G82(P) How confident are paediatricians at managing adolescents with acute mental health problems?

Abstract

BackgroundMental health problems are increasing in prevalence within the paediatric population. Paediatricians are expected to work alongside CAMHS teams to assess and support these children, often with little training. In rare cases a child may require sectioning under the Mental Health Act.This issue was previously raised in RCPCH consultation ‘Looked after children: knowledge, skills and competences of health care staff’.AimsWe wanted to examine the experience and training of paediatricians in managing children with mental health problems, particularly with sectioning children.MethodsAn online questionnaire was sent to paediatricians across one training deanery. Information was gathered on frequency and experience of sectioning children. We also looked at knowledge regarding available support and training.Results27 paediatricians responded: 13 (48%) consultants, 12 (44.5%) registrars, and 2 (7.5%) other doctors.With regard to managing children with acute mental health issues, 79% of registrars were involved at least weekly, with 85% of consultants involved monthly.Only 3 doctors (11%) had sectioned a child. Reasons for sectioning were suicidal ideation, food refusal, and acute mental health issues.All staff surveyed had received support from CAMHS or the hospital crisis team. All of the doctors involved in sectioning children had found the situation difficult and stressful.78% of doctors surveyed felt that further training on sectioning patients should be available. Those respondents who said disagreed or were unsure about this gave the suggestion that this should be the responsibility of the CAMHS team. There were, however, concerns raised about the availability of urgent expert CAHMS assessment and advice.ConclusionsChildren with mental health issues are increasingly presenting acutely to paediatric units. Paediatric registrars appear to be more frequently involved than consultants in their acute treatment. The experience of sectioning a child is rare and usually directed by CAMHS. This is recognised to be a difficult process for paediatricians, who have limited knowledge and confidence in this process.This survey demonstrates that the vast majority of paediatricians would welcome further training and support in this area.