Pathways to care : help-seeking for child and adolescent mental health problems

Although emotional and behavioural problems are relatively common in children and adolescents, they are rarely brought to the attention of general practitioners (GPs) or mental health professionals. The main aim of this study was to investigate the process of help-seeking for child and adolescent psychopathology. The contribution of various characteristics of child, family, and broader social context on (1) parents’ need for help for child emotional or behavioural problems, (2) help-seeking in general practice for these problems, (3) identification of child emotional and behavioural problems by the GP, (4) help-seeking in mental health care, and (5) help-seeking from informal sources of care, was investigated. Additionally, change in children’s emotional and behavioural problems over a one-year period was studied in association with parental problem recognition and utilisation of professional and informal services. The study was part of the Second Dutch National Survey of General Practice, in which GP contacts and morbidity presented to the GP were recorded for patients registered in 104 general practices. Over 2,400 children and adolescents were screened for the presence of emotional or behavioural problems. Parents of 360 children and adolescents with these problems were interviewed about problem recognition and service utilization. Psychiatric diagnoses for the participating children were obtained by means of standardized psychiatric interviews. After one year, participants were again asked to complete questionnaires concerning the presence of child emotional and behavioural problems, problem recognition and service utilization. Even in a sample selected for having emotional or behavioural problems, merely 16% of children and adolescents had used mental health services in the preceding year. By studying help-seeking as a process including various stages and service providers, several filters or potential obstacles on the pathway to mental health care were detected: (1) parents’ acknowledgement of the burden of child emotional or behavioural problems, (2) limited consultation of GPs in case of child emotional and behavioural problems, (3) limited recognition of child emotional and behavioural problems by GPs, and (4) the limited role of GPs in referring disordered children to mental health care. The roles of GPs and schools in the help-seeking process for child and adolescent psychopathology were dependent on the child’s age. For children aged 4-11 years, school-based personnel played a considerable part in the help-seeking process, and the GP was found to function less according to his formal role as gatekeeper to mental health care than was expected. The GP’s role in referring adolescents with internalising problems to mental health care was stronger than for younger children, and this was accompanied by a less prominent role of the school. Interventions to improve detection and referral of child mental health problems are only useful if services are sufficiently available to meet the demands of children. Access to care may be ameliorated by educating parents and adolescents about the nature and prevalence of mental health problems and about the availability and accessibility of care, by improving GPs’ skills in detecting child mental health problems, and by increasing collaboration between GPs, schools and mental health professionals. Interventions should be adapted to the age range of the target population