A small fraction of children who receive specialist mental health care in Scotland go on to account for a striking share of adult psychiatric treatment, according to the longest follow-up study of its kind in the United Kingdom. Researchers from the University of Edinburgh tracked almost half a million people born in Scotland between 1991 and 1998, linking health records from childhood into adulthood and following participants until 2023. The results suggest that contact with Child and Adolescent Mental Health Services (CAMHS) identifies a population at exceptionally high risk of requiring intensive mental health support later in life.
Approximately 8 per cent of the people included in the study attended CAMHS before reaching the age of 18. Among those former CAMHS patients, four in ten subsequently accessed specialist psychiatric services as adults. The proportion was even higher for individuals who first attended CAMHS during their teenage years: around half went on to use adult mental health services by their early 30s. That rate is considerably higher than estimates from previous research, which may have underestimated the extent to which severe mental health difficulties persist or re-emerge across the transition from adolescence to adulthood.
The study examined both inpatient and outpatient care, allowing researchers to measure not only whether people entered adult services, but also the intensity of their subsequent treatment. By the age of 32, former CAMHS patients accounted for 46 per cent of all adult psychiatric inpatient bed days in the cohort. They were also responsible for 41 per cent of all NHS adult mental health outpatient appointments. In other words, the 8 per cent of people who had used CAMHS during childhood generated nearly half of the recorded specialist adult mental health care in this population.
The researchers also found that former CAMHS patients represented substantial proportions of people diagnosed with severe mental illnesses in adult psychiatric hospitals. They accounted for 49 per cent of patients with personality disorders, 50 per cent of those with eating disorders, 39 per cent of those with schizophrenia and 39 per cent of those with opioid use disorders. These figures do not mean that CAMHS attendance causes these conditions. Rather, they indicate that children referred to specialist services often have complex, persistent or severe vulnerabilities that can continue to affect health, functioning and treatment needs over many years.
CAMHS is designed to provide assessment and treatment for children and young people experiencing significant mental health problems. Its interventions can include psychological therapies, medication, crisis support and coordinated care involving families, schools and social services. Early intervention is widely considered important because childhood and adolescence are periods of rapid brain development, educational change and social maturation. Symptoms that emerge during these stages can influence emotional regulation, relationships, substance use, educational attainment and physical health. However, the long-term consequences of specific CAMHS interventions remain difficult to evaluate because health systems have rarely followed patients continuously into adulthood.
The new research used linked, routinely collected Scottish health data to overcome part of that problem. By connecting records across age groups, the team could identify patterns of service use over decades rather than relying on short-term clinical trials or surveys conducted soon after treatment. This approach is known as a population-based cohort study. It can reveal how outcomes unfold across an entire birth population and can capture hospital admissions, outpatient contacts and diagnostic patterns that might be missed in smaller studies. At the same time, observational data cannot prove that a particular treatment caused a later outcome, because patients are not randomly assigned to CAMHS care and may differ in severity, family circumstances, deprivation, physical health or access to services.
The findings point to a major concentration of mental health need within a relatively small group of people. They also highlight the importance of the transition between child and adult services, when young people may lose access to familiar clinicians or face changes in eligibility, treatment models and responsibility for care. A gap during this period could be especially consequential for people with recurrent symptoms, neurodevelopmental conditions, self-harm histories, eating disorders or emerging psychosis. The results suggest that successful treatment in childhood should not be assessed only by whether symptoms improve before a patient leaves CAMHS, but also by whether benefits are sustained through later developmental stages.
Professor Ian Kelleher, Chair of Child and Adolescent Psychiatry at the University of Edinburgh and leader of the study, said Scotland already monitors long-term outcomes for many cancer types but lacks an equivalent system for mental health. He argued that CAMHS should be understood not merely as a childhood treatment service, but also as a way of identifying a group likely to become high-intensity users of specialist adult care. From a clinical, social and economic perspective, he said, health authorities need stronger evidence about whether existing interventions produce durable benefits and which approaches are most effective for different conditions.
The research team is calling for the Scottish Government to establish a Mental Health Observatory that would routinely connect childhood and adult mental health records while protecting patient privacy. Such a system could track outcomes after treatment, compare regional services, detect inequalities and assess the effects of policy changes. Dr Jane Morris, Chair of the Royal College of Psychiatrists in Scotland, said the findings reinforce the need to identify mental health conditions as early as possible and to provide sustained support in adulthood. The study, published in European Child & Adolescent Psychiatry, offers a powerful warning and an opportunity: the children entering CAMHS today may shape the future demand for psychiatric care, and understanding their long-term trajectories could help health systems intervene before difficulties become entrenched.
Subject of Research: People
Article Title: Adult mental health service outcomes for patients of child and adolescent mental health services: a total Scottish birth cohort study
Web References: https://www.nature.com/articles/s42004-026-01942-7
References: European Child & Adolescent Psychiatry. DOI: 10.1007/s00787-026-03135-y
Keywords: CAMHS, child and adolescent mental health, adult psychiatric services, Scotland, mental health outcomes, psychiatric hospitalization, longitudinal cohort study, early intervention, schizophrenia, eating disorders, personality disorders, opioid use disorders, mental health policy
