The work of a specialist multidisciplinary CAMHS team assessing and treating looked-after and adopted children necessitates in almost all cases consideration of whether a diagnosable mental health disorder is present, especially given present knowledge that suggests that this is so for almost 50% of looked-after children (Melt-zer et al., 2003). The well-known, strongly expressed antagonism to the making of diagnoses is based on a belief that damage is done to children by the process of labelling and a fear of the stigma associated with mental illness. However, the dangers of disadvantaging children and young people, their parents and carers, and the professional network by the failure to recognize a significant mental health problem outweighs these concerns. There is therefore a clear role for a child and adolescent psychiatrist in participating in the diagnostic assessment process undertaken by the multidisciplinary team. In addition to the significant level of mental health difficulties in this group of looked-after and adopted children, they also are more likely to have physical disorders, including epilepsy, speech and language disorders, developmental delays due to both organic and environmental factors, such as enuresis, conditions such as foetal alcohol syndrome, and other forms of learning difficulties (Meltzer et al., 2003). There is, therefore, an additional role for the psychiatrist in identifying physical health problems and referring young people, if needed, for investigation 52and further assessment by a paediatrician or, where appropriate, for a psychological assessment.