Letters Psychosis and schizophrenia in children and young people

Improving GPs’ responses to early psychiatric illness in children and adolescents

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f952 (Published 19 February 2013) Cite this as: BMJ 2013;346:f952
  1. Jane H Roberts, clinical senior lecture, University of Sunderland, general practitioner, chair of Royal College of General Practitioners Adolescent Health Group1
  2. On behalf of the Adolescent Health Group members
  1. 1University of Sunderland, Faculty of Applied Sciences, Sunderland SR1 3SD, UK
  1. jane.roberts{at}sunderland.ac.uk

The Royal College of General Practitioners (RCGP) Adolescent Health Group welcomes the newly published guidelines on psychosis and schizophrenia in children and young people.1 GPs’ responses to early manifestations of psychiatric illness have been found to be wanting,2 3 often with unacceptable delays in identification and diagnosis of early signs of illness.4

The imminent appointment by the RCGP of a youth mental health clinical champion aims to raise the awareness of the importance of responding effectively and therapeutically to early mental health symptoms in young people. The champion will be supported by the Adolescent Health Group, which makes the following recommendations:

  • The guidelines assume that young people and their families are ready to disclose symptoms suggestive of psychosis to their GP. This is essential, but the inadequate training for GPs in adolescent mental health often leads to superficial consultations and missed opportunities5

  • We are concerned that advising a wait of four weeks before the first, albeit urgent, referral may compromise the safeguarding of some young people; GPs should use clinical judgment on timing of referral

  • Child and Adolescent Mental Health Services (CAMHS) vary in their responsiveness to requests for urgent referrals, so GPs should follow up urgent referrals. Commissioners of children and young people’s services must insist on mechanisms that ensure prompt assessment

  • Best practice is for GPs to arrange to see all young people diagnosed as having a psychotic illness within the first six months and not to wait until transferral to primary care at 12 months for continued prescribing

  • GPs need to be adequately supported in the care of young people with psychoses and able to access CAHMS expertise promptly

  • Although outside of the remit of the guidelines, GP work carried out under “shared care” arrangements needs to be adequately resourced.

Notes

Cite this as: BMJ 2013;346:f952

Footnotes

  • Competing interests: None declared.

References