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Education And Debate

Child mental health: who is responsible? An overextended remit

BMJ 1997; 314 doi: (Published 15 March 1997) Cite this as: BMJ 1997;314:813
  1. Robert Goodman, reader in brain and behavioural medicinea
  1. a Department of Child and Adolescent Psychiatry Institute of Psychiatry London SE5 8AF


    Parents and teachers are seriously dissatisfied with the behaviour of many children. Other children experience considerable stress, misery, or anxiety. Epidemiological studies suggest that roughly 20% of all children and teenagers are maladjusted or distressed,1 with some estimates being substantially higher.2 In the child psychiatric literature and government strategy documents these maladjusted and distressed children are referred to as having psychiatric disorders or mental health problems.3 4 I believe that this medicalisation of all maladjustment and distress is a serious “own goal” for the health service, generating unrealistic expectations of what child mental health services can deliver and diverting health professionals from their areas of expertise.

    The medicalisation of maladjustment and distress is enshrined in the contemporary psychiatric classifications of the World Health Organisation and the American Psychiatric Association.5 6 Perhaps both these classifications were overinfluenced by the World Health Organisation's otherworldly definition of health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity”7; falling short of this ideal is then a lack of health, and it is only a small step to define any serious shortfall as a disease. Cynics will also note that the medicalisation of maladjustment and distress generates employment for doctors and …

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