Child and adolescent mental health disorders: Organization and delivery of care

Abstract

Ongoing debate concerns appropriateness of medication use in treatment of child mental health disorders; however, the benefit of rational medication use in some serious disorders is well proven. Medication use data from high income countries indicate ongoing substantial growth in prescribing of CNS active drugs, especially for treatment of conditions among older children and youth. Even children under 5 years of age are receiving more prescriptions for such drugs. Psychotherapeutic or psychological interventions, which are often the first line of treatment in the developed world, require specialised personnel frequently unavailable in low- and middle-income countries. Practitioners in poorly resourced settings almost always rely on drug treatment alone for children and adolescents. Consequently, therapy must become more evidence based. This chapter examines issues surrounding drug treatment of children and youth with mental health problems in the developing world and calls for an international effort to encourage exemplary trials of drug actions determining both safety and efficacy in relevant LMIC populations.