Sir: I was interested to read the report of Worrell and O'Herlihy (Psychiatric Bulletin, June 2001, 25, 219-222) summarising the views of psychiatrists on in-patient child and adolescent provision. I have completed a similar survey in Wales, with a response rate of 96% (25/26 responses).

In Wales no psychiatrist has access to an adolescent psychiatric in-patient bed for emergency admissions. Eighty per cent (n=20) usually use a bed ‘borrowed’ from adult services and 20% (n=5) use paediatric beds either primarily, or equally to adult psychiatric beds.

Eighty-eight per cent (n=22) believe appropriate in-patient care is delayed for adolescents with mental illness because of inadequate provision. All believe this is primarily because of insufficient beds. Sixty-eight per cent (n=17) identify the lack of specialist adolescent provision, particularly adolescent psychiatric intensive care and adolescent forensic mental health provision.

Forty per cent of psychiatrists (n=10) feel the regional adolescent units are frequently unable to offer a bed within an acceptable time. Those patients are managed locally in adult psychiatric (24%) or paediatric (16%) beds or referred out of area largely to beds within the independent sector.

The response rate of > 95% suggests the views expressed are representative of opinion in Wales. In my study higher percentages report delayed in-patient care (88% v. 36%) and inadequate specialist provision (68% v. 17%).

Regional differences in current provision may influence the level of concern expressed in Wales. My findings indicate the themes raised by Worrell and O'Herlihy are not only representative of opinion within the specialty but that experiences in Wales may be more extreme than those in England.