Rapids Crisis Service for Children and Adolescents 2019-2024: 6-Year Changes in Crisis Service at Lambeth Children and Adolescent Mental Health Services in London, United Kingdom.

Objective: The demand for children and adolescent mental health crisis services has risen dramatically in recent years, yet evidence on real-world implementation models remains limited. Rapids is a community-based crisis intervention service developed within Lambeth Children and Adolescent Mental Health Services (CAMHS) at South London and Maudsley NHS Foundation Trust. The primary aim of this study was to examine how clinical presentations, risk profiles, and service outcomes changed over time among children and adolescents accessing Rapids over a 6-year period. We also aimed to describe the characteristics of individuals accessing Rapids.

Methods: This service evaluation used routinely collected clinical data from all children and adolescents up to 18 years who accessed Rapids between January 1, 2019, and December 31, 2024. Sociodemographic, diagnostic, pharmacological, and risk-related variables were evaluated. Diagnoses were coded using International Classification of Diseases, 10th Revision (ICD-10) criteria. Descriptive and inferential analyses were conducted to assess changes in clinical presentations and service outcomes.

Results: In total, 325 children and adolescents were included (mean age = 15.5 years, 61.8% females, 64.6% non-White). Anxiety disorders (29.5%), depressive disorders (42.2%), and autism spectrum disorder (33.5%) were the most common diagnoses. Inpatient admissions increased (1.5%-5.8%, p = 0.043), and high risk to self also rose notably (19.5%-31.7%, p < 0.001). Referrals accepted to adult services decreased significantly over time (38.5%-16.8%, p < 0.001). Diagnostically, eating disorders increased (3.7%-10.0%, p = 0.032), whereas emotionally unstable personality disorder traits decreased (14.1%-7.4%, p = 0.049).

Conclusions: Rapids has evolved into an established model of crisis care within CAMHS, addressing acute needs through timely community-based interventions. We observed meaningful temporal changes in the clinical acuity, diagnostic profile, and service use outcomes of young people presenting to our community-based CAMHS crisis service. Our findings support the feasibility and scalability of intensive community-based crisis care and highlight the need for sustained investment in culturally responsive, multidisciplinary service models.