Paying attention to the mental health of our patients is an essential component of good paediatric care. So this section isn’t just for those interested in pursuing a special interest in mental health (although those people should check out the mental health sub-specialty page), but for ALL paediatricians looking to improve experience and outcomes for children and young people in their care.
Why does it matter?
Mental health permeates all aspects of paediatrics: in some presentations it is the reason for seeking our care, such as after episodes of self harm, while in others, the child’s emotional state is amplifying innocuous symptoms into a worrying crisis. Community paediatricians, of course, will be dealing every day with behavioural problems and the psychological complications of adversity, but all paediatric specialisms, from neonatology to public health, need some attention to mental health for optimal care.
An analogy is often drawn with safeguarding: sometimes in the foreground, but more often a background factor in the presenting difficulties, mental health needs to be a mainstream part of paediatrics.
What can we do?
Awareness and engagement with CAMHS
We all know that there is not enough CAMHS service available for the population need, and there may never be- but recognising those children and young people who may benefit from input from those teams is an important part of our role. For example, recognising the anxiety which underpins many unexplained neurological symptoms can lead to effective treatment and recovery.
Changing our approach
The ‘traditional’ approach is to start from a presumption of ‘organic’ disease and move onto the possibility of psycho-social factors once the ‘real’ conditions have been ruled out. The cartoon below illustrates how alienating this approach can be.
It also makes no sense: why not talk about mental health from the beginning? The second cartoon illustrates the advantages of taking a broad biopsychosocial approach to symptoms.
Working alongside colleagues across the child workforce.
We cannot work optimally in this area without the partnership of our local colleagues. See below for an example of cross-agency working
The Lambeth ADHD strategy group
This group is comprised of paediatrics, CAMHS, schools, local authority SEN team, educational psychology, OT and parents.
We have a wrap-around approach to CYP with ADHD, aiming for:
- Parent involvement at all levels including planned parent-led support services
- Clear, well-co-ordinated clinical pathways for diagnosis and management
- Guidance and accountability for schools to pursue best practice in ADHD
- Accessibility and information for professionals, CYP and families.
We believe that having a local system to support CYP is the only way to function in resource-stretched services
Advocating for and promoting the importance of mental health
Even when not tackling emotional and behavioural problems head-on, we can have a role in promoting mentally health lives by:
- Encouraging good sleep habits
- Explaining and engaging parents in parenting work
- Promoting exercise and shared family activity
- Modelling and advocating an open, non-stigmatising attitude to mental health
We have opportunities to do this at an individual, family, local and national level.
What is the RCPCH doing about this?
We feel this is a necessary shift in paediatric practice and culture, but acknowledge that it is a shift, and that it won’t be easy.
- We are working with local schools of paediatrics on delivering the mental health aspects of the Progress curriculum
- We run regular courses at RCPCH for paediatricians to improve practice in this area
- We have partnered with MindEd to produce a paediatric ‘learning path’ so that you can select content relevant to your needs
- We are working with colleagues in other professions to build partnerships in training, research and policy