“The menace of psychiatry”: does it still ring a bell? | Archives of Disease in Childhood

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“The menace of psychiatry”: does it still ring a bell?

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Paediatricians advocating for Consultation / Liaison Psychiatry
Donald Payne
Published on: 24 August 2009

Published on: 24 August 2009
Paediatricians advocating for Consultation / Liaison Psychiatry
- Donald Payne, Consultant Paediatrician and Adolescent Physician
- Other Contributors:
  Andrew Kennedy and Veronika Kretzer
Editor
Sebastian Kraemer writes that ‘the challenge for hospital paediatricians is to become advocates for a service that brings real benefits to their patients’ [1]. However, ‘because relatively few have seen what good liaison services can do, demand is not well articulated’ [1]. At Princess Margaret Hospital, the only tertiary hospital for children and adolescents in Western Australia, consultation / liaison...
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Editor
Sebastian Kraemer writes that ‘the challenge for hospital paediatricians is to become advocates for a service that brings real benefits to their patients’ [1]. However, ‘because relatively few have seen what good liaison services can do, demand is not well articulated’ [1]. At Princess Margaret Hospital, the only tertiary hospital for children and adolescents in Western Australia, consultation / liaison (CL) psychiatry is an established part of the clinical service, offering support to other teams within the hospital. Over the last few years the CL team has worked hard to develop this service and to improve working relationships with other departments. The process has been aided by an increase in funding, made available because other clinicians (not psychiatrists), when asked to identify significant gaps in hospital clinical services, identified psychological medicine as a priority area.
As a result of these increased resources, coupled with paediatricians’ willingness to work alongside them, the CL team has been able to embed mental health professionals (e.g. clinical psychologists, mental health nurses) in specific paediatric departments, such as Paediatric and Adolescent Medicine, Oncology, Respiratory Medicine and Endocrinology. This is in addition to the general CL service which is available to all hospital departments. Consultant Child and Adolescent Psychiatrists also provide regular supervision to paediatric colleagues: one example is the weekly meeting to discuss the management of adolescent patients presenting with a complex mix of physical and psychosocial problems. Sometimes this results in a direct referral to the CL team for a more detailed assessment. However, a frequent (and more efficient) outcome is for the psychiatrist or psychologist to support the paediatrician from the sidelines – providing a psychological perspective on the problem, along with specific management advice.
The current arrangement works well but it is not perfect. At an organisational level, Psychological Medicine and Paediatric and Adolescent Medicine remain separate and decisions about the psychological medicine service provided to the hospital sometimes appear to be made by administrators with little insight into life on the shop floor. History also continues to play a part, with those who have felt let down by psychiatry in the past unable to recognise the significant improvements in the current service.
In Australia, mental health problems as a broad cause group account for the highest burden of disease in children and young people [2, 3]. Suicide is the second most common cause of death in Australian young people aged between 12 – 24 years [3]. Physicians caring for children and young people need the support of Psychological Medicine and should not be shy in advocating for such services. A key ingredient in developing good liaison between paediatricians and psychiatrists is a shared interest in and respect for each other’s specialities. Liking your colleagues also helps.
References 1. Kraemer S. "The menace of psychiatry": does it still ring a bell? Arch Dis Child 2009;94:570-2.
2. A picture of Australia’s children 2009. Available at www.aihw.gov.au/publications/index.cfm/title/10704 (accessed August 2009)
3. Young Australians: their health and well-being 2007. Available at www.aihw.gov.au/publications/index.cfm/title/10451 (accessed August 2009)
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Conflict of Interest:
None declared.
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