Dr. Amanda Burke:

It is important to differentiate between the over-mediation of children and medicating in the absence of psychological intervention. They are different things. A psychiatrist taking a history from a young person will always view the case in terms of biological, which is the medication piece, and also in terms of the psychological and the social piece. A doctor would not prescribe for a child without the parts. They would not be done in isolation. However, we sometimes have challenges with psychological intervention. The vast majority of psychiatrists would also have pursued other studies in psychological interventions and would be therapy-trained. I do not want people to go away thinking that the only tool that psychiatrists have is medication. We think long and hard before we put any child on medication. Individual teams would have checks and balances in terms of medicating. It is not just part of a national audit; we audit ourselves. Individual teams audit themselves. Good practice would have multidisciplinary team meetings every week. Even though the consultant lead may not see every single person on the team, they would be part of the discussions. As Dr. Young said, they would sign off on the care plan for that individual. We never prescribe medication without looking at the other aspects for these young people. However, we have challenges in terms of psychological therapies. We also have waiting lists, which we are trying to work on.

I would also like to point out that as evidence base for treatments builds in, there are more and more specialist evidence-based and evidence-informed treatments. It is difficult to provide them everywhere. The evidence base for psychological therapies is for experienced practitioners who see people a lot with particular conditions and with fidelity to the model. In every generic CAMHS team, one may not be able to see that number of people or have those experienced practitioners. That is why, as part of the quality improvement and service development, we have been looking at the clinical programmes and developing hub-and-spoke models for these more specialised treatments, so that we can have fidelity to the model and specific clinical guidelines-----