The limits of psychiatry

A referral letter comes to CAMHS from the GP. A child is experiencing distress as a result of being bullied at school, and the GP wants us to see the child. At the team meeting, the consultant wonders whether this is really a psychiatric issue or more of a school issue. The letter is handed to the Primary Mental Health Worker (whose role it is to liaise with GPs, schools, voluntary agencies and other people who have contact with children but aren’t mental health specialists themselves), and she’s asked to find out a bit more about it. She writes back to the GP asking which school the child is at, if the school are aware of the problem, and if so what steps they’re taking to try to halt the bullying. She also asks for some more detail as to what psychiatric symptoms the child is displaying, if any.

The GP writes back to the PMHW. His reply doesn’t answer any of the PMHW’s questions. Instead he simply reiterates that the child is “acutely distressed” by the bullying and therefore he wants the kid to have a psychiatric appointment.

So far we still have no information to suggest this is even a psychiatric issue. We don’t even know what school the kid’s at, so we can’t ring the parents for consent to ring the school and do a bit of liaising with them. As for the child, well of course he’s “acutely distressed” if he’s getting the crap beaten out of him by the bullies.

Don’t get wrong. I’m not necessarily saying there may not be a role for CAMHS with this kid. But this is a case where the lead agency needs to be the school, not us. We can give him a bit of CBT or something, but it’s not going to do the slightest good if he then goes straight out of the clinic to be bullied again.

I sometimes wonder whether psychiatry is increasing expected to be some sort of “magic wand” service that can solve all of society’s problems - not just bullying but poverty, alcoholism, substance misuse, domestic violence…all of it apparently to be solved by a prescription of some SSRIs and six sessions of CBT. And as we’ve already discussed at some length, it’s actually pretty debatable whether the pills or the CBT are much cop for actual depression, let alone social problems. Ultimately, as The Shrink pointed out last week, we can treat mental illness, but we can’t treat life being shit.

I think Mr Ian will want to mention Thomas Szasz at this point, so I think I’ll beat him to it: Szasz.

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10 comments

Barstud.
Of course it’s your job. MH takes whatever no one else knows what to do with. I take it as a compliment and something of a god io;’m srunk…. sdomeighnth if a comliment… i acabbto teyope ui ams csoso drunk

a coml;imetn.
sompliment

anyhowe….

yes.

that’s right,.

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*laffs*

I raise a glass in your honour, Mr Ian. :)

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Yes, anyhow. Good morning.
This is how Prozac started - everyone wanting someone to fix something.
The GP no doubt is right he is ‘acutely distressed’ and having found the cause of the problem I’m curious why the GP wouldn’t make contact with the school - unless he has and the bully was the principal.

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Cockroachcatcher

Over the years in my little corner of the old NHS, I had to use my nose and sniff out those cases that may indeed be ours although the referrer was not that clear. Often the briefer the referral, the more severe the problem. The fastest route was to see the parents and the child. What appeared trivial often turned out to be a major problem and vice versa. You are right: “…it’s not going to do the slightest good if he then goes straight out of the clinic to be bullied again” This is like treating the First World War soldiers who suffered from shell shock and then sending them straight back to the front line to face almost certain death. Schools are often in denial when bullying is mentioned, especially in the current climate of performance and league tables. We never learn from history: Lawrence
or otherwise. Here is Thomas Szasz: “Behaviour is not – and cannot be – a disease, except in psychiatry. Controlling behaviour, with or without a person’s consent is not – and cannot be – a treatment, except in psychiatry. And faking illness is not – and cannot be – an illness, except in psychiatry.”

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Oh don’t get me wrong, Cockroachcatcher, we’re not refusing to see the child. The PMHW was just trying to get a bit of extra info.

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I like how with quite a few of these situations I know of or have experienced something similar… anyhoo.

My younger brother was in a similar situation: constant bullying at school due to his special needs status (behind in social intelligence being a trait that didn’t help him). My mum, after interfering at least 10 times with the school directly about this, finally had had enough. My brother was pulling his own hair out :/

She took him to a GP. The GP did not speak of a psychiatriac referral, or other such things: he simply signed my brother sick off school for 6 months, giving my mother time to bargin with the LEA with getting him into a smaller school with more dedicated special needs facilities. She found him a school, he started doing better at school (and cocky/annoying like all teenagers, hehe) and various signs of distress disappeared.

Now I don’t know what is the ideal thing in the situation in the post, but the GP being a bit more helpful providing information may get something helpful to come along quicker :/

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oops.

Re: Above

“I like how quite a few of these situations…”

should end with “it shows how universal the problems are”

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Leymoos situation highlights one thing for me -
Mother knew best at the start.
But authorities did not respond.
Get another authority (GP) to give you some credence to your position (ie 6 months of no doubt ’school related stress/bullying) and the school/LEA has to do something.

1. Why didn’t they just act on Mum’s word?
2. Would a psych referral have made a difference if things improved by eradicating the problem?

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I think the question here is one of perspective: turn the child into a career psychiatric patient where s/he can experience a lifetime of proper instituitional abuse, then child will be able to look back and say “oh, my schooldays were the happiest days of my life”.

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~ ouch

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