Provision of intensive treatment: Intensive outreach, day units, and in-patient units

Recently there has been a conceptual shift in thinking, reflected in the use of the phrase 'intensive services' rather than 'alternatives to inpatient provision' for the range of non-residential intensive CAMHS models on offer. This is a recognition based on the growing evidence, and philosophical changes, that children and young people are best cared for in their community and home settings, which also have the advantage of preserving the use of inpatient units for those who will most benefit from them. However, as we will discuss in this chapter, the evidence base is not sophisticated enough to direct us well about who will most benefit from residential or non-residential intensive model of care, and which community intensive models would be best developed in particular localities for specific groups of young people. Inpatient units are scarce resources especially in LMIC (low and middle income countries). Economic costs are potentially the major limiting factor in the development of inpatient services, and even with improved therapies and delivery there is likely an irreducible cost for inpatient care.