Transcript for
Biopsychosocial formulation and the key phases of a child mental health assessment

Runtime 00:37:07
Released 27/10/20

Narrator [00:00:02] Welcome to the Emerging Minds’ podcast.

Sophie Guy [00:00:08] This episode is one of a four part series that sits alongside the Emerging Minds’ e-learning course, ‘A GP framework for child mental health assessment (5-12 years)’. The course looks at engagement skills, formulation, phases of a child mental health assessment, and the ongoing management of a child with mental health difficulties.

Sophie Guy [00:00:28] Today’s episode is a conversation with Dr. Andrew Leech, a GP based in Perth. Andrew is a paediatric GP who has a strong commitment to providing quality healthcare to children and responding to their evolving needs. He completed a diploma in child health and has an advisory role within the RACGP and Emerging Minds. He joins the Emerging Minds’ podcast today to talk about biopsychosocial formulation in child mental health and the key phases of a child mental health assessment.

Sophie Guy [00:00:59] Hi, Andrew. Welcome and thank you for joining me on the Emerging Minds’ podcast today.

Dr Andrew Leech [00:01:04] Thanks, Sophie.

Sophie Guy [00:01:05] We’re here today to talk about formulation in child mental health assessment and the importance of a biopsychosocial approach. I wonder if we could start with the child mental health assessment and ask you to describe the key phases of a child mental health assessment.

Dr Andrew Leech [00:01:22] Yeah, well, it’s, it’s not always clear cut, a child mental health assessment. And up until this work I’ve been doing with Emerging Minds, there’s not really been a structure that I’ve worked to as we’re not really taught exactly what to look for or how to formulate a diagnosis and management plan for children presenting with mental health difficulties. And so I can completely understand why GPs would feel overwhelmed and even a bit burdened by this sort of work. It’s time consuming. It’s not always a clear answer and it can be quite anxiety provoking, hearing some of the stories that we hear in our GP offices. So I guess we’re just trying to think of some structure to how we assess children presenting to us with difficulty socially and emotionally, and how do we move forward with those children and how do we understand them better. So some of these things we talk about today will hopefully provide some clarity and a bit of a platform for doing that. And you’ve mentioned talking about the, the key features or key phases of a mental health assessment. I actually think as GPs we do this quite naturally and we may not even realise it. We actually run through some of these phases day-to-day with every single patient. But to make it more obvious and to make some sense of it all, these phases help to sort of reinforce what you’re doing and to help you to use them to your advantage when you’re connecting with children.

Dr Andrew Leech [00:02:56] The first phase is that. It’s connecting. And I would feel for me personally is the most valuable stage in a mental health assessment. It takes time. It’s an investment of time. And it often makes me run late in my consultation to actually sit down and talk to the child. That’s your patient and connecting on their level. It may involve just listening to what they have to say. Or as we often experience, the child is not willing to open up. And we need to help to make them feel comfortable by using child friendly language. By talking about common interests. By talking about things that we know kids of that age might enjoy. So I’m often using sport as a good one. I’m often using computer games that I know of. I’m talking about friendships that they might have at school. Things that they do at school in their year. So just really trying to firstly see eye-to-eye with the child, letting them know this is a safe space. This is where we’re here to talk about big emotions. We’re here to talk about feelings that are troubling them. And instead of a general introduction to why they might be presenting or why their parent might be concerned.

Dr Andrew Leech [00:04:08] Then the listening part of connecting as well. So, you know, if the parent has something specific to say, I think just sitting back for a couple of minutes and letting them talk. It’s often built up inside them. I know in the waiting room they thinking it over and over. What are they going to say to us? And so they bring it in or I’ve had a letter already sent to me before they come in and they just want to go through that with me. So listening. And I’ve had parents feedback to say that was really the most important thing to them, that someone actually listened. They’ve gone through all these different hoops and steps and no one’s really got what they’re coming in about or thought that they’re overreacting, that kind of thing. So if you can do that, you’re halfway there. And validating is important as well. Saying that, you know, I totally understand. This is a very difficult time for you. You must be finding it very hard. Using those sort of supporting kind of words.

Dr Andrew Leech [00:04:59] The next phase of a mental assessment is explore. So exploring further what has been raised. This might happen in a second consult. You might have finished 30 minutes of listening and engaging the child and need to get them back to explore. Or it might just naturally flow on in the consult you’re in. So exploring is really those sort of prompting questions, you know, exploring background to what is presenting to you. And we all have ideas in our mind of what questions we want answered. And that might be around mental health type questions. Are you feeling anxious? Are you feeling worried? What degree of anxiety do you have between zero and ten? How is your mood? Are you coping? Are you getting up and enjoying your day? Are you having fun at school? So exploring a little bit deeper some of those mental health aspects. And then out of all that is often where the problem will lie. Another aspect of explore that I like to do is to draw a genogram or a family tree. And we can often see really clearly the relationships within the family. And that forms a really key part of this child’s world. And who is at home. Who are the grandparents? Who do they interact with? Who are the siblings? And where is dad? Why are you not mentioning Dad today? Do you still talk to your dad or, you know, often things will come up that will prompt you to understand a bit more about their world, as I said.

Dr Andrew Leech [00:06:28] Planning is the next phase and planning comes, again, from formulating an understanding of their needs from the exploration you’ve done with the child. We will generally find that we now have an opportunity to plan what our goals are. So I usually ask parents, what do you think would be helpful from here to give you some direction or to give you some relief from what’s going on? And parents often have a preconceived idea of where they might go next. It might be that they have an idea that they will be seeing a psychologist or a specialist out of coming in to see us. They may wish for you to consider that as an option, but it’s a to-ing and fro-ing. And I will lay out things that I think might be helpful and some goals that we can work towards moving forward. It’s very much a team-based approach. It’s very much involving the parent. It might be the teacher, the GP, a psychologist, with the child at the centre and the team working together to try and lift that child and bring them to a happier mental health.

Dr Andrew Leech [00:07:39] So with planning, it may just be, look, we’re going to see you again in two weeks and we’re going to have a longer appointment to further discuss what we’re doing. And that is in itself therapeutic. And GPs often forget that seeing patients and supporting them and listening to them is a form of therapy. We are actually helping to treat that patient. We’re actually helping to treat that child by just doing that. It’s doesn’t feel like we’re doing anything, but we are. And it is okay to say, look, I’m not exactly sure what the next step will be. Let’s see you again. And let’s follow you and let’s see where this goes and even think of some basic suggestions. I often find those out of the history of things that could easily be tweaked in that child’s environment. And that often comes down to diet, exercise, sleep, computer screen use, gaming, all those sorts of basic inherent lifestyle interventions.

Dr Andrew Leech [00:08:36] So follow-up and review. And then collaboration is the final phase. And collaboration is speaking to the team, collaborating with the parent, collaborating with the school. And I often have to end up calling people and that might be a psychologist. And there’s all that sort of unpaid time that you spend writing letters and ringing people. But it does make it more valuable. Once you meet with that child. You have more information. They think you care because you’re actually reaching out to people in their network. And of course, you do need consent from the parent to be able to do that. But it can be very, very useful collaborating maybe through the letters you send through the mental health care plan that you create, through the letters that you get back. It can be simple collaboration. But don’t forget to include other people. So it also helps with the burden of the work. As I said, this is hard work and you don’t need to have it all on your shoulders if you feel that others can help with you. So the phases again, connecting, exploring, planning, and collaborating. As I said, they happen quite naturally in our day to day work, but it’s important to pluck them out and think, oh, this is what I’m actually doing now. This is what, what will come next and gives you a bit more confidence in the skills that you bring to this area.

Sophie Guy [00:09:49] Okay. I next want to ask you about one of the key themes of this conversation, which is what is biopsychosocial formulation, and how does this help with understanding the needs of the child and the family that presents to you?

Dr Andrew Leech [00:10:07] With seeing children, it’s never clear cut what might be leading to their presentation. It’s never one simple aspect of that child’s life. And with the biopsychosocial formulation, we’re taught through medical school, this sort of idea that there is more than one aspect that might be impacting or influencing on a presentation and to think very broadly about why that child is coming to you. It gives you that sort of backbones to your history and to the understanding of that child’s ecology and the behaviours that they are presenting with and the influence from other people around them. So it basically helps you to broadly assess the child. I guess we, we normally think of those history type questions when we deal with mental health consultation. So as I said, you know, anxiety-related questions, depression-related questions, risk assessment, and they’re very important. But this takes it one step further, to look at that underlying influences. So the biological side of things is really the temperament, the genetics of that child. Is there a family history of mental illness? Are there medical factors at play? And these are strong influences onto that child’s ability to deal with emotions, but also an influence on, and a risk for mental illness. So medical factors such as sleep disorders, chronic illness where they’re in hospital a lot, where they’re missing school. ADHD I probably consider as a significant risk factor for mental illness. Trauma, which probably sits across all three domains and exposure or impacted by trauma. I would say these domains are actually quite fluid because biological factors can quite easily sit in psychological factors as well.

Dr Andrew Leech [00:12:06] Psychological factors are, again, development and behaviours. When we see children we, we do need to sit back and think, is this actually normal developmental behaviour? Is this actually where they should be at? A two year-old who is having repeated tantrums doesn’t necessarily have anxiety. Even a three year-old or a four -year old or five year-old who’s having trouble self-regulating their emotions, who’s quite agitated, worried, and is expressing that, it may just be that that’s their stage of development. It’s something that they are dealing with themselves. It may not be to do with an anxiety component. And so sitting back, thinking about where that child is at and there is a wide range of normality and some kids are very extreme with their emotions and very outspoken and very emotional and very sensitive and deal with things through anger and yelling. And that might be quite normal for that child. They just need support and understanding and they need some, maybe some boundaries or they may need some strategies for parents to help when these emotions come up. Whereas, you know, and often we’re probably more worried about the other side of things, the child who is more quiet and internalises things and doesn’t sort of have a voice and very difficult to engage in the consult. I’d probably be more concerned about that. But you might delineate that to find that the child is actually usually very shy and very quiet with strangers. So you work out that is actually part of their normal behaviour. So there just working out what’s normal first before going into the psychological and biological areas.

Dr Andrew Leech [00:13:52] Psychological also involves those thoughts and emotions that are kind of similar to what I was just mentioning. So their normal thought and emotional response to events in their life and how they talk and socialise with people, how they deal with friendships and how they can self-regulate their emotions. Is it, is it something that they are good at? Or do they tend to explode and become very emotional children. Really thinking about their response to emotions and their emotional regulation as a whole and where they’re at developmentally. The social side of things is who’s at home? The family supports. The genogram, the friendships. And I usually do that through asking them, who are your best friends at school? Who who do you click with? What are their names? Do you see them on the weekends outside school? Or if it’s a younger child, who’s your friend at kindy? Do they socialise at the park with other kids? And then who’s around in the family network? So who’s at home in terms of parents? How often is dad home? Does he do fly in, fly out type work? Which is quite a big thing where I am and where I work. Is there a grandparent’s support? Are there friends that support? Do have a babysitter? Do you get time out for yourself? So really like looking at the parents as well as the child. Siblings as well, can have a big impact on a child’s mental health and so, who are your brothers and sisters and how do you get along with them?

Dr Andrew Leech [00:15:23] So in summary, the biopsychosocial model is designed to help you really think about how you are seeing the child in their world and how you are understanding their development. And what are some of the key areas to explore with that child, to help you to further work out if there’s problems. And the impacts on those are quite wide from that family through to the school, through to the community. There’s lots of factors that can really be raised as part of that. I think out of all of that, if you can figure out where that child fits in their home situation, where they fit with their relationship with their parents, and how the parents see that but also how the child sees that, that’s probably one of the key components of this. Because the interplay of relationship between child and parent is significant in how they develop an emotional response and how their mental health is responding. I really like to know what their relationship is like with mum and what their relationship is like with dad and what parent relationships are like and what the child might be hearing or seeing at home. And I think that sort of sits nicely in all three areas of that approach. And keeping in mind this is a child centred approach. So I’m always coming back to the child, do you agree with what mum said today? Is that something that’s worrying you? Is that something that you thought was important? Or have you got another problem that you’d like me to look at or consider or listen to? Do you want to write that down for me? That child needs to continually be validated as we work through this.

Sophie Guy [00:16:58] Yeah, that sounds really important.

Dr Andrew Leech [00:17:00] So with formulation, using some key questions can help with how you process that information, how you approach the formulation. And we were taught HEADDDSSS at medical school. Most GPs will know of HEADDDSSS, which is H-EA-D-D-D-S-S-S. And it’s an assessment of adolescent patients, exploring their home life, their education, alcohol and drugs and et cetera, et cetera. So like HEADDDSSS was for adolescents, we’re now thinking of an acronym called CHILD for dhildren and assessing children. And I think GPs will start to hear more about this acronym, moving forward. But it’s just to sort of give a little introduction to CHILD. And CHILD stands for Child, which is the child’s temperament and who that child is. Home, which is sort of all those things we mentioned around home life, around trauma, around financial stability, stresses at home, and interactions. The third is I, which is interactions between the parent and child. And this is what I highlighted earlier as being a really key area to explore early, that relationship. How that child talks about their parents and how the parents talk about the child and what behaviours and interactions you see in front of you occurring between the two of them. L is links in the community and supports that that parent might have. And D is development, which is again what we said about where is this child developmentally? Are they falling behind developmentally? Is this normal developmental behaviour? What are their social and emotional skills with other children? And can they regulate their behaviours. So the CHILD tool will be something useful when you are doing your formulation.

Sophie Guy [00:18:52] And it sounds as though consideration of the biopsychosocial aspects fits in that exploring phase that you talked through of the child mental health assessment.

Dr Andrew Leech [00:19:03] Yeah, connecting and exploring. Often just flows with what the parents are most concerned about. You tend to ask these questions because they come in for a specific reason. So then you explore that reason. You explore school because there’s bullying going on. You talk more, in more detail about what’s happening at school. Or you talk more detail about what’s happening with friendships or home life. So it sort of goes depending on where you are at with that presentation. But it does sit with exploring and it can take, again, one, two consults, maybe more, three consults to really appreciate what’s important here and what’s important with the child that is here in front of you. And it may come out in that last consult, the key issue. You would hope it doesn’t take that long, but it can. I’ve come to discover that children are quite complex, even though they’re so young. And there are so many factors that we need to think about that I can never do it quickly. But I don’t want GPs to feel overwhelmed, thinking, oh, my goodness now it’s just even more confusing. It’s not meant to be. It’s just to know that diagnosis is not necessarily a clear cut thing. This is the formulation. This is the real crux of, the real bulk of information is and this is where you’re going to get your goals from. This is where you’re going to get a plan. Because you’re going to work out from knowing the biological, the psychological, the social world of the child. You’re going to find out through that questioning and through that approach where things are being disconnected and where things are falling back and it will become clear as you move on. And if it doesn’t, it’s okay. Get help. Get someone else to help me. A psychologist, a school counsellor, even another parent. Yesterday, I asked mum to come in as well because dad and I weren’t quite understanding what the problem was. So I said, let’s get mum in as well, let’sreally try and work this out. So it’s not necessarily going to be clear initially.

Sophie Guy [00:21:02] Okay. And so you’ve touched on diagnosis now and the next question that I wanted to explore with you is what is the difference between formulation and a diagnosis working in the child mental health space?

Dr Andrew Leech [00:21:16] So formulation is taking all that information that was presented in that approach that you’re taking of listening, connecting, exploring all those different aspects, and forming an understanding of that child’s needs and family’s needs and the priorities of the next step. So it takes into account the whole picture, the whole ecology as we’re, as we’ve summarised already. Diagnosis is more of a set criteria. And we all know the DSM criteria. It’s a set criteria that is met with consistent symptoms over time that enables you to put a label down that would explain that presentation. So we don’t always find a diagnosis from the formulation and it’s bit more specific. It’s a little bit more black and white, whereas the formulation is a bit more grey. But the DSM criteria, so for a generalised anxiety disorder, there’s usually quite specific tick boxes that need to be covered to diagnose that child with a generalised anxiety disorder or an obsessive compulsive disorder. It may not come from your formulation, but it certainly helps, the formulation helps you to work that out. So I’m wary of using a diagnosis. I’m wary of putting that out especially early.

Sophie Guy [00:22:37] Why is that?

Dr Andrew Leech [00:22:38] I think until I really know what’s going on. Until I really understand the symptoms and presentation, I’m wary of giving out that diagnosis. So just being thoughtful. But I don’t think it’s a problem if you have a diagnosis that’s quite clear. If a child is always anxious, unable to relax, unable to sleep, it’s giving them tummy aches, headaches, you know, they’re missing school, generalised anxiety disorder becomes quite clear. And letting the parent know that this is what I think’s going on, this is the treatment that’s evidence based, can be quite reassuring for parents. But I think GPs often get mixed up between anxiety as a symptom and anxiety disorder as a diagnosis. And they’re actually quite different. And anxiety as a symptom is something that we all experience. But is it becoming an actual disorder? It depends on your history and ticking those boxes as part of the DSM criteria. And is it becoming clear? I’m not exactly sitting there ticking every box, by the way. I’m thinking of it in my head and it becomes quite obvious. And I think GPs will know this. When you see them enough, you can pretty clearly understand when it is becoming a disorder. And I usually think of those terms and those diagnoses when it is impacting both home and school life. When it really is causing a problem for both. So why else would I be wary of diagnosing? I think that can sit with the child and parent and sometimes parents feel a bit shocked or overwhelmed having that thrown at them. So I guess being careful with how we explain it to them when we do think there is a diagnosis. Letting them know it’s not necessarily a lifelong condition [okay]. That it is treatable and that it is nothing that they need to feel guilty for or regret things they’ve done or just really sitting with them and talking to and explaining carefully why you’re thinking. Rather than just a throwaway line, this child has anxiety disorder. You know, you have to be quite sensitive with this and understand parents are already a little bit on edge and nervous. So explaining it to them and letting them know this is an important condition that is treatable is probably the best way to do that.

Sophie Guy [00:24:55] Okay. There is some value in diagnosis, isn’t there? In terms of what that might mean for the types of services you offer and Medicare items you’re able to claim when working with children in this space, and also is it around what you might then do next? Referring and things like that?

Dr Andrew Leech [00:25:15] Yes. So as part of our planning, a diagnosis can trigger off referral. And we know that anxiety disorders in particular, I use them because they are my most common presenting complaint, presenting diagnosis. Anxiety disorders are best treated by psychology or occupational therapy. So psychologists referrals with anxiety in the background can be done with this mental health treatment plan that you’re referring to. And yes, Medicare has that sort of criteria of needing a diagnosis to fulfil their needs to fund a mental health treatment plan, to gain access to that psychologist. So in terms of that section, there is a section on the mental treatment plan that says, what is your diagnosis? I will again further explain to the parent that I’m putting this down as anxiety disorder, or as a disorder that we can’t yet explain, or as a somatic problem that may be related to anxiety. There’s a wide list of diagnosis that Medicare lists that you can put in this section. But I’m really open and upfront with parents that I’m putting this down but it is very fluid and it can change. And we often find as they start to talk and engage with a psychologist, it wasn’t anxiety at all. It was actually OCD. I’ve had a few that ended up being obsessive compulsive disorder, which is the type of anxiety, but it wasn’t to do with generalised anxiety. Or it was presenting like anxiety, but it was actually something else, it was a form of depression. So as time goes on, this can change, this label or this diagnosis that we put onto this mental health care plan and to not become worried or upset that it’s listed there on the paper. And the communication that we have with the psychologist will help us to shape that. And that it goes on there so that we can help to access Medicare funding to support them with psychology. And it is good to have a mental health treat plan so that we can open up that conversation with the psychologist. We can open up that funding to see them, and we can get the ball rolling on treatment. Of course, it’s not a compulsory thing, if they wish to fund it themselves, but it certainly helps in creating that link, I find it certainly helps.

Sophie Guy [00:27:35] Okay. What I want to ask you about next, I feel as though you, you’ve really touched on this quite a bit, but what are the key challenges for GPs when forming an understanding of a child’s mental health needs?

Dr Andrew Leech [00:27:49] The key ones would be time. I think if we were to survey GPs they would say, we don’t have time for all this. It’s actually really hard to fit all this in. We’re dealing with the day-to-day problems and then fitting in quite challenging, difficult consultations that can be emotionally involved. But even more so important, is time consuming. And we do have to be careful that we don’t suddenly run one hour late. It affects the whole day. It affects other patients. So time is a challenge. But I’ve tried to say here, don’t feel like you have to do it all in that first consultation. Get an introduction. Introduce yourself to the child. Build some basic rapport. And then ask mum or dad to write down more concerns that we’ve missed. To send that through so that we can look at that next time or to come in next time on their own. We can go into more detail in a longer consult. So just that regular follow-up that keeps them going and keeps them in the system now that we’re started.

Dr Andrew Leech [00:28:56] I think another challenge is actually just engaging the child. And I’ve had many consultations where I don’t think the child said a single word. It happens and you sometimes leave consults going, oh that really didn’t work. All my tricks in the book didn’t work. What am I gonna do? And kids can be difficult. They don’t usually like coming in to deal with this stuff. Mum or dad has said ‘you need to go into the doctor and talk about your feelings because they’re not going well’ or something like that. That’s their heads up. And they think, oh why do I have to do this? It’s, you know, the last thing I want to do. I don’t want to come out of school to do this. So they’re coming in already a little bit resentful. So you’re up against it. And if that first consult is basically just talking to mum or dad, then that’s okay. But I always explain to the child, even if they’re not responding to me, I always say this is really important that we deal with this. And I’m here to help you. We are going to help. You are not broken. You don’t need to be fixed. We just want to make it easier for you. We want to improve these tough things that are happening to you. So I hope that that gets their trust and confidence to come back.

Dr Andrew Leech [00:30:12] The third thing is accessing services and we are in an area of growth here. This is a really busy area now.

[00:30:22] You mean literally your, the region where you are?

Dr Andrew Leech [00:30:25] Here. But I would assume that Australia-wide, mental health in general is an area that is overburdened in terms of the support and the services. And therefore, there’s a backlog. There’s actually quite hard to get into child adolsecent mental health services quickly. Into a psychologist quickly. You know, I’ve just heard this morning that all our local psychologists are booked out. And I know this would reflect what other GPs are seeing. So have access to some psychologists locally that you know, that you trust, that you use quite regularly. And feel free to pick up the phone and say, I’m really worried about this child and I think they should be seen. And can you please look at these referral? And that sort of link is really helpful, I find. I have them on my mobile now. I call them, I text them and say, I’ve got a patient I’m, I would really like you to see. And I think that’s good to collaborate like that. And look more widely. It’s not unusual for me to use psychologists 30, 40 minutes away if parents are willing to drive and they will. But aim for local because it’s more convenient. But if there’s someone who specialises in OCD, for example, it’s helpful to have that specific service.

Dr Andrew Leech [00:31:40] And then the lack of training is probably my other thing that I think about as a challenge, is we don’t really get taught any of this at medical school or in GP training. We get basic information on how to structure a mental health consultation. We don’t get taught all the ins and outs of evaluating a child with mental health difficulties. And so a lack of, sort of, knowledge is probably another aspect. What do I actually do here? What’s the next question I should ask? You might be thinking I don’t have children on my own. How do I actually talk to this child? What do they like at age six? I don’t know. And so that is challenging. I would think that’s another big area that GPs find, they’re just not confident to engage or to do, to know what the next step is.

Sophie Guy [00:32:24] So then what advice do you have for GPs who complete a child mental health assessment or generally for GPs in understanding children’s mental health needs?

Dr Andrew Leech [00:32:36] I think if there’s one thing to say, it’s that we’re all capable of this. This is all teachable, learnable skills that we do already. That we cover off when we assess someone with abdominal pain or with a rash. We think about what could be causing it. What’s in there world that could be linked to these symptoms. And so we know the basics of any assessment. And to give GPs that confidence. You can do this. It’s not rocket science. So all the skills we’ve explained today and all the skills in this course are things that you can learn and adapt to your practice. Even if you’re in a very busy clinic and you’re seeing people every 10 minutes, you can do bits and pieces of these skills and make a really big difference in children’s mental health. We are probably at the core of that network as a go-to person and I’d like to think that that will grow in time. That people will see us as a key support for helping them to navigate the system or to understand what’s going on at home and so be aware that they’re going to come to you. That’s who they’re going to turn to. It’s not silly. It’s the world we live in at the moment, that there is a general increase in paediatric mental health. And I was interested to read that 13% of 4 to 11 year-olds in Australia experience a diagnosable mental health condition this year. In the last 12 months. That’s a lot. That’s really high. And not all of them are going to get picked up. And so [no], be aware of it. Be open to the idea. Know that you have skills. Think of it in other presentations. That might be, the child presenting with abdominal pain. Think of anxiety. It’s, it’s there. It’s one of your differential diagnosis. Obviously, you eliminate all your medical things first. But mental health is an important influence on that child and their, and their physical health. And I’m I’m always just asking as a sort of a throwaway line at the end of any kid’s consult. How are things going? Is everything going okay? Are you all right? To mum. Is school going alright? Just little throw away key questions that might give you a little feeling for what is happening and whether there’s any early issues coming.

Dr Andrew Leech [00:34:51] And that’s probably the other thing to tell GPs. Early intervention. Don’t be afraid to refer. Get help early. The quicker you get onto things, the quicker they will be dealt with. And it’s a lot easier. The mountain is not quite as high to climb. So don’t be afraid to intervene early, even if you think it’s a bit of overkill. Even if you think, oh this is so simple. It’s just a very anxious child. If two, three sessions of psychology is all it needs, that’s magic. You’ve done it. Rather than 12 months later and that child is now withdrawing from school and falling behind and regressing. I think early intervention in all of these aspects are so key. Grief is another one, you know, where where you can say that child is really not coping with those emotions. It’s a normal emotion, just like anxiety. But they’re not coping. And a good psychologist would be able to help with that. Having some key psychologists, we talked about already. Having some links in the community that you can turn to when you need help. Knowing their numbers. Being able to contact them easily by email or phone. And being aware of those local crisis support services. Because sometimes things do need urgent escalation and you need to know where you can go in those periods. And it can’t wait. So knowing your local crisis services and being able to follow-up and review. So they’re probably my main areas of advice.

Sophie Guy [00:36:12] Great. Thank you. Well, I’ve asked all the questions that we had planned. And it’s been a really valuable conversation. I think you’ve just spoken with such clarity about this topic and I think in a way that will help GPs, not to be naive about the challenges, but to build their confidence as well. So thank you very much for your time today, Andrew. I really appreciate it.

Dr Andrew Leech [00:36:35] No problem, Sophie. Thanks for having me.

Narrator [00:36:39] Visit our website at to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.

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