Dr. Crippen's Perspective on Children with Depression

Submitted by tonyplant on November 9, 2006 - 18:42.

The excellent Dr. Crippen has posted a remarkable discussion of children with depression. He goes through the NICE guidelines for managing depression in children and young people.

The discussion makes for grim reading. Earlier this year, the Great and the Good of the BMJ's Science Committee published a very dispiriting report about the state of children's mental health in the UK. What makes Dr. Crippen's analysis particularly disappointing is the news that GPs seem to be so overlooked despite their front-line position.

Crippo has left a comment on Dr. Crippen's post. He articulates much of the pain and difficulty experienced by families who care for a family member who is depressed.

I don't know what the solution is to the estimated mental health treatment needs of 1 in 10 children. I strongly suspect that the only probable large-scale delivery mechanism that is practical will be based in schools. I am confident that any multi-agency solution must involve the family doctor.

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From Itchy Wrists to Schizophrenia

Submitted by tonyplant on October 27, 2006 - 12:55.

Dr. Crippen saw a patient with 'itchy wrists' (Dr. Crippen's Case Notes, Thursday 26th October, patient no. 5).

There is nothing to see. I tell him I have not got a clue why his wrists are itching. Then he tells me why he really came. His 26 year old daughter has schizophrenia and has just been discharged from hospital after a prolonged 14 month admission, during most of which she was on a section.

This is not an unusual case. Parents have lived with schizophrenia for so long that, although their love isn't burned out, their resilience is. The daughter in this case has sheltered accommodation near to the parental home. However, she only stays there overnight: everyday, she turns up in the morning and only goes back to her accommodation when her parents take her there.

Dad cares for his daughter but cannot manage being with her for more than short periods. But he feels guilty if he turns her away. They need to have a distance between them, both physically and mentally. I have to try to give dad “permission” to do that. Not easy. He still feels guilty that he does not have her living with him permanently.

Some sheltered accommodation offers a full range of activities but they don't always appeal to the residents. I don't know if any facilities are available here. It would be good to know if Social Services are in touch with the family and listening to them during this time.

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The Role Of Supportive Communities

Submitted by tonyplant on May 20, 2006 - 10:46.

 

Dr Crippen has written several entries in his diary for this week that elicit both sadness and anger. Sadness for the predicament of the patients who consult him and anger that the resources are not available to help them. In the Thursday 18th entry for the diary, Dr Crippen poses the question:

What happens to children with learning difficulties? They become adults with learning difficulties. Because they are grown up, people do not realise and are less tolerant.

We learn about Patrick who is 42 and has learning difficulties. Patrick is currently not working and when he is cross he hits people. Patrick does not meet the criteria for help from the local mental health departments. His local 'regular' psychiatrists do not work with people with learning difficulties: his local learning difficulties psychiatrist had diagnosed a Borderline Personality Disorder which Dr. Crippen translates as, "I can't help you and I don't like you."

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