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GPs made to treat child mental health beyond their competence, say local leaders

GPs have been coming under pressure from mental health officers to prescribe certain drugs for children with mental health problems, even though this is outside their knowledge and expertise.

Glasgow LMC says that Children and Adolescent Mental Health Services (CAMHS) officers have requested prescriptions for drugs such as sedatives and tranquilisers, plus medicines for attention deficit hyperactivity disorder (ADHD) – some of which have complex properties and are not licensed for use in children.

Dr John Ip, medical secretary of Glasgow LMC, argues that the situation has arisen since the Royal Hospital for Sick Children moved earlier this year from the city’s Yorkhill area to its new site in south Glasgow, where the pharmacy has struggled to handle the demand for prescriptions.

As a result, CAMHS officers have been coming to GPs to write these prescriptions, he said.

Dr Ip said: ’We think that specialists should be prescribing these drugs and they should be issued by the pharmacy on the new site. This is safer than asking GPs who may have no previous experience of prescribing drugs for children with mental health needs.

’The LMC has highlighted this to try to stop it in its tracks. NHS Greater Glasgow and Clyde has agreed with us that this should not happen anymore but we have written a section in our latest newsletter asking GPs to come forward if they are still experiencing it.’

A Scottish Association for Mental health survey of 460 GPs published last year showed half of respondents had not undertaken mental health training in more than a year, and that one in 10 had never done such training at all, even though 30% of patient consultations have a mental health component.

Almost three-quarters of GPs called for more alternatives to pharmaceutical treatment, and 85% said there was not enough local support for patients.

NHS Greater Glasgow and Clyde was contacted for comment, but was unable to reply.

 

Readers' comments (2)

  • In the last month two Consultants wrote to me to refer children to local CAMHS.
    Both referrals were rejected as they did not have 'enough information'. That was all the information that I had been able to obtain from the family and the Consultant. So what do I do .....sit back and take a wrap in future or use a power drill to squeeze out information from a family that won't divulge any more.
    This system has gone to the dogs and blaming GPs later doesn't help. Paediatricians need to refer directly to MH services.
    In this particular case, I informed the Consultants in question that the referrals were sent as they had advised but have been rejected. One of them called me over the phone and said she was not commissioned to deal with PTSD in children so she was helpless. And I said, so am I. Where does this leave the child?

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  • This is all rather rich and precious of that particular LMC given that around a quarter of all children who are 'regular attenders' of Primary Care have an underlying mental health disorder. It was disingenuous in the article to suggest that only 10% of GPs had no formal mental health training because this referred to lifespan psychiatry rather than paediatric psychiatry where the figure is far, far, higher. At best, this suggests a huge unmet training need on their parts and, at worst, a continuing pattern of letting down affected children and their families through this ignorance of a significant proportion of the potentially treatable morbidity coming through their doors. Of course we require better CAMHS services, but the psychopharmacology of of conditions such as ADHD and paediatric depression is extremely well-researched, safe and relatively easy to learn; indeed there are regular approved training courses available nationally, so why deny these children the opportunity to share the care involving effective treatments that are NICE/SIGN recommended? One could argue that this LMC's decision is discriminatory or even in breach of these extremely vulnerable patients' human rights.

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