Children’s Mental Health and the Inequality of Knowledge

In my last post (9 December 2010) I commented on two particular challenges among those identified by the Children and Young People’s Mental Health Coalition.  These challenges relate – obviously – to children’s mental health, and centre on (1) the ongoing problem of stigma surrounding mental health issues, and (2) the matter of the unheard voices of children from particular backgrounds.  In both cases I referred to how these things can delay people (i.e. children and their families) from accessing help.

The assumption is that if you access help for a mental health condition early on, then there is less opportunity for that condition to worsen and require a more drastic intervention.  I am very aware, however, that my novel, Delivered Unto Lions, is all about a drastic intervention (residential psychiatric care) directed at a child who happens to be suffering from depression.  Are we to suppose that this child and his family did not seek help early enough, hence the severity of the intervention?

This question is not answered (or even raised) in my book.  But given that this novel is based substantially on my own childhood experience in the 1970s, I am able to say, with reasonable confidence, that the timing of the intervention is not the issue.  What matters here is the nature and the appropriateness of the intervention.

In a media release that was issued at the time of my book’s publication, I am quoted as expressing the hope that Delivered Unto Lions might not only increase awareness of how children’s mental health problems were once treated, but also encourage parents and professionals to consider the possible unintended consequences of treatments used today.

The main character in my novel, Daniel, became a residential psychiatric patient because his parents accepted the advice of the professionals (as did my own parents).  This does not imply a criticism of the parents (in either case), but hints at some essential differences between (most) parents and (most) psychiatric professionals. 

Parents (in common with all of us) may have their own areas of experience and skill, but this won’t usually be in psychiatry or psychology.  This inequality of knowledge places parents, and their children, in a disadvantaged role in relation to the psychiatrist (or other mental health professional).  While child psychiatrists may have the best of intentions (and we all hope they do!), they are in a position of power because, as the saying goes, ‘knowledge is power’.  It doesn’t necessarily matter whether that knowledge is being used appropriately or not, it is a source of power either way.  Faced with this, parents have a choice: they can submit to this power and agree to everything the professional suggests (as many have done), or they can resist (as many others have done) and accept the incredible responsibility that goes with defying the ‘expert’.

But there’s another significant difference between parent and professional.  The professional is not involved in the child’s life in the same way that the parent is.  Good parents care deeply for their child’s wellbeing; professionals – while they may well be caring people – do not care in the same way, and so they have less at stake. 

Obviously, if a professional makes an obvious blunder it may well harm his or her career, but the ‘best guess’ which later turn out to have been a mistake is not likely to have the same effect.  Professionals (mostly) do not have to live with the consequences, but children and their parents do.

What I am suggesting (not that I expect many people to hear me) is that parents and child mental health professionals both need to think about what could go wrong with the treatments being considered for a particular child, and weigh-up these possibilities against the hoped-for benefits. 

I would also urge parents – and children, where they are able – to ask plenty of questions of the professionals, and not blindly accept everything suggested.  The professional is, after all, the expert, so get him or her to share some of his expertise – but not in a ‘this is how it is’ sort of way, but in an open and scrutinised way.  Clearly, the more assertive and better educated the parents, the easier this will be, but hopefully all parents will be able to wrest some power from the expert.  And hopefully the expert will be pleased at the opportunity of working with more actively involved parents and children.

And what qualification do I have for making these bold (and possibly arrogant) pronouncements?  Well, I make no claim to being an expert or professional, but I do claim the knowledge of what can happen when a child is ‘delivered unto lions’, subjected to unchecked professional and institutional power, though no fault of his own or his misinformed parents.

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Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu