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The importance of multi-agency collaboration has been emphasised in virtually every piece of recently published guidance relating to the development of children's services including CAMHS. The Government Green Paper, Every child matters (DfES, 2003), which proposes the development of Children's Trusts, will further impact on this agenda. Surprisingly, there has been much less written about factors contributing to the success of multi-agency collaboration than there has about barriers to it. Research is beginning to emerge informing on key criteria required for the development of multi-agency collaborations for children with mental health problems. Much work remains to be undertaken on the use of language and definitions between agencies before a common understanding about children's needs and the services they require can evolve.

A B S T R A C TThis article reviews the literature on bullying with particular reference to associated psychiatric symptoms and presents data and case examples from an inpatient and outpatient adolescent service and a school for emotionally and behaviourally disturbed children (EBD school). Bullying or its effects do not seem to be a distinguishing factor among those admitted to an adolescent unit. In the outpatient group, however, being bullied is frequently a factor in the presentation of adolescents to psychiatric services, with depression being the diagnosis in over 70% of cases. In contrast, bullies and bully/victims were most likely to present with conduct disorders, which were frequently co-morbid with hyperkinetic disorder/attention deficit hyperactivity disorder (ADHD). Unsurprisingly, regardless of whether bully, victim, bully/victim or neither, the most common psychiatric diagnosis of the EBD school pupils who were interviewed was that of conduct disorder. This was sometimes co-morbid with AD(H)D but also seen alongside generalized anxiety disorder and major depressive disorder.In an adolescent unit and in an EBD school, being bullied or a bully is an important factor associated with psychiatric symptomatology and should be regarded as a substantial mental and public health issue. K E Y W O R D S adolescent, bully, depression, health, victim

It is now widely agreed that meeting the mental health needs of children and young people is a task only possible if all children's services work together. Recent epidemiological data indicate that schools are a key entry point to mental health services for children and young people, and have an important role in the assessment and management of children with neurodevelopmental disorders. This paper explores the rationale for collaborative working between health and educational professionals, examines some examples of good practice, explores factors contributing to their success or failure and considers future developments.

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This qualitative study aims to explore the types and purpose of discourse emerging when professionals from a Child and Adolescent Mental Health Service meet with professionals from other agencies to discuss cases. The aim reflects current political and contextual agendas influencing agencies to work more closely together and obstacles to achieving this goal highlighted in the literature such as the need for agencies to develop a common language to discuss children of concern. Data were collected through eight audio-taped meetings involving CAMHS and members of other agencies such as social services and education. A thematic analysis identified nine themes, defined according to their discourse type, including: single agency discourse; case complexity discourse and multi-agency discourse. Results indicate that agencies are hindered from working more closely together and developing a common language for use in multi-agency meetings, because they tend to have different understandings of the terminology used and a common consensus about language and meaning is not usually negotiated within the meeting. There is a need for greater awareness amongst staff from different professional groups and agencies that meaning given by one group will often need to be clarified by others and assumptions about common understandings should not be made.

Most child and adolescent psychiatrists and community paediatricians have a heavy commitment to the assessment and management of children with ADHD. The paediatric approach is heavily biased toward clinical investigation and psychostimulant treatment. Child and adolescent psychiatrists prioritise mental health assessment and have access to a wider range of treatment options. This survey clearly suggests the need for joint working between the two disciplines to provide a holistic approach to the condition to exclude and manage coexisting mental health, physical and developmental problems.

The Community Intensive Therapy Team (CITT) has been operating since 1998. It was developed to cater for the needs of patients with complex difficulties referred to a specialist Child and Adolescent Health Service (CAMHS) in South Wales, UK. The patients served by the CITT are comparable with patients who might be referred for admission to an inpatient unit and include patients with eating disorders, psychosis, affective disorders, adjustment disorders or repetitive self-harm. The theoretical model used is based on a biopsychosocial model which aims to empower and support family members. The philosophy of the CITT is to work with the child and family in their own environment, tailoring the therapy to the needs of all concerned. CITT makes use of the strengths within the patient, the family and extended family, the agencies already involved and the environment. Since its introduction, the CITT has been able to manage all the complex referrals made to it from the generic Tier 2/3 CAMHS teams it serves, with minimal recourse to inpatient beds.