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Child Mental Health in Primary Care
  1. Mary Mather

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Over the school holidays, this book was left on my desk whilst I was away on holiday. During this time, my secretary photocopied two chapters for an anxious general practitioner, a health visitor, and a junior doctor borrowed it and when I finally got time to read it, the book was missing because our locality mental health worker had taken it home. Reviewers normally read books in pristine condition, this one was distinctly creased and dog-eared. It therefore goes without saying that this is an excellent book.

Knowledge of the psychological and psychosomatic disorders of childhood is not an optional extra for primary care teams and paediatricians. In primary care settings in the United Kingdom, 2%–5% of children brought to the general practitioner by their parents have mental health problems as their main complaint and 25% of children have a combination of both psychological and physical problems.

The Audit Commission has recently revealed the striking regional and local disparity in services for children with mental health difficulties. An important component of this variation is a tendency, in some districts, to refer all children, as fast as possible to a specialist. Inevitably this practice leads to long waiting lists, months of anxiety for parents, children's behaviours becoming more entrenched, families more dysfunctional, and the over investigation by doctors of non-existent organic disease.

This book will go a long way to equip practitioners with the basic skills and knowledge and, almost as important, the confidence to successfully manage problems at an early stage. This can only be good for children and their families. The book is written in a common sense, down to earth, easy to read way. It recognises the reality of the clinical situation. The chapters are short and contain useful case histories and amusing cartoons. The chapter headings are helpful and logical. This is a book for the busy professional who needs rapid access to help and advice.

The book takes a developmental approach. It is clearly divided into problems which occur at any age, following logically through the difficulties of the pre-school years, school years and adolescence. There is even a detailed chapter on treatment options for the truly enthusiastic professional.

Criticisms are few and far between. It is however disappointing that the whole range of multidisciplinary services for children which constitute community child health receive only scant mention. Families with children with emotional and behavioural difficulties are helped and supported by a range of agencies. The lack of emphasis on working with day nurseries, schools, the social services, therapists, and the voluntary sector, to name but a few, is a real omission. These services are often more important to parents than even the best of health professionals and have a vitally important role to play in the teaching of socially appropriate behaviour

Primary care team members rarely pick up the phone to talk to a child's teacher or school nurse. Done with parental consent this exercise can bring a whole new dimension to a difficult family problem. The strategy was not mentioned even in the chapter on school refusal. Social services are acknowledged as the key agency in the protection of children but there is a disappointing lack of reference to their role of supporting children in need.

The book would also benefit from a chapter on what to do when all else fails. Every primary care team will look after a number of truly dysfunctional families. In these families, the children will always be presented as the “problem” but few of the eminently sensible suggestions in this book will work. The families normally fail to attend specialist appointments, but return time after time to the general practitioner's surgery.

These reservations are however minor. This book should be within easy reach of every general practitioner, health visitor, and paediatrician and they should buy the book instead of appropriating the reviewers copy!

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