Whilst all developed countries report high rates of adolescent mental disorder, there has been a decline in adolescent in-patient provision in the UK in recent years. This report shows that only 0.3% of adolescents requiring psychiatric admission in the North West of England were admitted to an adolescent psychiatric unit, the rest being treated in adult mental health or non-psychiatric facilities. These findings point to a considerable need for and under-provision of adolescent psychiatric services, including in-patient beds, in North West England. This situation probably exists elsewhere in the UK, where development of adolescent and youth services has lagged behind Europe and North America.