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Assessing feasibility of routine identification tools for mental health disorder in neurology clinics
  1. Sophie D Bennett1,
  2. Isobel Heyman1,2,
  3. Anna E Coughtrey1,2,
  4. Marta Buszewicz3,
  5. Sarah Byford4,
  6. Caroline J Dore5,
  7. Peter Fonagy6,
  8. Tamsin Ford7,
  9. Rona Moss-Morris8,
  10. Terence Stephenson1,
  11. Sophia Varadkar1,2,
  12. Erin Walker9,
  13. Roz Shafran1
  1. 1 UCL Great Ormond Street Institute of Child Health, London, UK
  2. 2 Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  3. 3 Research Department of Primary Care and Population Health, University College London, London, UK
  4. 4 Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  5. 5 Comprehensive Clinical Trials Unit, University College London, London, UK
  6. 6 Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
  7. 7 University of Exeter Medical School, University of Exeter, Exeter, UK
  8. 8 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  9. 9 Patient Insight and Involvement, UCLPartners, London, UK
  1. Correspondence to Dr Sophie D Bennett, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; Sophie.Bennett.10{at}ucl.ac.uk

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Introduction

Common childhood mental health disorders are up to five times more frequent in children with neurological conditions than in those without a chronic illness, yet ‘contemporary standards of practice fail to integrate screening and treatment of the comorbidities into routine clinical care’1 and there is a high unmet need for treatment.2 This situation is not unique to neurological conditions; up to 80% of those with a chronic illness and symptoms of a mental health disorder are not in contact with child and adolescent mental health services.3–6 Left untreated, mental health disorders seriously impact social, occupational and educational functioning into adulthood.7 8

While most paediatricians may consider it a part of their responsibilities to identify mental health difficulties9, there are a number of barriers to accurate and timely identification. In the UK, one study found that paediatricians correctly identified only 25% of children meeting criteria for impairing symptoms of emotional/behavioural disorder as having definite or severe mental health difficulties10 and another that general practitioners (GP) have difficulty identifying mental health needs in children.11 Physical health specialists may also not have the time to ask about and/or assess mental health; mental health discussions can take up a significant proportion of clinic time12 13 and clinicians may not wish to ‘uncover a can of worms’ that will warrant a significant amount of extra work.

One solution to the challenges in identifying mental health disorders is to embed mental health specialists within paediatric teams.14 15 However, many paediatric centres do not have access to embedded psychiatric liaison services, despite guidance to the contrary16 and provision is variable where such services do exist.17 Given the already stretched capacity of child and adolescent mental health services, it may be unfeasible for a qualified mental health professional …

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