Mental health team of the yearBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1856 (Published 15 April 2015) Cite this as: BMJ 2015;350:h1856
- Nigel Hawkes, freelance journalist, London, UK
Outcome oriented child and adolescent mental health services
Improving outcomes for children and adolescents was the focus at Lincolnshire Partnership NHS Trust. It is an open secret in psychiatry, says Sami Timimi, that matching treatment to diagnosis has less effect on outcomes in this group than non-therapeutic factors such as social support and a good relationship between client and therapist.
“A focus on diagnosis is not the most important thing—you have to spend more time trying to figure out what they want to change than in managing their symptoms,” he says. “For example, if the diagnosis is depression, it could be caused by loss of contact with a father. It is better to try to get the father in than to treat the depressive symptoms. The danger is that if the patient doesn’t respond to treatment, you assume the problem is more serious and add on more treatments, creating chronic patients. Less is more, sometimes.”
The service was changed by adopting a model called outcome oriented child and adolescent mental health services, which focuses on addressing external factors first, monitoring outcomes and relationships session by session, and functioning as a team. The change is difficult at first but once learnt becomes more rewarding for staff, and outcomes for patients are better. Referrals for inpatient treatment have dropped by two thirds, the number of open cases halved in two years, and clinics are better attended. The gap often observed between what is achieved in clinical trials and what is achieved in the real world has …