South London and Maudsley NHS Foundation Trust. The primary aim of this study was to examine how clinical presentations, risk profiles, and service outcomes changed over time among children and adolescents accessing Rapids over a 6-year period. We also aimed to describe the characteristics of individuals accessing Rapids.
Methods:
This service evaluation used routinely collected clinical data from all children and adolescents up to 18 years who accessed Rapids between January 1, 2019, and December 31, 2024. Sociodemographic, diagnostic, pharmacological, and risk-related variables were evaluated. Diagnoses were coded using International Classification of Diseases, 10th Revision (ICD-10) criteria. Descriptive and inferential analyses were conducted to assess changes in clinical presentations and service outcomes.
Results:
In total, 325 children and adolescents were included (mean age = 15.5 years, 61.8% females, 64.6% non-White). Anxiety disorders (29.5%), depressive disorders (42.2%), and autism spectrum disorder (33.5%) were the most common diagnoses. Inpatient admissions increased (1.5%–5.8%, p = 0.043), and high risk to self also rose notably (19.5%–31.7%, p < 0.001). Referrals accepted to adult services decreased significantly over time (38.5%–16.8%, p < 0.001). Diagnostically, eating disorders increased (3.7%–10.0%, p = 0.032), whereas emotionally unstable personality disorder traits decreased (14.1%–7.4%, p = 0.049).
Conclusions:
Rapids has evolved into an established model of crisis care within CAMHS, addressing acute needs through timely community-based interventions. We observed meaningful temporal changes in the clinical acuity, diagnostic profile, and service use outcomes of young people presenting to our community-based CAMHS crisis service. Our findings support the feasibility and scalability of intensive community-based crisis care and highlight the need for sustained investment in culturally responsive, multidisciplinary service models.
AdamoN, SinghSP, BölteS, et al.Practitioner review: Continuity of mental health care from childhood to adulthood for youths with ADHD—Who, how and when? J Child Psychol Psychiatry, 2024; 65(11):1526–1537; doi: 10.1111/jcpp.14036
2.
AliK, FarrerL, GulliverA, et al.Online peer-to-peer support for young people with mental health problems: A systematic review. JMIR Ment Health, 2015; 2(2):e19; doi: 10.2196/mental.4418
3.
BenchimolEI, SmeethL, GuttmannA, et al.; RECORD Working Committee. The reporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med, 2015; 12(10):e1001885; doi: 10.1371/journal.pmed.1001885
4.
BenkeT, MarksteinerJ, RueppB, et al.Decision making under risk in patients suffering from schizophrenia or depression. Brain Sci, 2021; 11(9):1178; doi: 10.3390/brainsci11091178
5.
BovairdT, LoefflerE. From engagement to co-production: The contribution of users and communities to outcomes and public value. Voluntas, 2012; 23(4):1119–1138; doi: 10.1007/s11266-012-9309-6
6.
CloitreM, GarvertDW, WeissB, et al.Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. Eur J Psychotraumatol, 2014; 5:25097; doi: 10.3402/ejpt.v5.25097
7.
de BeerCRM, NooteboomLA, van DomburghL, et al.A systematic review exploring youth peer support for young people with mental health problems. Eur Child Adolesc Psychiatry, 2024; 33(8):2471–2484; doi: 10.1007/s00787-022-02120-5
FiorilloA, BarlatiS, BellomoA, et al.The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review. Ann Gen Psychiatry, 2020; 19:43; doi: 10.1186/s12991-020-00293-4
10.
FranzenM, KellerF, BrownRCet al.Emergency Presentations to Child and Adolescent Psychiatry: Nonsuicidal Self-Injury and Suicidality. Front Psychiatry, 2019; 10:979; doi: 10.3389/fpsyt.2019.00979
11.
Fusar-PoliP, De MicheliA, SignoriniL, et al.Real-world long-term outcomes in individuals at clinical risk for psychosis: The case for extending duration of care. EClinicalMedicine, 2020; 28:100578; doi: 10.1016/j.eclinm.2020.100578
12.
García-SempereA, Hurtado NavarroI, Robles-CabaniñasC. et al.Prescriber-recorded indications for antipsychotic use in children and adolescents in Spain, 2015–2023: a population-based, real-world study. Eur Child Adolesc Psychiatry, 2025; doi: 10.1007/s00787-025-02875-7
13.
GleesonJFM, LudwigK, StilesBJ, et al.Systematic review and meta-analysis of family-based interventions for early psychosis: Carer and patient outcomes. Schizophr Res, 2025; 276:57–78; doi: 10.1016/j.schres.2025.01.006
14.
HartleyS, BakerC, BirtwhistleM, et al.Commentary: Bringing together lived experience, clinical and research expertise—a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?). Child Adolesc Ment Health, 2022; 27(3):246–249; doi: 10.1111/camh.12586
15.
HoagwoodKE. Family-based services in children’s mental health: A research review and synthesis. J Child Psychol Psychiatry, 2005; 46(7):690–713; doi: 10.1111/j.1469-7610.2005.01451.x
16.
IBM Corp. IBM SPSS Statistics for Macintosh, Version 29.0. IBM Corp: Armonk, NY, 2024.
KeillerE, MasoodS, WongBH, et al.Intensive community care services for children and young people in psychiatric crisis: An expert opinion. BMC Med, 2023; 21(1):303; doi: 10.1186/s12916-023-02986-5
19.
KingT, FazelM. Examining the mental health outcomes of school-based peer-led interventions on young people: A scoping review of range and a systematic review of effectiveness. PLoS One, 2021; 16(4):e0249553; doi: 10.1371/journal.pone.0249553
20.
KwokKHR, YuanSNV, OugrinD. Review: Alternatives to inpatient care for children and adolescents with mental health disorders. Child Adolesc Ment Health, 2016; 21(1):3–10; doi: 10.1111/camh.12123
21.
LoadesME, SchleiderJL. Technology Matters: Online, self-help single session interventions could expand current provision, improving early access to help for young people with depression symptoms, including minority groups. Child Adolesc Ment Health, 2023; 28(4):559–561; doi: 10.1111/camh.12659
22.
MayoralM, ValenciaF, CalvoA, et al.Development of an early intervention programme for adolescents with emotion dysregulation and their families: Actions for the treatment of adolescent personality (ATraPA). Early Interv Psychiatry, 2020; 14(5):619–624; doi: 10.1111/eip.12934
23.
McNicholasF. Child & adolescent emergency mental health crisis: A neglected cohort. Ir Med J, 2018; 111(10):841.
24.
MezaJI, ZulloL, VargasSM, et al.Practitioner Review: Common elements in treatments for youth suicide attempts and self-harm—A practitioner review based on review of treatment elements associated with intervention benefits. J Child Psychol Psychiatry, 2023; 64(10):1409–1421; doi: 10.1111/jcpp.13780
MorrisAC, DouchS, PopnikolovaT, et al.A framework for remotely enabled co-design with young people: Its development and application with neurodiverse children and their caregivers. Front Psychiatry, 2024; 15:1432620; doi: 10.3389/fpsyt.2024.1432620
Northern Ireland Commissioner for Children and Young People. Review of CAMHS data from 2013–2022. 2023.
29.
OugrinD, CorrigallR, PooleJ, et al.Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: A randomised controlled trial. Lancet Psychiatry, 2018; 5(6):477–485; doi: 10.1016/S2215-0366(18)30129-9
30.
OugrinD, CorrigallR, StahlD, et al.Supported discharge service versus inpatient care evaluation (SITE): A randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: Self-harm, functional impairment, and educational and clinical outcomes. Eur Child Adolesc Psychiatry, 2021; 30(9):1427–1436; doi: 10.1007/s00787-020-01617-1
31.
OugrinD, ZundelT, CorrigallR, et al.Innovations in Practice: Pilot evaluation of the supported discharge service (SDS): clinical outcomes and service use. Child Adolesc Ment Health, 2014; 19(4):265–269; doi: 10.1111/camh.12038
32.
PanchalU, Salazar de PabloG, FrancoM, et al.The impact of COVID-19 lockdown on child and adolescent mental health: Systematic review. Eur Child Adolesc Psychiatry, 2023; 32(7):1151–1177; doi: 10.1007/s00787-021-01856-w
33.
PastoreM, IndrioF, BaliD, et al.Alarming increase of eating disorders in children and adolescents. J Pediatr, 2023; 263:113733; doi: 10.1016/j.jpeds.2023.113733
34.
RoseD, FleischmanP, WykesT. What are mental health service users’ priorities for research in the UK? Journal of Mental Health, 2008; 17(5):520–530.
35.
Salazar de PabloG, ArangoC. Debate: Prevention of psychosis in adolescents—does CAMHS have a role? Child Adolesc Ment Health, 2023; 28(4):550–552; doi: 10.1111/camh.12662
36.
Salazar de PabloG, De MicheliA, SolmiM, et al.Universal and selective interventions to prevent poor mental health outcomes in young people: Systematic review and meta-analysis. Harv Rev Psychiatry, 2021a;29(3):196–215; doi: 10.1097/HRP.0000000000000294
37.
Salazar de PabloG, EstradéA, CutroniM, et al.Establishing a clinical service to prevent psychosis: What, how and when? Systematic review. Transl Psychiatry, 2021b;11(1):43; doi: 10.1038/s41398-020-01165-x
38.
Salazar de PabloG, GuinartD, CornblattBA, et al.Demographic and clinical characteristics, including subsyndromal symptoms across bipolar-spectrum disorders in adolescents. J Child Adolesc Psychopharmacol, 2020a;30(4):222–234; doi: 10.1089/cap.2019.0138
39.
Salazar de PabloG, GuinartD, CornblattBA, et al.DSM-5 attenuated psychosis syndrome in adolescents hospitalized with non-psychotic psychiatric disorders. Front Psychiatry, 2020b;11:568982; doi: 10.3389/fpsyt.2020.568982
40.
Salazar de PabloG, MorenoD, Gonzalez-PintoA, et al.Affective symptom dimensions in early-onset psychosis over time: A principal component factor analysis of the Young Mania Rating Scale and the Hamilton Depression Rating Scale. Eur Child Adolesc Psychiatry, 2021c;31(11):1715–1728; doi: 10.1007/s00787-021-01815-5
41.
Salazar de PabloG, RaduaJ, PereiraJ, et al.Probability of transition to psychosis in individuals at clinical high risk: An updated meta-analysis. JAMA Psychiatry, 2021d;78(9):970–978; doi: 10.1001/jamapsychiatry.2021.0830
42.
Salazar de PabloG, RodriguezV, BesanaF, et al.Umbrella review: Early-onset psychosis: Atlas of the meta-analytical evidence. J Am Acad Child Adolesc Psychiatry, 2024; 63(7):684–697; doi: 10.1016/j.jaac.2023.10.016
43.
Salazar de PabloG, StuderusE, Vaquerizo-SerranoJ, et al.Implementing precision psychiatry: A systematic review of individualized prediction models for clinical practice. Schizophr Bull, 2021e;47(2):284–297; doi: 10.1093/schbul/sbaa120
44.
Salazar de PabloG. Editorial: Short interventions and self-help interventions in child and adolescent mental health. Child Adolesc Ment Health, 2023; 28(4):471–472; doi: 10.1111/camh.12678
45.
SavaglioM, O’DonnellR, HatzikiriakidisK, et al.The impact of community mental health programs for Australian youth: A systematic review. Clin Child Fam Psychol Rev, 2022; 25(3):573–590; doi: 10.1007/s10567-022-00384-6
46.
SolmiM, RaduaJ, OlivolaM, et al.Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry, 2022; 27(1):281–295; doi: 10.1038/s41380-021-01161-7
47.
UK Bipolar. It’s about time: The urgent need to reduce diagnosis delay for people with bipolar disorder [Commissioned report]. UK Bipolar; 2023.
World Health Organization. ICD-10: International statistical classification of diseases and related health problems (10th revision, 2016 version). Geneva: World Health Organization: 2016.
