Evidence based medicine and evaluation of mental health services: methodological issues and future directions
- aLeopold Muller Department of Child and Family Mental Health, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK, bDepartment of Medicine, University of Southampton School of Medicine, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
- Dr Barnes.
It is becoming increasingly evident that paediatricians and general practitioners play a key role in assessing and treating children with mental health problems. A recent national survey in England and Wales found that paediatricians are probably treating more emotional and behavioural disorders in children and young people than any other single professional group and that, on average, this group of patients comprises one fifth of their referrals.1 In one large survey in the UK, almost one quarter of 7–12 year olds from a large urban area visiting their general practitioner had a psychiatric disorder,2 and more than half of the children attending a child mental health clinic in a six month period had been referred by their general practitioner.3 In the USA, a large study of 7–11 year old children referred to paediatric clinics found that almost one quarter had a diagnosable mental health disorder, with a further 42% showing threshold disorders.4
The particular role of general practitioners and paediatricians has been highlighted in the recent NHS Health Advisory Service report “Together we stand”,5 which resulted from a thematic review into child and adolescent mental health services (CAMHS) in England and Wales. The importance of closer working relationships between practitioners of a wide variety of disciplines is emphasised and a strategic and tiered approach to commissioning and delivering child and adolescent mental health services is presented, albeit without supporting evidence on how best to achieve this. In the four tier framework, tier 1 includes professionals such as general practitioners, social workers based in the community, school nurses, and health visitors, who usually make the first contact with children and their families. Tiers 2, 3, and 4 consist of specialist child and adolescent mental health professionals working in increasingly restrictive treatment settings through to inpatient provision. …
