Evidence based medicine and evaluation of mental health services: methodological issues and future directions

It is becoming increasingly evident that paediatricians and general practitioners play a key role in assessing and treating children with mental health problems. A recent national survey in England and Wales found that paediatricians are probably treating more emotional and behavioural disorders in children and young people than any other single professional group and that, on average, this group of patients comprises one fifth of their referrals. 1 In one large survey in the UK, almost one quarter of 7‐12 year olds from a large urban area visiting their general practitioner had a psychiatric disorder, 2 and more than half of the children attending a child mental health clinic in a six month period had been referred by their general practitioner. 3 In the USA, a large study of 7‐11 year old children referred to paediatric clinics found that almost one quarter had a diagnosable mental health disorder, with a further 42% showing threshold disorders. 4