Opinion statementTo truly understand the challenges and solutions of the safety of children in our community, we should be willing to embrace its complexity. Child safety itself goes further than some might conceive, encompassing the prevention of all types of injury: physical, emotional and psychological as well as interventions to promote resilience to harm. We believe child safety is a 'call to action' to paediatricians, government and society in general to advocate for children who remain vulnerable and often voiceless. We have chosen to take a narrative approach examining one particular case and have identified different preventable safety issues that occurred throughout her childhood. Acknowledging that early events have an impact later in the life course, we emphasise the importance of prompt early intervention and reflect on 'missed' opportunities for action. In particular, we have tried to use a holistic lens to view the case, exploring issues in the system around the child, in their family, school and the wider environment. In exploring the solutions to these issues, we look at three key areas (the 3 R approach): firstly, effective communication between professionals (relationships) and how this might be practically facilitated at ground level; secondly, how to best ensure protocols Patient Safety (P Lachman, Section Editor) (roadmaps) are followed wisely within an organisational and human behaviours framework; and finally, by putting the child at the centre (recognition), we can address the multiple issues affecting them and identify factors that build his/her own resilience. Child safety is a complex far reaching public health priority, which requires holistic ways of identifying safety issues, as well as practical solutions that support professionals and empower children and their families.

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Background Due to lack of funding in the local borough, there is no formal Tier 2 clinical CAMHS (Child and Adolescent Mental Health Services). Tier 3 CAMHS will see children with severe mental health disorders, however those that don’t meet the thresholds have to be supported by schools, children’s services and charitable organisations. Aims To find out what type of mental health support is provided in schools and to understand schools perspectives on this topic. Method All 48 state schools in the local borough were emailed an electronic survey. The survey requested quantitative and qualitative responses. Qualitative responses were analysed thematically. Results 21/48 (44%) schools responded. 90% had a counselling service but 42% of service providers did not have mental health training. The most common problem encountered by services was Anxiety and Depression (89%). 53% of schools expressed difficulties with the onward referral process to Tier 3 CAMHS. 21% of schools mentioned concern with the level of skills within their own service including lack of diagnostic abilities, as well as lack of supervision. 31% of schools felt more funding and provision was required in this area. Limitations The data may be skewed because provision status in non-responders was unknown. The majority of non-responders (81%) were primary schools. It is possible they did not respond because they did not have a service. Conclusion The current mental health provision in schools cannot adequately substitute for a formal Tier 2 CAMHS service. Service provision is not uniform. Some schools had no service at all and some services did not meet Tier 2 criteria because providers were not mental health trained. Lack of skills within the service is worrying, particularly when dealing with depression, which needs adequate risk assessment. A difficult referral process to Tier 3 services may also be a barrier to accessing treatment. Considering the importance of early intervention to prevent significant mental health problems, the lack of good quality services at Tier 2 is concerning.