By DR MIKE NEVILLE
“Your child’s mental health is more important than their grades.”
THIS is not the area of my greatest expertise, but one could argue that this subspeciality is the most important in the Bahamas today.
The ever-growing young population, the failure of so many institutions and the rising levels of crime both by and towards young people all point towards an enormous need for help in whatever way possible. The availability of a speciality which looks at problems in children and can advise on best practice based on international research would seem essential.
The sad reality however is that from the early eighties all departments in the Sandilands Rehabilitation Centre put aside their pet projects and campaigned together for a specialised child and adolescent unit to be built; it took numerous consultants, many architects renditions, millions of dollars and over 30 years for it to come to fruition.
Child psychiatry is often seen as amazing Freudian analysis of a drawing that will lead to remarkable changes in behaviour. The reality however is usually a slow assessment by a highly trained team of mental health professionals; the child psychiatrist interviews the child and family while observing the interactions between them. The interview includes a mental state examination looking for any symptoms or signs that can help with the diagnosis. The clinical psychologist will perform a battery of tests to discover how the child performs cognitively and behaviorally, these scales are then compared to the general population and may for example reveal learning difficulties that could be contributing to the child’s problems. The social worker spends more time with the family finding out about the development of the child’s problems, a parenting history looking for possible abuse or neglect and information from the school where other issues may come to light.
The child may need a period of hospital care where the observation of the psychiatric nurse is invaluable as behaviour is seen over the whole day. The involvement of occupational, art and recreational therapists is also possible when the child spends time at an inpatient unit, these are again highly trained individuals who use their skills in the diagnosis and later as to develop the therapeutic plan. It is at meetings of these professionals that diagnosis and treatment plans are made.
Children can suffer from most of the same illnesses as adults with mood and anxiety disorders seeming to be become increasingly common; depression can start very young and whilst the incidence of suicide in children is still rare the numbers begin to increase in adolescence and the numbers who attempt suicide during adolescence continues to grow. Bipolar disorder can be frightening in childhood, it is difficult to treat and often needs long term medication which usually the psychiatrist tries to avoid.
The whole area of developmental disorders seems to continue to grow, learning disorders have transformed schools around the globe as educators have changed how they manage children in the classroom. Autism has increased dramatically with no real understanding as to what has caused this dramatic rise in diagnosis. Attention Deficit Disorder has become mainstream with many children getting diagnosed. It is so important to see this as a variance of normal; the medicalisation is essential for research and treatment options but the amazing lateral thinking of kids with ADD can be missed if it is only seen as a problem.
Anxiety disorders in children often present as physical symptoms, very real pains but caused by worry, clearly this is where the team approach can find out the reason for the anxiety.
Eating disorders are more common in girls with many celebrities explaining both the dangers and the complexity of these difficulties.
Cutting oneself is scary but maybe more frightening is the description they give; that the physical pain distracts and is not as bad as the psychic pain inside.
The options for treatment are improving all the time and whilst medication can at times be essential other modalities are used first. It is my humble opinion that the Bahamas needs much more help in this overburdened speciality.
• Dr Mike Neville is a forensic psychiatrist who has practised for more than 40 years in The Bahamas, working at Sandilands, the prison and in private practice. Comments and responses to firstname.lastname@example.org