Featured letters

In Gilbert and Sullivan’s comic opera The Gondoliers, two gondoliers from Republican Venice are discovered as heirs to the kingdom of Barataria. When they get to the Kingdom, the inequalities of monarchy offend their sensibilities and they find ways to promote all and sundry to high rank, creating “the Lord High Coachman on the box, the Lord High Vagabond in the stocks” to take their place with “the Lord High Bishop Orthodox”. The wise, if lugubrious, Grand Inquisitor sees the flaw in their kind-hearted scheme and points out to them in his sonorous bass that, “when everyone is somebody then no one’s anybody”. I couldn’t help reflecting on this when I heard the news that all full members of the Colleges of Forensic and Clinical Psychologists (two Colleges to which I belong) are now to be called ‘Fellows’ instead of ‘Members’. As this is a fait accompli, it may well be in vain to protest, but I cannot see a valid reason for this move, nor can I agree with it. In general use, the title of Fellow is granted to members of a body who show some outstanding achievement, pass some rigorous post-academic trial (as in fellowship of medical colleges), win a funded position to perform a particular role, or demonstrate significant longevity as working members along with a contribution to governance. It appears that none of this applies to the Colleges’ decision, which makes it seem a bit self-indulgent, considering the requirements for membership. Our profession already abounds in high-sounding titles – check out LinkedIn some time. My letter does not seek to overturn the Colleges’ decision – I acknowledge it is too late for that – but rather to contribute to a conversation about the valuing of titles.

It is astonishing that in the three articles in the December issue of InPsych (2017) addressing child mental health (Littlefield, pp. 6-7; Cavanagh, pp. 8-10; O’Grady, pp. 11-12), there is no mention of a description of school-based screening for mental health in 
early childhood.

What is missing is that while there is a well-established system for immunising children for physical health, presently there is no employment of a validated system of early universal prevention for child mental health.

Cavanagh reported, “Cognitive, social, emotional and physical development … lay the foundation for a wide range of outcomes later in life” (p. 9), but did not emphasise speech-language or auditory processing disorder which have been revealed as key factors.

O’Grady does not report which risk and protective areas are involved in prevention such as SES, gender, genetic, perinatal, speech-language impairment, auditory processing disorder, mobility, resilience (parent-child relations and ability levels), internalising and externalising behaviour, early academic achievement and success areas.

Littlefield described “Low Intensity Mental Health Services” to help reduce “highly prevalent disorders such as anxiety and depression as well as substance abuse”, but emphasised “there is little supporting evidence for low intensity interventions” (p. 6)…” and that “PHNS and GPs will need considerable support to know which clients are likely to have their needs met” (p. 7).

Critically missing from these reports is any mention of an early universal school-based screening system for child mental health – that has been
recommended by international researchers. Identification by teacher observation should be rejected since it has been shown  to be error-prone. Also, KidsMatter, although a good school-promotion system for mental health, is only one referral obtained from a scientific system of identification.

Where are the comments from APS clinical and educational psychologists concerning the proposal endorsed by Education Minister Rob Stokes to have teachers from kindergarten onwards try to teach children about how to recognise and deal with mental health issues (The Sunday Telegraph, January 7, p. 7)? The only expert consulted for that article was psychiatrist Patrick McGorry, who understandably would support this idea.

There seem to be a number of problems with the proposal. Firstly, the prevalence of genuine mental disorders is actually quite low and talking about them in school is mainly going to cause a plague of imagined symptoms with many children starting to believe they are depressed, clinically anxious, or worse, psychotic. We already have, arguably, too much over-diagnosis and over- medication of mental disorders and this program is not going to help. Secondly, everyday battles and failures are a fact of life for most children and they have to learn for themselves how to cope, just as earlier generations did. Also, it should be remembered that worries, anxieties, and self-concept doubts are not classifiable as mental disorders unless obvious and persistent disturbance in everyday functioning is observed. This can be observed by teachers and parents and reported to a GP or counsellor.

Lastly, how are schools going to find the time, as well as enough psychologically qualified teachers to teach this new ‘subject’? Australian children are falling behind in the subjects that matter and will never catch up if valuable class time is given to matters that should be handled outside of school hours.