Teenage kicks
Adolescents need better service from the man on Miesian Plaza and better advice from the man in Rome, shouts Maurice Gueret from the hospital tannoy system
Scattergun Screening Teenagers are the poor relations in healthcare, falling between the shaky stools of child and adult services. They lack the lobbying power and political clout of the groups focused on elder care and women’s health. As the schools went back, we saw some rare media focus on adolescent issues. First up was an interesting medical paper suggesting that one-off screening of young sports people for relatively rare heart abnormalities is not all it’s cracked up to be. Five out of seven young athletes who died from cardiomyopathy over the course of the 20-year study had normal heart tests when they were aged 16. The response to the study has been one of, “Well, let’s screen them much more often”. Less prominent were calls for scrutiny of the harm that scattergun screening can do. Test-happy medicine finds many things, but rarely discovers its own limitations.
Amnesia Plaza
Something serious is afoot in a neighbourhood where one-in-four 14 year-old girls is self-harming. That’s the analysis of a UK children’s study following youngsters since they were born in the year 2000. Irish figures mightn’t be that different. Mental-health services for teenagers are in rag order. The main child and adolescent service in south Dublin wrote to GPs in July about chronic understaffing and the difficulties it is encountering. Their routine waiting list has doubled in five years. They can’t recruit enough doctors. They have decided to prioritise seeing young people with active suicidal thoughts, psychotic symptoms, bipolar disorder, and eating disorders with significant weight loss. Young people with anxiety or behavioural disorders can no longer be prioritised. They recommend that family doctors refer young people to A&E departments if they need urgent psychiatric assessments. It’s a meltdown. I can see a day coming when GPs might refer troubled patients directly to the health minister in the swanky new Baggot Street headquarters he calls Miesian Plaza. For a man who promised so much for mental health and young people, Amnesia Plaza sounds more apt.
Papal Bull
The Pope isn’t helping teenagers, either. On his flight home from Ireland, Pope Francis was asked by a journalist what his advice might be to parents who observed homosexual traits in their children. The Holy Father suggested prayer, dialogue, understanding and, erm... psychiatry. There is a lot that can be done by psychiatry when homosexuality arises in childhood, he added unhelpfully. The Vatican later rowed back quickly on this remark, stating that the Pope did not mean to say that homosexuality was a mental illness. But it was a clumsy mistake, especially from one whose dogma claims he is “preserved from the possibility of error”. Psychiatrists did officially classify homosexuality as an illness back in 1953 when Francis was at school in Buenos Aires. But doctors saw the light in 1973 when it was hastily removed from the classification of mental disorders. By that time, Francis was head of the Jesuits in Argentina. I’m sending him an updated Oxford Textbook of Psychiatry for Christmas.
Campus Fags
Does anyone heed hospital loudspeakers proclaiming the joy of smoke-free campuses? Private hospitals don’t appear to have them, and you rarely find smokers or mounds of stubbed butts huddled outside them. They all have no-smoking policies, but there may be an unofficial tolerance for those who wish to nip discreetly outside the back where your treating doctor won’t see you. Public hospitals, on the other hand, blare out dire warnings on their tannoys. Directly below the speakers, you will find groups of wheelchair users, drip-stand holders, and dressing-gown wearers, puffing away, often in unison with their families. There are no ashtrays. Lighted butts are often thrown to the air or disposed of in the refuse. It’s a messy scene. Born of an uneasy truce between official policy and real life. I’m not sure it’s doing anybody any favours. A more enlightened health service might combine some sort of shelter for committed smokers with health-promotion activity. Maybe a harmreduction programme that encourages fewer cigarettes. Perhaps a specialist nurse who visits the shelter with advice for smokers. Anything’s better than the current racket.