all new child diabetics must be refered to psychiatry ( CAMHS

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Niamh

The Crippen Diaries - 2008 : November (1)

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posted by Dr Crippen at 2:12 PM What do you want to do when you grow up...November 2008 (1)I saw Amy this morning. She is 11 years old, and as bright as a button. Six weeks ago she presented looking distinctly pasty with a history of weight loss and urinary frequency. I dipped her urine to find glucose +++ and ketones +++. A BM stick showed a blood sugar well into double figures. A new diagnosis of diabetes in a child is always a shock, more so to the parents than to the child. And even though they had already thought this was going to be the diagnosis, Amys parents were still shocked. I sent her into hospital. As is the fashion nowadays she was only kept in for 24 hours or so, stabilised, started on insulin (a dose with each meal, and one at night) and sent home with all the kit. Amy is now doing her own injections both at home and at school and is managing extremely well. Of course she is still in the honeymoon period, both of the physical side of the diabetes and, more importantly, the psychological side. At the moment, indeed, she is positively enjoying the attention. The novelty will wear off.She was in to day because she had earache and a temperature. She is not eating much and so mum had suggested she missed a couple of doses of insulin. Its a common mistake, particularly in the early days, and we talked it through. She had a bulging purple eardrum and so I started her on some amoxicillin.Chatting to mum, she said that later in the week Amy had an appointment at the child psychiatry department. You mean CAMHS? I said. Mum laughed. Well, thats the trendy acronym, but its still the psychiatric department, isnt it? I guess its better than calling it the child guidance clinic as they used to.I have known this family a long time. I cannot conceive of them needing psychiatric help of any sort so I asked why they had been referred. Mum said that it was policy that all children with newly diagnosed diabetes should be referred to CAMHS and the diabetic nurse specialist had duly made the referral. Whether or not they want to go? I asked. Mum laughed again. It seemed churlish to refuse, they have all been so helpful at the hospital, so we went along with it. Then she stopped smiling and said, Trouble is, if you dont go, and then sometime in the future there is a problem, you would be open to criticism, wouldnt you?Oh! Brave new world!Trouble is, Mum is right. It is the sort of refusal that would count against parents in a report to social services. I cannot imagine Amy and her family ever needing social services but then you never know. A lot of adolescent, teenage diabetics go through a difficult period during which they semi-deny their illness and neglect their treatment. At that stage they need sympathetic support and management. I still hate this protocol driven knee-jerk referral. It removes original thought from the process. It is an intrusion into the civil liberties to which Amy is entitled, despite her youth, and despite that fact that she does not yet know what civil liberty means. Amy has developed a chronic medical condition but she is not potty.She wont see a psychiatrist. It will be a senior mental health worker whatever that is. Whatever it is, even though it is not medically qualified, it is well meaning. It is, I suppose, some sort of replacement for the extended family. Mental Health workers, like nurses and all other health care professionals these days, are always labelled as senior this, or senior that. If the junior sub-group of HCPs exist at all, they are not let loose on patients. It amuses me. Count the number of times you see the word senior in this context.Amy will be fine. Her family are sensible and supportive. The diabetic nurse specialist is excellent despite all her referral protocols. Amy has good support from her GP too, if I dare say that. She does not need to go to CAMHS and it annoys me that she is being sent. It is insulting and it is a waste of resources. This is one of the reasons why it is difficult to get help for children who do have serious mental health problems.