Irish Times Letter to the Editor: Mental health services for children
The Irish Times has today published a letter by CPsychI President Dr Lorcan Martin and Chair of the Child & Adolescent Faculty, Dr Patricia Byrne in response to an opinion piece by Professor Mac MacLachlan on 22 May.
Read the letter in full below or on the Irish Times website here.
Independently, Professor Matthew Sadlier discussed the topic with Professor MacLachlan on RTÉ Radio 1 Drivetime, and read a further Letter to the Editor in the Irish Times from Dr Paul Matthews.
Mental health services for children
Psychiatrists will continue to provide and advocate for evidence-based services
Thursday, 25 May 2023
Sir, – It was disappointing to read Prof Mac MacLachlan’s reductive and dismissive analysis of psychiatry in relation to the provision of mental health services and particularly child and adolescent mental health services (Camhs) in Ireland (“Mental health services are in the grip of a model that fails”, Opinion & Analysis, May 22nd). It is highly concerning to think that, having read Prof MacLachlan’s piece, parents might be misled into thinking that children’s diagnosis are inaccurate or invalid, their treatment incorrect, and that prescribed medication is not provided based on evidence of effect. Such commentary can itself cause harm.
Many children and young people have and will experience mental health distress or difficulties, which can be treated by psychosocial support or single clinician intervention alone in the community. Approximately 2 per cent of children and adolescents will develop an illness of such severity that they require specialist intervention of Camhs, where assessment and treatment is provided by a multidisciplinary team, including psychiatry.
Prof MacLachlan rejects the standards for mental health diagnosis formed by the World Health Organisation as “inaccurate and unreliable”, rejecting standards which guide his own profession of psychology, as well as psychiatry. He incorrectly states that there are no physical health correlates to mental illness, showing a lack of knowledge regarding organic brain disorders.
He infers that psychiatrists may not take into account psycho-social factors which contribute to mental illness. All psychiatrists, as specialist doctors, are trained in and practice a bio-psycho-social understanding of a person’s presentation, where biological risk factors, such as physical illness and genetics, as well as psychosocial stressors, are included, and guide multidisciplinary treatment planning.
Of the group of severely unwell children and young people, medication may be required as part of a holistic care plan. Medication is prescribed based on evidence-based treatment. There is no evidence to support the notion of general overprescribing in Camhs nationally. As noted in the Oireachtas Sub Committee on Mental Health, less than 50 per cent of children attending Camhs are prescribed medication.
Prof MacLachlan offers a number of particularly unhelpful statements that serve no use other than to attempt to drive a wedge between medical and allied health specialties who work together every day to improve patient outcomes. His assertions regarding the leadership and governance of Camhs teams are incorrect. Camhs are in fact governed by area management teams with multidisciplinary representation of all allied health professionals. Within individual teams, care and treatment planning is provided using a multidisciplinary team approach. His notions regarding the supposed thought processes of psychiatric consultants and team members about assessment and intervention are without basis, and do not reflect the diligent collaborative teamwork of multidisciplinary teams on the ground.
Psychiatrists will continue to provide and advocate for evidence-based services, in cooperation with our multidisciplinary colleagues involved in clinical care, to achieve the best outcomes for our patients. – Yours, etc,
Dr LORCAN MARTIN,
Dr PATRICIA BYRNE,
Faculty of Child
& Adolescent Psychiatry,
College of Psychiatrists