Dr. Harry Barry:

On signposting, the difficulty for general practitioners is that they can do the assessment but the opportunities available to them after that are limited. Where a child is acutely distressed often the only place of referral is accident and emergency. If extremely fortunate, a general practitioner might get a child seen by CAMHS within 24 hours. However, many of these cases are not at the level of acute distress. Very often when a child is distressed he or she does not even know the reason for the distress. The child might not realise what is going on but the parent is desperately looking for help. The GP can try to calm the situation and assess whether in his or her opinion the child is depressed or, perhaps, just anxious owing to bullying and so on. The difficulty for the GP is that if the child is under a certain age the referral must be to the child psychology service. In that case, the GP can only complete the referral to the child psychology service in the hope that the child will be seen within a couple of months. Often, as happened to me on occasion, the GP will get a letter back from the child psychology service to the effect that the child should be more appropriately referred to CAMHS. This back and forth process is not helpful. If the GP is to have a signpost system then he or she must have access to a service where the child can be assessed within 48 hours. Very often one or two sessions with a psychotherapist skilled in a particular area can address the issue before it progresses. One of my greatest beliefs is that one should never allow emotional distress to grow legs because when it does it goes to bad places. We need to able to address emotional distress early and not only in respect of children but the wider community. We need to prevent emotional distress growing legs.