The mental health needs of looked after children are reviewed and the challenges involved with developing accessible mental health services are discussed. This article describes a multi-agency approach to the delivery of mental health services and focuses on the development, operation and evaluation of a Tier 4 multi-agency team; The Behaviour Resource Service (BRS). The BRS community and residential teams provide an intensive service to children and young people identified as having the most complex needs. Approximately 50% of the service users are looked after children. The needs-led model of multi-agency assessment, intervention and collaborative working is described with attention to the role of the BRS within the professional network. Particular issues pertinent to multi-agency work with looked after children are considered.
Munchausen Syndrome by Proxy (MSBP) is generally categorized as an unusual variant of child abuse, and one where the mother is the usual perpetrator. Explanations of this extraordinary condition focus on characteristic features of the mother and the family. This article attempts to complement these findings with a narrative approach, viewing MSBP as the outcome of a particular human story. A detailed case history is presented and linked to clinical and research findings in an attempt to track the evolution of the behaviour we categorize as MSBP. This view suggests that MSBP is best seen as a process, and one in which the key relationship is between the mother and the child's doctor. Such a view has important implications for the detection and management of this increasingly recognized problem.
Factitious Disorder By Proxy (FDBP) has been gaining increasing amounts of media attention and is being diagnosed more commonly. Here we propose a wider definition to include seven other, related clinical presentations. We then go on to review ‘classic’ FDBP and the role of mental health professionals. FDBP often has grave consequences both physically and psychologically, and may result in extensive misuse of health care resources. The literature concerning FDBP has largely been written by paediatricians, but this review pays particular attention to aspects of FDBP that concern child mental health professionals. The presentation, investigation, diagnosis, and management of FDBP are discussed with reference to the role of child mental health professionals, particularly psychiatrists. What little is known of the prognostic factors is reviewed and suggestions are made for further research.
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