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Pp 106; £20. London: Audit Commission, 1999. ISBM 186240-8.
The Audit Commission, established in 1983, reports on a 2 year study of the specialist Child and Adolescent Mental Health Services (CAMHS) as provided by local authorities and NHS trusts. Local information has been processed centrally to generate facts and figures and comparative data.
The 13 000 bodies providing CAMHS spend £100 billion (sic) of public money annually in England and Wales. The Commission's team of seven have met with external advisers with a view to shaping of the audit, its comments, and guidance. The aim is to achieve economy with efficiency and effectiveness. The report is in five chapters and five helpful appendices. It lists 71 references and has an index.
Under the heading “The changing context” it is revealed that one in five children and adolescents (alas, not defined for females and males) suffer from a wide range of mental health problems of variable degrees of severity from social ineptitude through psychological to severe psychiatric disorder. Strong links are noted with juvenile crime, alcohol and drug abuse, eating disorders, and of course self harm.
The key components of the CAMHS are viewed as four “tiers”: (a) Those providing primary intervention, eg, GPs, health visitors, residential social workers, juvenile justice workers, school nurses, and teachers. (b) Professional providers of services, eg, clinical and educational psychologists, paediatricians, child psychiatric nurses in the community, and child psychiatrists. (c) High grade specialist services for severe, complex and persistent disorders, eg, child psychiatrists, community psychiatric nurses, psychotherapists, occupational therapists and art, music, and drama therapists. (d) Consists of hospital services especially unnamed “highly specialised outpatient teams”. This clearly applies to accident and emergency departments, obstetric and gynaecology departments, and genitourinary medicine departments. These deal very adequately with self poisoning episodes, premarital abortions, and sexually acquired infection, but fail to see the underlying behaviour as but one manifestation of an ongoing complex of medicosocial pathology. Clearly, services for the care of our adolescents, unlike paediatrics and geriatrics, are seriously fractionated.
What follows should help the holistically minded hospital doctor to increase his awareness and skills and so make more regular and early use of referral routes and emergency cover arrangements provided by developing CAMHS.
It is clear that in many areas there is an urgent need to plan how best to meet unmet needs, including appropriate monitoring. The final chapter of this book purports to show how, with national support, highly active local coordination can establish and advance improvements. Recommendations are provided. There are opportunities for masterly leadership.
As the first specialty to be nationalised in the United Kingdom, genitourinary medicine has come a long way from the days of “pox doctoring” in “clap clinics”. Has the time come for it to give a lead in the development of more appropriate and comprehensive services for adolescents?
For the long sighted and adventurous GU physician this book suggests how to begin.
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