Posts Tagged ‘child psychiatry’

The Government announced in last week’s Budget a plan to screen children at the age of three for not only physical health, but also emotional health. It’s part of a bigger package of spending on the prevention and early intervention of mental illness in infants and children.

Can we even diagnose mental illness in three year olds? And is it a good use of money?

Prevention and Early Intervention

 We as a community readily accept the concepts of prevention and early intervention in physical health. To prevent illness, we immunise our children. We try to detect diseases at an early stage by screening babies in utero and at birth, and as adults we go for cervical smears and mammograms.

Like physical illness, mental illness causes serious suffering, disability and even death. Depression alone will affect 20% of adults, and according to the World Health Organisation is the leading global cause of years of health lost to disease. Mental illness encompasses more than depression: when we add in anxiety, psychosis, and substance abuse the impact is staggering.

We can’t immunise against mental illness, but we can detect problems at an early stage and act on them.

Do mental health problems in young children even exist?

Yes, without a doubt. Studies show that 11%-18% of children under two have a mental health disorder. They don’t present in the same way as adults, but emotional and behavioural disturbances are common.

A quarter of people with a mental disorder experienced their first episode before the age of 12, and almost two-thirds before the age of 21.

Why should we screen for mental health problems in young children?

We can reliably diagnose many common disorders in young children. We know that emotional and behavioural disorders in childhood seriously harm a child’s development. A child who is displaying problems even before going to school will not be able to make friends, or learn, or develop a healthy self esteem. Problems will continue throughout adolescence and early adulthood. They will lack social and educational protective factors and be far more vulnerable to mental illness and substance abuse later in life.

Children with mental health issues are suffering, as are their families.

They are children. We need to do something.

Could the money be better used elsewhere?

 It’s a harsh reality that Australia has a limited budget and decisions must be made about where each health dollar is spent for the maximum impact. There is $11 million (over 5 years) earmarked for this project: a small amount in the grand scheme of things, really.

Children with emotional difficulties grow into adults with emotional difficulties and mental illness. There comes a time when we need to try to break the cycle. We can keep spending all the money on those people who have already developed mental illnesses, or we can try to allocate some of the budget to child and adolescent mental health, and make sure our children grow into healthy, resilient teenagers, adults, and parents.

Prevention is better than cure

There is no doubt that the entire public mental health system needs more money. Ideally, all Australians with mental health issues would be promptly assessed and have optimal access to community and hospital resources, regardless of their age, location or diagnosis.

But with the limited resources that we have, isn’t prevention better than cure? By intervening early in life, we can make sure that as our children grow up, the rates of mental illness in adults are reduced. Investing in the mental health of our young children now means that we can make a step towards improving the mental health of our adolescents, adults, and their own children.




 The Royal Australian and New Zealand College of Psychiatrists: Report from the Faculty of Child and Adolescent Psychiatry. Prevention and early intervention of mental illness in infants, children and adolescents: Planning strategies for Australia and New Zealand, 2010




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I have just heard that Australian artist/film maker Shaun Tan has won an Oscar for his short film, ‘The Lost Thing’, along with Andrew Ruhemann. Congratulations!

The Lost Thing

I first heard of Shaun Tan when I read his illustrated book, ‘The Arrival’. For those of you unfamiliar with his work, he is a fantastic artist and illustrator who has ‘written’ several picture books. I had never ‘read’ an illustrated book before, and was amazed by ‘The Arrival’. There are images in this book which capture an amazing depth of emotion which I think would be almost impossible to express in words. I think it allows the ‘reader’ more freedom to interpret  the story for themselves.

The Lost Thing

The Oscar was for a short film based on one of his books, ‘The Lost Thing’ and it is a beautiful film, narrated by another West Australian Tim Minchin (a musical comedian is the best descrption for him!) Shaun Tan is originally from WA, although now lives in Melbourne.

Shaun Tan’s website is also beautifully illustrated and has information about his books, art and film. I hightly recommend that you check it out.

Shaun will be a keynote speaker at the joint Child and Adolescent Psychiatry and Australian Association for Infant Mental Health conference in Perth, Western Australia from May 12 to 14th 2011. I am lucky enough to be talking (on psychiatry and writing) in the same forum as him. How’s that for a hard act to follow!

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I am delighted to introduce a guest blog post by Dr Philip Tam, a Child and Adolescent Psychiatrist based in Sydney, Australia. Philip has an interest in ‘internet addiction’  in young people, and has appeared in the media discussing this subject. He has written a fantastic post below. Please do comment: it would be great to get a discussion going on this controversial topic…

Problematic Internet Use – A 21st-Century Affliction?

In recent months, there has been much interest in the Australian media and in the broader public about the modern phenomenon of ‘problematic internet use’, or internet addiction as it commonly termed. In my own clinical practice, and that of some colleagues, we have been seeing young people – generally male, but often female – presenting to us for about the past 5 or 6 years; it may come as a surprise that the first ‘cases’ of problematic internet use, or PIU, were being described in the psychiatric literature back in 1996 in the USA. As with other modern-day afflictions with a ‘pop-cultural’ element, such as ‘sex addiction’ and ‘shopping addiction’, there is heated debate within my profession as to whether this a real mental condition, deserving of diagnosis, research and treatment, or simply a form of human behaviour responding to the huge changes brought about by the ‘internet revolution’ of the past 2 decades. Diagnosing a mental condition requires a concise definition, so here is one suggestion : PIU is the pervasive, long-term and heavy use by a person of internet and computer-based technologies, including gaming, which is out of keeping with one’s educational, social or occupational role, and which results in a clinically significant negative impact on schooling, work, relationships or general well-being and health.

As a colleague of Dr. D, and also as another ‘Psychiatrist Parent’, I’d like to start a new discussion thread about this issue if anyone is interested. I’d be keen to hear of anyone’s clinical experience with the condition, or even if they could share any personal/ family experience of the problem! As I note below, we still don’t know much about the phenomenon, let alone how best to address it, and the best way is to listen to people’s own stories.

The 3 questions I am most commonly asked by concerned families, other clinicians, or media commentators are: How extensive is the problem in Australia? How do we recognise the signs of a problem in a teenager or young adult? What can be done to assist these people? Unfortunately, the short answer is: we don’t really know. While formal research has been done for some years in China, South Korea and the USA, Australia appears to lag behind in investigating the issue at a ‘population-based’ level. Good quality surveys are expensive, time-consuming and require major commitment, a situation which has affected attempts to investigate mental conditions such as depression and anxiety in the Australian community. And, as some readers will know, there is currently no official recognition of PIU in the ‘bible’ of psychiatry and classification, the DSM-IV – though it is possible it may be included in the 5th edition, due to come out in 2012.

I am also well aware that many sceptical members of the public may accuse clinicians such as myself of scare-mongering, or indeed of disease-mongering, and that the issue is primarily one about personal responsibility and common-sense, and decent, firm parenting. I must state unequivocally that I agree that, for most people with problems spending too much time online, it is about better time-management and discipline; however, there is a small percentage (probably around 5% of regular users), who do tip into true PIU as defined above, and who often do not recognise that they have a problem. Analogous to other disorders of impulse-control such as pathological gambling and alcoholism, the sufferers themselves often are oblivious that they have a problem; it is concerned family members or their teachers who refer them to specialists. Since clients with more severe PIU are at risk of dropping out of school, affecting their physical health, or losing their job, it would be unethical not to address their problems in a professional manner. In my personal experience, the key to successful treatment is getting the client to fully recognise that they have a problem – what we term ‘gaining insight’.

Clearly, the internet has brought about immense changes in human society, affecting business, recreation, education and science; it is almost impossible now to imagine going through daily life without the great benefits that it has given us. However, there are clearly a few less-desirable effects of this revolution, and since technology is likely to continue to expand rapidly, and in ways we cannot yet imagine, we need an open, active and informed debate as to how we best manage these issues! Thanks for any input you can provide.

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