December 2020 – The Bridge

Dr. Stephanie J Lewis is Clinical Lecturer in Child and Adolescent Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. Steph is keen to promote the translation of research and expert evidence into clinical practice to improve mental healthcare for young people, so is delighted and proud to be editor of the Bridge.

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Welcome to the December 2020 issue of The Bridge, click on the front cover to download the issue as a pdf or read the individual December 2020 articles online.


Welcome to the December 2020 issue of The Bridge.

This year has been extremely challenging for our field, as we’ve needed to understand and address the impact of the coronavirus pandemic on young people’s mental health.

Emerging evidence suggests that youth mental health may have worsened overall during the pandemic, exacerbating trends observed over recent decades of increasing prevalence and poorer outcomes.(1) The Mental Health of Children and Young People in England Surveys found that probable mental disorder rates increased between 2017 and July 2020, and are highest for older adolescent girls, one in four of whom had a probable disorder in July 2020.(2) These findings are perhaps unsurprising, given COVID-19’s health and economic threat, as well as the academic and social disruption experienced by young people, at an age when their emotional and cognitive skills are developing. Since the summer and as schools have re-opened, the Co-SPACE study has found some evidence that their participants’ mental health difficulties may have reduced.(3) We’ll learn more about the ongoing impact of the pandemic, and about which individuals are at greatest risk, as research continues.

For young people with persistent and impairing mental health disorders, access to evidence‐based interventions is crucial. At the start of the pandemic, CAMHS services faced major disruption,4 referrals and emergency presentations declined,(5,6) and some people felt abandoned by services.7 But we have worked extremely hard to adapt to challenges, and there have been many swiftly implemented innovations to address mental health needs.(7,8) In this issue of The Bridge Dr Christopher Abbott and Dr Bruce Clark, who lead CAMHS teams in South London (one of the first areas severely affected by COVID-19 in the UK), provide an expert reflection on lessons learnt and future considerations for providing effective care in our physically-distanced world.

In addition to adapting to new ways of working, the chronic underfunding of young people’s mental health services needs to be urgently addressed to meet rising demand. If not treated, youth mental health problems often persist into adulthood,(9) and for both children and adults mental health disorders are a leading cause of disability worldwide.(10) In light of the evidence for cost-effectiveness of interventions, regions that invest in mental health care will reap rewards.(4) Let’s hope this becomes a priority with meaningful action in 2021.


1 Ford T (2020). Editorial Perspective: Why I am now convinced that emotional disorders are increasingly common among young people in many countries. J Child Psychol Psychiatr; 61: 1275–7.

2 Vizard T, et al. (2020). Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey. NHS Digital:

3 Skripkauskaite S, et al. (2020) Changes in children mental health symptoms from March to October 2020. The Co-SPACE Study:

4 World Health Organization (2020). COVID-19 disrupting mental health services in most countries, WHO survey:

5 Tromans S, et al. (2020). Patterns of use of secondary mental health services before and during COVID-19 lockdown: observational study. BJPsych open; 6: e117.

6 Ougrin D (2020). Debate: Emergency mental health presentations of young people during the COVID‐19 lockdown. Child Adolesc Ment Health; 25: 171–2.

7 Sheridan Rains L, et al. (2020). Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: framework synthesis of international experiences and responses. Soc Psychiatry Psychiatr Epidemiol; published online doi:10.1007/s00127-020-01924-7.

8 Johnson S, et al. (2020). Impact on mental health care and on mental health service users of the COVID-19 pandemic: a mixed methods survey of UK mental health care staff. Soc Psychiatry Psychiatr Epidemiol; published online doi:10.1007/s00127-020-01927-4.

9 Kessler RC, et al. (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry; 62: 593.

10 World Health Organization (2016). Global health estimates 2016: disease burden by cause, age, sex, by country and by region, 2000-2016. World Health Organization:

Articles from the December 2020 edition

CAMHS services in our physically distanced world

Are children of any age susceptible to suicidal behaviour?

Do CAMHS collect less PROM data from certain sociodemographic groups?

The DSM-5 criteria for DMDD overlook children with context-specific impairing irritability

Insufficient sleep might affect children’s emotional health

Does an internet gaming disorder prospectively predict psychiatric symptoms?

Consistency is needed when measuring and reporting outcomes in child and adolescent anxiety disorders trials

A developmental language disorder might increase the risk of reoffending

Is infant empathy linked with later externalizing problems?

Does late-onset ADHD share the same neurocognitive markers as childhood-onset ADHD?

Do ADHD and ASD symptoms have similar characteristics in childhood and young adulthood?

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