British Society for Paediatric and Adolescent Dermatology assessment and support of mental health in children and young people with skin conditions: a multidisciplinary expert consensus statement and recommendations

Abstract

Background Psychological and mental health difficulties are common in children and young people (CYP) living with skin conditions and can have a profound impact on wellbeing. There is limited guidance on how best to assess and support the mental health of this population who are at risk of poor health outcomes. Objectives The primary objective was to provide consensus-based recommendations on the assessment and monitoring of and support for mental health difficulties in children and young people (CYP) with skin conditions (affecting the skin, hair and nails). The secondary objectives were to address practical clinical implementation questions relating to consensus guidance; and to provide audit and research recommendations. Methods This set of recommendations has been developed with reference to the AGREE II instrument. A systematic review and literature appraisal was carried out. A multidisciplinary consensus group was convened with two virtual panel meetings taking place: an initial meeting to discuss the scope, review the current evidence and identify areas for development; the second to agree content and wording of the recommendations. Recommendations were then circulated to stakeholders, following which amendments were made and agreed by email. Results The expert panel achieved consensus on eleven recommendations for health workers managing CYP with skin conditions. A new patient completed history taking aid – ‘You and Your Skin’ was developed and is being piloted. Conclusions The recommendations focus on improved mental health assessments for CYP presenting with a skin condition with clinical guidance and suggested screening measures included. Information is given regarding accessing psychological support for CYP when required and recommendations provided for training in mental health and neurodiversity for staff. Embedding a psychosocial approach within services treating CYP with skin disease should ensure that CYP with psychological needs are able to be identified, listened to, supported and treated. This is likely to improve health outcomes.

Healthcare professionals' views on psychological support for children and families affected by skin conditions in the UK: A qualitative study

“…There was consensus for the need to conduct thorough assessments with a range of screening tools and skills to identify psychological distress (e.g., standardised measures, clinical observation, interviewing). 27 , 29 These findings are supportive of previous research carried out by the British Society for Pediatric and Adolescent Dermatology, 29 and highlight how HCPs felt the most comprehensive way to assess distress was by asking direct questions, with assessment tools as a guide. Although this appeared to be the favoured approach, there could be restrictions in terms of time pressures during clinic appointments.…”

“…Most recently, the British Society for Pediatric and Adolescent Dermatology have provided recommendations for the management of children with skin conditions, including improving assessment and adopting a psychosocial approach to care. 29 Given the acknowledged need to increase psychological services within paediatric dermatology, 2 , 28 this study aimed to: (1) investigate the experience of HCPs in the National Health Service (NHS) of addressing the psychological needs of children with skin conditions and their families, and (2) gain expert opinion on the relevance and need for specific forms of psychological support. Importantly, this research builds on previous work by Hughes et al.…”

“…Most recently, the British Society for Pediatric and Adolescent Dermatology have provided recommendations for the management of children with skin conditions, including improving assessment and adopting a psychosocial approach to care. 29 Given the acknowledged need to increase psychological services within…”