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Child and adolescent mental health problems in primary care

Although childhood psychiatric disorders are relatively common, only 1 in 10 of cases is seen in specialist mental health services for children. Two to 5 per cent of children attending primary care during any one year present with emotional or behavioural disorders. Pre-school children present predominantly with oppositional deficient disorder, while school-age children present with emotional and conduct disorders. Primary care recognition of disturbance is an important factor in referral to specialist mental health services. Children are less likely to be referred unless they present with overt psychological problems.

GPs are often the first point of contact in the referral system. They are in a unique position to implement preventative intervention and deal with less severe psychological problems. They have knowledge of the family’s circumstances and can offer a service which is less stigmatizing. There is an increasing emphasis on collaborative support from specialist mental health services and paediatric services focusing on primary care intervention targeting high risk populations. Many primary care practices employ counsellors, community psychiatric nurses and psychologists offering consultation and assessment in primary care settings. The appointment of primary care liaison workers offering consultation-liaison has helped reduce referrals to increasingly long waiting lists for specialist child mental health services. They also have an input in enhancing GP skills in managing milder cases and making more appropriate referrals to specialist services. The future of consultation and collaborative working will need modification as primary care trusts move from being commissioners to providers of specialist child mental health services.

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