Child mental health checks contentious

Below are a sample of stories on the federal government initative to screen 3 year old children for social and emotional difficutlies.

Child health check `is reckless’

The Australian, Tue 12 Jun 2012

THE nationwide program to screen the social and emotional health of three-year-olds was “reckless”, not evidence-based and could lead to an explosion of false diagnoses that would see youngsters overmedicated and labelled with a mental illness for life, one of the world’s leading psychiatry experts has claimed.

American psychiatrist Allen Frances, who authored the DSM IV, the diagnostic bible for the psychiatry profession, said three-year-olds were developmentally fluid — making it very difficult to be certain whether they genuinely had a mental condition.

Before the federal government program is rolled out from January 1, 2013 it must be tested and the risks of false positive diagnoses weighed, said Professor Frances, speaking at a mental health conference in Perth.

“There is a tendency to use labels loosely and kids who are going to outgrow them are going to be harmed by the label and some of them medicated, which may cause difficulty, stigma, change a parents expectations of a child and affect their life chances,” he told The Australian.

The $25.6 million Healthy Kids Check was introduced by Labor in 2008 and originally applied to four-year-olds. The age of assessment was brought forward from four to three years of age and the test changed to include consideration of a child’s emotional wellbeing and development as part of the government’s $2.2 billion mental health reforms unveiled in the 2011 budget.

Parents have to prove their preschool age children have undergone a medical assessment to claim the Family Tax Benefit Part A annual supplement worth $736 and the Healthy Kids Check is one of three health checks that can be used to fulfill the requirement.

Frank Oberklaid, who chairs the government committee devising the criteria for the new check, said it was wrong to see the Healthy Kids Check as a mental health check on children. The public and academic outcry about the check had been misinformed and there was “zero” danger of it resulting in overmedication or psychiatric labelling of children, he said.

“It’s not about psychiatric diagnosis, it’s not about putting kids on drugs, it’s nothing of the kind,” Professor Oberklaid said.

Instead the procedure would check the child’s immunisation status, allergies, height and weight and ask parents if they had any concerns about their child’s behaviour.

It would also involve checking the child’s progress against a validated instrument of child development, Professor Oberklaid said. Each of the criteria to be used was based on peer-reviewed evidence that has been “solidly tested” and used in the US, Britain, and sometimes in Australia, he said.

The Early Childhood Australia yesterday backed the check, with chief executive Pam Cahir claiming all the evidence showed the earlier a child’s developmental problems were identified and treated the better the outcome.

“Early intervention matters, every bit of research shows the outcomes are better in the long term the earlier you intervene,” she said.

But leading child psychiatrist Jon Jureidini said he had serious concerns about whether the program could lead to a situation where a child had an “unhelpful label” placed on them.

‘It’s social engineering’: AMA and GPs blast kid mental health checks

Medical Observer, Tues 12 June 2012

THE federal government’s contentious Healthy Kids mental health checks, which are set to begin on 1 July, have been labelled ‘social engineering’ by Queensland GP and AMA Queensland board member Dr Wayne Herdy.

“[The mental health check] is a waste of GP and nurse time; getting them to go through a formal process any competent GP would have done by the time the child is four anyway,” Dr Herdy told MO.

“GPs should be credited with the clinical acumen to decide, without government intervention, when a child needs to be referred to a specialist for further evaluation but this government has taken the attitude, ever since it was elected, that 38,000 GPs out there don’t know how to do their job.

“I’m quite confident GPs are sensitive to mental health disorders in young children. The problem is not getting GPs to recognise potential mental health issues, but giving them resources they can access to address the issue.”

Dr Herdy, whose own practice includes a significant mental health component, said the introduction of the mental health checks was a matter of “ideology or politics” which most GPs would be reluctant to be involved with.

“There are few GPs who would confidently diagnose one of these mental health disorders in children,” he said.

“Most GPs would refer to a specialist before giving a child a life-long label when a lot of behavioural disorders are caused by lack of parental education.

“[These checks] are going to medicalise a problem caused by lack of adequate parental training.

“What we need is more ready access to specialists, child psychologists or child behaviour specialists; we don’t need life to be complicated with special item numbers and mandated checks.”

Mental Health Minister Mark Butler said the risk of misdiagnosis was why child-care experts had been spending months getting the program “precisely right”.

“Parents can be confident that when they go to a GP or a practice nurse in a GP surgery to check that just before their child starts pre-school or steps into primary school, that they’re developing in a way that we all hope and expect that they will be,” Mr Butler said.

“The experts who have been designing this tool have made it very clear that their overriding objective has been to do no harm [but] to provide a positive opportunity to families to take their children at that critical time of three years of age.”

The government experts more than 27,000 children will benefit from additional support after being tested.

Safeguards for healthy kids test: gov’t

aap Australian General News, Mon 11 Jun 2012

Mental Health Minister MARK BUTLER says safeguards are needed to ensure the government’s plan to check three-year-olds under the new Healthy Kids Check program is properly followed up.

Mr BUTLER says the 11 million dollar program is the latest addition to the government’s $2.2 billion mental health reform package, where children are checked for heart, eyesight and other physical health issues.

From July 1, the government expects more than 27-thousand children to benefit from additional support after being tested, but concedes safeguards need to be in place to ensure there’s are no over-reaction to clinical experts’ advice.

Mr BUTLER admits there is always the danger misdiagnosis or oversubscribing and says that’s why child care experts have been spending months getting the program precisely right.