Two years ago I gave a talk in London to esteemed colleagues and friends on this subject.

In cases where young people are using Class A drugs there are clear safeguarding issues because young people in these contexts are exploited the same of these drugs through their participation in the illegal economy, in organised crime.gang culture and sex working.

Suicide is not a rare event if the World Health Organisation (WHO) estimates that 800 000 - 1 000 000  people die by suicide in the world each year. There is regional variation in suicide rates across the world. In 2016 just over 222 000 young people aged 10-29 years were recorded as having committed suicide. According to WHO Global Health Estimates 2016, in the 15-29 year old group, suicide accounted for about 200 000 deaths compared to 400 000 deaths by road traffic accidents. Of these statistics about 125 000 young men had died by sucide, compared to 170 000 by interpersonal violence.

If we can understand this issue then parents and teachers can learn from us and apply the positive messages in their interactions with their children. About 10% of children under the age of 10 years in the UK have one or more diagnosable mental illnesses which impair their progress in education and the social world. About 10% of all children are subject to maltreatment in the UK.

THE HEALTH SYSTEM IS NOT STAFFED WITH ENOUGH PEOPLE TO MEET DEMANDS AND THE NEEDS OF THESE CHILDREN.

Teenagers with Autistic Spectrum Disorder ASD often threaten suicide which is very stressful for parents. Each family is unique in its structure and quality of relationships and functioning. Parents and carers in this siutation when a child is threatening suicide and self harming are subject to very significant levels of stress. Their natural preoccupation with the idea that their child could die by suicide can become intolerable.

At present I see many teenagers with a diagnosis of Autistic Spectrum Disorder (ASD) who are stuck. Many live at home and do not go to school. Some have struggled to meet the combined academic and social demands and feel unmotivated and are difficult to engage.

Severe Depression may affect at least 3 % of young people under the age of 18 years.

About 2% of all people have ASD.

Depression is common in teenagers with ASD, affecting as much as 30-70%, impairing them in their progress at school.

Over the last 19 years as a psychiatrist I have made referrals to specialist centres for young people who present with depression with suicidal thinking and transgender identity.

In the last five years there has been an increase in the number of these types of cases referred by doctors to the Tavistock and Portman Clinic in London , where young people have to wait for over one year before they are seen.

I have been thinking about the relationship between depression and eating disorders for over a year. There is a range of eating disorders, although today I will consider Anorexia Nervosa. In the UK the NICE Guidance 2017 on the subject of treatment of depression in eating disorders has confirmed that there is a need for further research in this field.

Just over one year ago the Impact Study was published following a collection of data from multiple Child and Adolescent Mental Health Services in the United Kingdom. Essentially it was a landmark study looking at whether or not we are effective enough in treating depression in young people.

Cognitive Behaviour Therapy and Brief Psychoanalytic Psychotherapy were shown to be as effective as a Brief Psychosocial intervention and support. Most of the work was delivered in 28 weeks but data was collected up to 86 weeks.

In the last two years I moved job from West Sussex to Wiltshire, where I am specialising in Eating Disorders and more complex cases of depression, which often have child protection issues.

In the last two years we completed and depression audit, thought about the family is its of the impact study and thought more creatively about research that will focus more on the benefits of exercise and diet and the pursuit of personal goals comparison to medication.

I have worked as a Consultant Child and Adolescent Psychiatrist in the NHS in England for 7 years and recently we have received news that our fabulous small team is being cut further. How can we deliver a comprehensive and high quality service in this NHS environment. Maybe we should innovate, but not reinvent the wheel or cut corners.