Letters

Who is responsible for child mental health?

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7103.310a (Published 02 August 1997) Cite this as: BMJ 1997;315:310

The increasing fragmentation of health services for children is the main problem

  1. Rashmin C Tamhne, Consultant community paediatriciana
  1. a Fosse Health Trust, Leicester LE5 0TD
  2. b Peacehaven Clinic, Peacehaven, East Sussex BN10 8BN
  3. c Health Centre, Thame, Oxfordshire OX9 3JZ
  4. d Medical Foundation for the Care of Victims of Torture, London NW5 3EJ
  5. e Royal Free Hospital School of Medicine, London NW3 2PF
  6. f Camden and Islington Community NHS Trust, London NW1 2LT
  7. g Queensland Health, PO Box 946, Rockhampton Q 4700, Australia

    Editor—Robert Goodman is right to point out that a huge number—a fifth or possibly even more—of children and teenagers experience distress or are maladjusted.1 It does not follow, however, that child mental health is, or even should be expected to be, the responsibility of child psychiatrists alone. Parents and other caregivers have a major responsibility, but many professionals other than child psychiatrists manage children with mental health problems. A recent report indicated that the “paediatric profession deals with more children and young people with emotional and behavioural disorders than any other single discipline.” 2 Paediatricians, especially those practising in predominantly non-inpatient settings, can, by virtue of their holistic and developmental perspective, help in “recognising the boundaries between disorder and extreme form of distress,” as envisaged by Sue White.1 A considerable proportion of my own workload as a paediatrician is “behavioural paediatrics.”

    In their origin and expression, mental health problems in children are influenced by the interaction between biological and environmental factors. Their amelioration, and the promotion of mental health generally, necessitates coordination at strategic level and at clinic level between health, social services, and educational agencies. Health professionals—for example, health visitors, general practitioners, paediatricians, psychologists, and psychiatrists—have a part to play in prevention, early detection, and management of mental health problems. Rather than abdicate their responsibility by leaving the management of some major mental health problems to social services and education, health professionals should aim to maintain their legitimate role in partnership with the two agencies, at all levels.

    The main problem at present is the increasing fragmentation of health services for children, which makes it extremely difficult to achieve the goal of close, professional multidisciplinary functioning. Developing innovative approaches to collaborative working in helping to solve the problems of individual children and families and convincing politicians of …

    View Full Text

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
    Sign up for a free trial

    Subscribe