Managing child and adolescent mental health problems in primary care: taking the leap from knowledge to practice

Abstract

In 2009, a conference at Imperial College London brought together experts on the primary care provision of child and adolescent mental health. The following paper highlights various themes from the conference, and particularly focuses on general practice. Despite international and national guidance, child and adolescent mental health provision in primary care is limited in the UK and globally. We argue that primary care services are in fact well placed to assess, diagnose, and manage child and adolescent mental health problems. The barriers to such provision are considered from the perspective of both service users and providers, and the possible ways to overcome such challenges are discussed. The paper is informed by various epidemiological and intervention studies and comparisons between different countries and health systems are explored.

Trends in GP prescribing of psychotropic medications among young patients aged 16–24 years: a case study analysis

“…This finding is consistent with previous research suggesting that GPs are reluctant to ‘over-medicalise’ young people [5]. Low rates of prescribing to this age group may also be influenced by the negative views held by young people about pharmaceutical treatments [6] and a preference for non-pharmaceutical intervention [7].…”

“…UK, Canadian, and Australian studies show that GPs face many challenges in managing mental illness for this patient group, such as grappling with the unique behavioural and biological changes associated with adolescence; navigating the difficulties associated with triadic consults (i.e., where a third party such as a parent or friend might be present during the GP consult with a young person); negotiating different expectations by young people and families around socially accepted behaviours regarding alcohol and substance use, use of digital media, and relationships between teenagers and parents; working out ways to forge effective and trusting therapeutic relationships with young people; [2] and treating severe and persistent mental illness [3, 4]. Studies show that GPs are apprehensive about over-medicalising young patients [5] and are less likely to prescribe psychotropics if their young patient’s hold negative views about psychotropics [6], express a preference for non-pharmacological treatments [7], or are new patients at their clinic [8]. Health warnings also reduce the likelihood of prescriptions; for example, the imposition of US and European regulator suicidality warnings on Selective Serotonin Reuptake Inhibitors (SSRIs) use in young people resulted in a decline in SSRI prescriptions among US and Dutch clinicians [9].…”

Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners’ perceptions

“…Financial concerns were common across all stages but were a particular barrier to managing children with mental health problems within primary care. Notably, although many common issues were seen across different countries, as also found by Vallance et al , 91 all studies that endorsed insurance and reimbursement restrictions were based in the US; 61 , 65 – 71 this highlights the fact that different challenges may arise within different healthcare systems. Barriers in the undifferentiated section provided a more inconsistent picture, possibly due to the fact that the initial questioning was not asked in relation to the specific stages of primary care practitioner management, resulting in primary care practitioners reporting on different things.…”

“…Excluding specific populations, such as those with a primary health diagnosis other than a mental health problem, may limit the generalisability of the review beyond ‘general’ populations. Studies also differed markedly in the age range of children and young people being considered, focusing specifically on pre-adolescen ts, 49 , 52 , 55 , 56 , 58 , 66 , 67 , 70 , 73 – 76 adolescents, 50 , 53 , 57 , 61 , 77 , 78 or a combination of the two, 48 , 51 , 54 , 59 , 60 , 62 – 65 , 68 , 69 , 71 , 72 , 79 – 91 limiting the extent to which the needs of each group can be identified.…”

Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health

“…The Commission on the Social Determinants of Health (CSDH) recognised the multiple forms of oppression and disadvantage experienced by the poorest members of society [1]. Building on seminal multi-national agreements such as the Ottawa Charter [5], the Alma Ata Declaration [6] and the Bangkok Declaration [7], the CSDH called for a 'joined up', multi-sectoral approach to addressing the problem.…”