United we stand, divided we fall?
We note with interest McGorry and Birleson’s arguments regarding the
creation of a speciality of Youth Mental Health.1 As trainees working
within a Child Psychiatry in-patient setting we are unsure about some of
McGorry’s statements regarding the potential benefits of splitting service
provision in such a way
Mc Gorry’s proposal of substreams for 0-12 and 12-25 year olds seems
to be tailored to the needs of those falling within “the surge of new
morbidity between the ages of 15 and 25” (1). It would not serve the
needs of those presenting with earlier developmental and other childhood
onset disorders. These patients comprise the group for whom mental
illnesses truly are “the chronic diseases of young people”(1), with
difficulties commonly extending throughout the lifespan (2). Surely the
creation of a system in which multiple service transitions are required
does not best serve this population?
We would also question McGorry’s assertion that “extending the
subspecialty to include the age group with peak incidence could help
ensure funding” (1). This is contrary to our experience locally, in which
we have seen the proposed expansion of adolescent and early intervention
services juxtaposing with the proposed closure of our child in-patient
unit. One could question whether this represents a reallocation of
resources, orchestrated at a commissioning level, in favour of the more
high profile vogue towards the provision of youth services at the expense
of provision for children.
We would argue that the solution does not lie in the division of
psychiatric services but rather partly in collaborative working with other
agencies. All too often mental illness in young people goes unrecognised,
with their presenting difficulties being dealt with by other agencies.
By better working with such agencies, and the subsequent funding stream
which such partnerships could generate, Child and Adolescent Psychiatry
could be better placed to “reduce the financial and human costs
associated” (1). Surely the old adage of “united we stand, divided we
fall” rings true here. However, if we can also successfully argue that
mental illnesses, whatever their precise age of onset, are indeed “the
chronic diseases of young people” (1) then more resources may accrue. This
would require a leap forward in effectiveness of lobbying in order to
convince public opinion.
1. 1 McGorry P, Birleson P. Should youth mental health become a speciality
in its own right? BMJ 2009; 339: 834-835
2 McArdle P. (2004) ADHD and life span development. British Journal
of Psychiatry 184:468-469.
The authors are higher specialty trainees currently working within a child psychiatry in-patient unit.
Competing interests: No competing interests