Psychiatric services in developing countries

Bass et al (2001) have recently drawn attention to the insufficient recognition given by clinical services to somatoform disorders. Although the authors explicitly exclude children and adolescents, most of the issues they raise apply equally to the younger age groups.

It has long been known that impairing functional aches and pains unexplained by medical disorders are common in children (Garralda, 1999). As in adults, those associated with chronic widespread pain and persistent fatigue have been shown to be associated with marked functional impairment including school non-attendance, which is substantially higher than in serious chronic paediatric conditions (Rangel et al, 2000). There is considerable continuity with functional symptoms in adulthood and family aggregation of health problems (Garralda, 2000). Although less extensive than in the adult literature, there is evidence for the effectiveness of psychological treatments in children (Garralda, 1999). However, the development of dedicated psychiatric—paediatric liaison services often has low priority, is poorly coordinated and monitored, and the training of paediatric staff in this area is clearly limited.

In line with Bass et al I support the view that young patients with severe forms of somatoform disorders require specialised multi-disciplinary treatment which is not appropriately administered in either a psychiatric or paediatric ward. I would echo the need for a serious joint business case between paediatric and psychiatric providers and general practitioners. Although in itself not sufficient, it might help to increase awareness and action if the Royal College of Psychiatrists were to issue guidelines on the number of paediatric liaison psychiatrists required for a given population and on job specifications.