WEST MIDLANDS - EXEMPLARS OF GOOD PRACTICE.

In Europe we often use the more rigorous ICD10 criteria which are funded by  governments.

This is preferable to using DSM4 which is funded partly by the US drug companies who clearly have a vested interest in the high levels of diagnosis.

These criteria are to be replaced by DSM5 in 2013 which will if not challenged widen categories greatly.

Again from around the West Midlands:


1) One child was due to be Sectioned under the Mental Health Act due to his continuing dangerous behavioural difficulties but thanks to a number of  colleagues having meaningful conversations with the Child Psychiatrist involved about some positive family variables e.g. his good relationship with his father, this did not happen.The young person was placed with his dad following a multiprofessional meeting and within three weeks all three medications were removed and he started to re-engage with school again for the first time in a year.This is a major success story that demonstrates the power of effective positive challenge.A child who has been sectioned is severely disadvantaged all their life e.g. can never get a visa for the U.S.

2)At least twenty children in one authority have had their medications reduced to safer levels as a result of conversations by the Educational Psychologists with the respective Child Psychiatrists or Paediatricians.

3) One child who looked "ghostly white" on a home visit and who was reported by his carers to be losing weight rapidly had his medication levels reviewed and significantly reduced as a result of feedback from an educational psychologist to the psychiatrist concerned.His medication had not been reviewed for at least twelve months prior to this point and his carers had just asked for repeat prescriptions which again is against N.I.C.E. guidelines for good practice.



4)More and more headteachers are asking questions about the numbers of children in their school( see 16 Best questions Post), sometimes as a result of questions asked by Governors. Some are developing a more consistent policy as a result where if the parent wants a medication given they then have to come into school to administer it and can not reasonably expect untrained staff e.g. school secretary to do that on their behalf.

5) One LEA in the West Midlands has set up a multi professional clinic at a Short Stay School to aim to offer alternative approaches to medication.It was featured on the ITV Tonight programme on the 28th Julyn 2011. 

Can be see on one of Most Popular Posts above.

Educational Professionals as Change Agents.

Let us all do more to increase the levels of appropriate effective challenge in cases where educational professionals feel that a childs psychological wellbeing is being adversely affected.

Please notify me of any other good exemplars by leaving a comment. 

or contact me on:

traxsondave@gmail.com

CASE STUDIES OF QUESTIONABLE PRACTICE (posted October 2010.)

https://www.youtube.com/user/Humanagement2011 

For more information on this topic and the BBC Radio programmes on over-prescrition for kids.

These examples of bad practice were collated whilst being involved in co-writing this resource for parents from around the West Midlands.

1) In one very alarming case one of colleague in the West Midlands supported a parent who had had a prescription turned down by a pharmacist.When the mother took in a prescription for twice the maximum dose of methylphenidate (144mg), a maximum dose of an S.R.I. antidepressant and a commonly used antipsychotic drug the pharmacist made several phone calls and the refused to issue the triple prescription saying,"this is a life-threatening combination of drugs,you must go back to the prescribing psychiatrist."

2) In another case a mother asked for an additional SRI antidepressant to be prescribed when the child was already on twice the maximum dose advised of methylphenidate. This was given without the locum psychiatrist seeing the child which is against the GMC and NICE guidelines.A senior psychiatrist was very shocked by this and took the matter up with her managers  and discussed with her professional bodies.

3) Top Up doses are regularly administered across the West Midlands with a "kick-start dose" first thing in the morning and a "booster dose" at lunch time despite the child already being on at least the maximum the manufacturer recommends.Many professionals including some peadiatricians are alarmed by this practice as slow release methylphenidate already has a proportionate dose built into the outer casing in the drugs design.

4) In one local authority without a child psychiatrist a senior health authority colleague regularly took a batch of commonly used checklists to a neighbouring authority"s psychiatrist and the drugs were issued without the children being seen.This is clearly against NICE guidelines.

5) Doctors regularly say they do not have the manpower to regularly monitor the childrens weight every six months despite this being a clearly stipulated in NICE guidelines.


6)Relying on parental evidence alone has been criticised by many academics such as Professor Steven Rose (O.U.) as untenable.In one local authority in only 47% of cases did the prescribing doctor contact the school to see if the pattern of behaviour identified existed there as well.
Many headteachers have great concern about this practice as they perceive children as "Vibrant,energetic,full of joie de vie and dramatic" who then go on to be medicated and seemingly lose their enthususiasm for learning and sadly for life in general.

7)Many children who become medicated are felt by a range of colleagues to have the main presenting factor of very high anxiety levels brought about by a number of interactive variables. N.I.C.E. see this as a contraindicator to the use of amphetamines which as they are stimulants can exacerbate the anxiety further.

There are a huge number of similar stories and case examples emerging from colleagues and parents who share these concerns around the country.

Please let me know of other examples that you have come across by leaving a comment.

Let's help children cartwheel for joy without fear of medication!