Gowers & Cotgrove (Reference Gowers and Cotgrove2003) correctly draw attention to the scarcity of emergency access to in-patient care for adolescents. It is therefore disappointing that they have reported the evidence from Snowfields Adolescent Unit (Reference Corrigall and MitchellCorrigall & Mitchell, 2002) – the first unit in the UK to offer an all-beds, 24-hour, 7-day-a-week emergency admission service – in such a misleading way. Gowers & Cotgrove claim that the paper describes a service focused principally on responding to emergencies, but neglecting other aspects of a comprehensive Tier 4 service. This is not true. The service was designed from the outset to be comprehensive, inclusive and adapted to local needs. An emergency admission service was a necessary response to need, not an end in itself, and has not been provided at the expense of other aspects of care. Evidence in the paper demonstrating the comprehensiveness of the service includes the broad range of diagnoses covered, the wide distribution in length of stay, the high rate of admissions with learning disabilities and, most tellingly of all, the very low rate of referral on to other forms of Tier 4 adolescent service. In fact, since publication, the need to seek alternative in-patient provisions has dropped even further. In the past 3 years, out of 189 discharges, only one case has been transferred on to another type of in-patient care as a result of Snowfields being unable to meet the patient's needs – and that individual went to a specialist adult service (the National Psychosis Unit), not a Tier 4 adolescent service.

The Snowfields approach has now been generalised to other settings, with similar principles having been successfully incorporated into new adolescent services such as the Coborn Unit in East London.

Gowers & Cotgrove call for the establishment of specialist units to complement existing services as an answer to the need for more emergency access, but a failure to rethink existing provision would be a mistake. The Snowfields and Coborn Units have shown that it is perfectly possible to provide an integrated and comprehensive adolescent in-patient service that includes emergency access.