Risk formulation, lived experience, and patient leadership in European CAMHS

Abstract

Child and Adolescent Mental Health Services (CAMHS) across Europe face rising demand, uneven provision, and increasing scrutiny regarding safety and quality. One in seven young people in the WHO European Region lives with a mental health condition, yet many systems lack the infrastructure and policy required to respond effectively [1, 2]. Ensuring safety is therefore central to high-quality CAMHS. However, the way services conceptualise and manage risk remains contested.

Historically, risk management has relied on predictive assessment and stratification, categorising young people as low, medium, or high risk. Such approaches lack reliable predictive validity [3, 4], and their institutional authority sits uneasily alongside commitments to meaningful participation, which range from consultation to youth leadership with shared decision-making authority [5]. When risk procedures marginalise young people's involvement, tensions emerge between protection and agency.

Against this backdrop, how risk is defined and enacted becomes a question of ethics as much as safety. This commentary argues that risk formulation, grounded in lived experience and strengthened through youth and patient leadership, offers a clinically robust and ethically coherent alternative. Lived experience is positioned as knowledge that reshapes how risk is understood, taught, and governed across systems.