This study aimed to investigate the occurrence of psychiatric morbidity in children and adolescents referred to a tertiary national epilepsy center (inpatient unit) and the extent of the unmet need for psychiatric services in this group. Participants were 74 children and adolescents aged 9-15 referred from February 2001 to October 2002 (67% response rate). The multi-informant (parent, teacher, self-report) Strengths and Difficulties Questionnaires (SDQs) were answered before or at admission. Patients with severe mental retardation or pervasive developmental disorder were excluded. We found a large proportion (77%) with a possible or probable psychiatric disorder. The parents, teachers, and adolescents themselves had higher mean SDQ scores than a British community sample on total difficulties, emotional symptoms, conduct problems, hyperactivity-inattention, peer problems, and impairment, but not self-reported conduct problems. Nearly 80% of the children who probably had a psychiatric disorder had no contact with the psychiatric service.