Consultation clinics in child and adolescent psychiatry are not uncommon. The consultation clinics in Derby were set up by the child and adolescent mental health service and serviced the area of central Derby, which has a population of 250 000. The service was provided by two psychiatrists and primary mental health workers.

The child and adolescent mental health services in Derbyshire are sectorised primarily into central Derby and surrounding rural area services. There are two bases in central Derby, with the Town House providing tier 3 services and the Mill providing tier 1 and 2 services and housing the mental health workers. At other bases, situated in the surrounding towns, the different tiers of service are mostly provided under one roof. Housing the primary mental health workers and therapists at two different sites created communication and logistical problems and stretched consultant psychiatric and managerial support. Central Derby has two full-time consultants, and the service receives over 800 referrals a year. The child psychological services are separately provided and based at the children's hospital site. There are currently no established learning disability services for children; this need is provided for by the generic child and adolescent mental health teams. Recruitment problems and the recent exodus of therapists and mental health workers due to governmental changes such as Agenda for Change (2004) and the extension of responsibility for child and adolescent mental health services to cover up to the age of 19 years, has placed further stress and strain on the generic teams. There is therefore now an urgent need for new ways of working for psychiatrists in child and adolescent mental health services teams, and consultation (rather than direct hands-on involvement with children and their families) seems contemporary and much needed.

Method

Results

Of 50 questionnaires, 25 were received back; 96% (24 of 25) of the respondents thought the report that they had received was clearly written; 92% (24 of 25) thought it was helpful to them; 64% (16 of 25) thought it was helpful because of the information contained; 20% (5 of 25) thought it provided an assessment of their patient; and 16% (4 of 25) felt that the report was supportive. The referrers made some suggestions for change, such as wanting a ‘clearly written plan for follow up and ongoing support’; ‘a summary and actions rather than a report of who said what’; and ‘a way to speed up the process of the waiting list’. Although they valued the information that they received from the consultation clinics, 64% (16 of 25) were interested in more direct work and only 12% (3 of 25) were not.

Discussion

Black et al (Reference Black, Cottrell and Kaplan1993) recognised that consultation offered by psychiatrists to other professions is an important and valuable use of their resources. Markantonakis & Mathai (1990) showed that referring professionals are often poorly aware of the type of services offered by child psychiatric clinics. Consultation with other professions, such as nurses, social workers and health visitors, is therefore an excellent way to educate and empower them. Cheseldine et al (Reference Cheseldine, Manders and Mcgowan2005) showed that this can be valuable to nurses working with children and young people who have learning disabilities and/or autism. The skills of these professionals can be improved so that they can carry on trying to help their patients. Communication can be enhanced between primary care and specialist care providers. There is a recognised difference between consultation and supervision, but the two terms are often confused. Supervision is regularly provided by child psychiatrists, psychologists and other professionals to their colleagues, and is important in helping to maintain objectivity and safety in their clinical work. The supervisor is often professionally close to the worker involved. Consultation, however, is provided to the worker involved with the case in an indirect way. The person seeking consultation is seeking the consultants’ views and comments and is ‘picking their brains’ about the case. The worker can then continue to work with the patient without handing the responsibility of the case to the clinic. Prior et al (Reference Prior, Stirling and Shepherd2003) reported positive findings when consultation was used with health visitors. They reported that supervision also had a positive impact on the referral rates, increased health visitor competence and reduced feelings of isolation and vulnerability. Stallard (Reference Stallard1991) highlighted the potential of consultation to sort appropriate from inappropriate referrals, thus helping to foster a more relevant referral pattern.

We suspect that many of the referrers may have seen the consultation clinics as a possible way of bypassing the waiting list for child and adolescent mental health services, which was substantial at the time of undertaking this survey. Despite this we did begin to see a slow change in referral patterns with some referrers starting to seek specifically a consultation rather than direct hands-on therapy for their patients. We found this hopeful; although most referrers still sought direct involvement from child and adolescent mental health services for their patients, 12% (3 of 25) did not. We hoped that this group of referrers felt empowered after the consultations and were able to continue to help their patients on their own. Perhaps some went on to seek help from a different, more appropriate agency. We also hoped that this meant that the service was spared a workload of 12% of the referrals, which would have gone to the tier 3 service. It is too early to predict the long-term effect on referrers in regard to change in their overall skills in helping such families and also the eventual change in referral patterns to child and adolescent mental health services.

We felt retrospectively that having two different questionnaires, for GPs and for other referrers, was a weakness in the study and that in future we would use a common questionnaire for all referrers. We sent feedback of the results of this study to referrers and to professionals working in child and adolescent mental health services. We hope to encourage more of the latter to continue to offer this service to future referrers, as we perceive potential benefits for referrers, for referred children and families, and for child and adolescent mental health services who are struggling to cope with the currently escalating number of complex and challenging referrals.

Declaration of interest

None.