Sir, – “First do no harm” is a fundamental tenet of medical practice. The recent events in Kerry child and adolescent mental health services have (among many other concerns) rightly led to a focus on the appropriate and safe prescription, as well as monitoring, of medication for all patients, but particularly for children with mental illness.
As a result of that focus and concerns about medication however, it is vital that we do not deny our children effective and evidence-based medical treatments that are known to relieve suffering and improve wellbeing by not prescribing when it is indicated.
We know the discovery of medications revolutionised the treatment of human illnesses, and their appropriate prescription remains the linchpin of medical care. We also know that their efficacy varies and that they all have side-effects. We entrust prescribing for each individual patient and monitoring thereof to those medical doctors we believe are trained specialists in the area of medicine they are practising in. We take it as a given that these doctors will be provided with the appropriate medical facilities and tools to monitor the medications and their side-effects by the employer.
So too in the treatment of children with mental illness. There is very good evidence for the efficacy of some medications in improving suffering and therefore the lives of children and their families. For example, in attention deficit hyperactivity disorder some of the medications used in its treatment are among the most efficacious available in all of medicine (not just in mental illness.) Similarly medical treatments for depression, psychosis, autism and other illnesses can be life changing. That said, studies of Irish prescribing rates suggest we might be under- rather than over-prescribing, compared to other similar countries. There is a risk that under-use of appropriate medication may do a disservice to our children who are suffering.
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Nobody is saying that medications are a panacea or are complete treatments on their own. All patients need the availability of a wide range of both medical and non-medical treatments delivered by skilled healthcare professionals.
However, at the end of the day children with mental illness have the same needs as children with any other illness and have the right to the availability and choice of evidence-based medical and non-medical treatment according to clinical need and to deny one because of an absence of the other is itself potentially harmful.
Clinical care should be delivered by verifiably trained specialist staff in properly resourced facilities, and in the case of trainee doctors, under specialist medical consultant supervision.
In any review by the Government or other State agencies, let us not throw the baby out with the bathwater and potentially cause children who are suffering more harm by not even considering the prescription of known effective treatments. – Yours, etc,
BLÁNAID GAVIN,
Consultant Child and
Adolescent Psychiatrist,
School of Medicine, UCD;
JOHN HAYDEN,
Senior Lecturer,
School of Pharmacy
and Biomolecular Sciences,
Royal College of Surgeons
in Ireland,
Dublin 2;
FIONA McNICHOLAS,
Professor of Child
Psychiatry,
School of Medicine, UCD
and Crumlin Hospital;
KIERAN MOORE,
Consultant Paediatric
Liaison Psychiatrist,
Crumlin Hospital,
Dublin 12.