When to refer a child for psychiatric care? Experts explain

SHAH ALAM - The tragic incidents involving youth violence in schools saw a pressing conversation on when and how children showing severe emotional or behavioural disturbances should be referred for psychiatric care.

Experts emphasise that early intervention, compassion and structured protocols are key in ensuring troubled children receive the help they need before situations escalate.

Mental Illness Awareness and Support Association (Miasa) Malaysia Founder and President Anita Abu Bakar said that psychologists could refer a child to a psychiatrist when symptoms indicate the need for medical management, particularly in cases involving psychosis.

"A psychologist can refer a child to a psychiatrist when the symptoms need to be managed by medication, for example, when the child exhibits signs of psychosis such as hallucinations or delusions.

"These situations require medical assessment and possibly medication to help stabilise the child’s condition,” she told Sinar Daily.

She added that such referrals often follow thorough assessments and when persistent emotional or behavioural difficulties do not improve despite consistent therapy or when safety becomes a concern, a hospital-based multidisciplinary team should step in to conduct a more in-depth evaluation.

"The referral should always be framed with compassion so that the child and family understand this is not a punishment, but an act of care," she added.

Meanwhile, Malaysian Mental Health Association (MMHA) President Professor Datuk Dr Andrew Mohanraj said that schools must also have a child protection protocol in place to ensure timely and appropriate action when serious issues arise.

"Schools should have child protection protocols in place, which involve legal reporting if sexual offences or serious violence occur.

"Referrals to specialised mental health services should be made depending on the seriousness of the situation," he said.

Dr Andrew said that the urgency of referral is often dictated by the severity of the behaviour and the potential danger the student poses to themselves or others.

“What one looks out for is whether the actions exhibited by the student bring danger to themselves or others, meaning if there are any homicidal, suicidal or non-suicidal self-harm ideations or behaviours involved, those are cases that require urgent referral,” he said.

He reiterated that psychotic symptoms such as hallucinations, delusions or losing touch with reality, should never be ignored.

“The cardinal features that dictate whether a child must be referred urgently include a significant decline in social or academic functioning, any homicidal or suicidal thoughts or behaviours and any odd behaviours that suggest psychosis. These are situations where immediate intervention is critical,” he said.