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EMOTIONAL CRISES IMITATING TELEVISION
856 EMOTIONAL CRISES IMITATING TELEVISION
i
SIR,-We were intrigued to read the letter by Dr Ellis and Susan Walsh (March 22, p 686) reporting an increase in admissions to an East London hospital with deliberate self-poisoning in the week after the BBC television character Angie was shown to have taken an overdose of tablets on the popular soap opera Eastenders. Angie appeared to be in hospital for less than 12 hours; presumably she underwent gastric lavage (not shown), and when she was allowed home later that day she looked only slightly the worse for wear. Subsequently, her wayward husband Den has appeared to be more in tow, and thus Angie might rightfully consider the overdose to have had the desired effect. At about the same time, Channel 4 was showing, on its own soap opera Brookside, the very emotionally charged break-up of the relationship between Lucy Collins and an older, married man. Although she did not resort to self-poisoning, tension built up around a locked bathroom door; her parents were unable to obtain a response from her for a long time. This eventually resulted in a wave of sympathy for her from her parents. To see whether the screening of such events on television might have had as much effect in the north of England, where there is’ likely to be just as much pressure on beds for medical admissions as in the south, we have looked at the number of admissions with selfpoisoning to the accident and emergency department of the University Hospital, Nottingham, during the 10 weeks before the screening of the overdose in Eastenders on March 2, 1986 (mean 23; range 14-30), the week after the screening (43), and the same week over the past six years (mean 23 - 5; range 20-28). Thus it is clear that in Nottingham, as well as in east London, there was a considerable increase in the number of patients presenting to casualty during the week after Angie’s overdose was shown in Eastenders. We conclude that a rise in the numbers of patients presenting to the casualty department after a deliberate overdose, in the north of England as well as the south, may well be related to the incidents screened in television soap operas and the "favourable" outcome for the "victims". At a time when television companies and government are investigating the link between violence depicted on television and in real life, this is a warning that should be heeded. Departments of Medicine and Accident and Emergency, University Hospital, Queens Medical Centre, Nottingham NG7 2UH
DAVID A. SANDLER PATRICIA A. CONNELL KEN WELSH
SIR,—At
the time of the NHS junior doctors’ "work-to-rule" made of an apparent change in the incidence of parasuicide, as revealed by hospital admission figures. On that occasion it was said that would-be overdosers could not be certain of recovery because of the absence of junior staff. While not denying the influence of television on our society, I can report that the experience of Dr Ellis and Susan Walsh was not repeated in Northampton. Although there may be a geographical explanation for this, other factors should be borne in mind before the British Broadcasting Corporation is accused of irresponsibility. ’Seasonal changes, atmospheric pressure, and the vagaries of emotional experience are only some of these factors. much
was
Accident and Emergency Department,
Northampton General Hospital, Northampton NN1 5BD
R. G. DANIELS
We have taken three important steps. First, one of the five general from the health centre is the clinical medical officer, and M. R. is a paediatrically qualified general practitioner trainee. We are well-known to all the patients, and work very closely with the health visitors. Second, since 1982 we have made our clinic open access; before this clinic attendance was poor. We had been encouraged by our success in bringing to the clinic a large group of Rastafarians, once we had established a good relationship with them; this followed a screening programme in which we identified and treated 7 cases of nutritional rickets in 42 children.l,2 All children presenting to the clinic are seen and we offer a treatment and counselling service (27% of patients) as well as routine clinic surveillance and immunisations. In this way we attract many children who would otherwise not attend the clinic. Third, by combining clinic and practice notes, opportunistic screening is possible. Where necessary we do clinic procedures in surgery time. Since 1982, clinic attendances have more than doubled and uptake of immunisations has increased by 15%. Of the patients registered with our practice 95% are up-to-date with diphtheria, tetanus, and polio immunisation; 93% have been immunised against
practitioners (J. J.) working
measles.33 Accepting that clinical medical officers are generally appointed from outside the general practitioner services, Nicoll and colleagues have made excellent improvements in their clinic. If child health clinics were run by suitably trained general practitioners a more integrated and comprehensive service could be made available. Uptake of health care in deprived areas will only improve when
patients are offered a service that meets their needs. JOHN JAMES CAROL CLARK MICHAEL ROSSDALE
Montpelier Health Centre, Bristol BS6 5PT
PS, Drakeford JP, Milton J, James JA. Nutritional rickets in Rastafarian children. Br Med J 1982; 285: 1242-43. 2. James JA, Clark C, Ward PS Screening Rastafarian children for nutritional rickets. Br Med J 1985; 290: 899-900. 3. James JA, Clark C, Rossdale R. Improving health care delivery in an inner city well baby clinic Paper to be presented at the British Paediatric Association Meeting on April 16, 1986. 1. Ward
SIR,-The article by Dr Nicoll and colleagues, contrary to their assertion, is strong evidence in favour of the primary health care team undertaking developmental surveillance of the preschool
population.
The
their
clinic!
were
improved results since the previous study from achieved by using "the same nursing and medical team to maintain continuity of care". These are the features that pertain in such clinics run by interested general practitioners. The other major change was to see children referred by other agencies rather than attempting to screen the whole population. Not surprisingly this resulted in a striking rise in disorders detected at these non-routine checks, but the question of what abnormalities lay undetected in the unscreened population remains unanswered. They state that: "Of 158 medical consultations for routine checks only 44 detected an abnormality requiring intervention". This abnormality rate of 28% in itselfwould seem to justify the extension of routine checks beyond the age of 18 months. Perhaps the newly developed team spirit could be used to encourage parents to bring their children for these additional checks and thereby detect and treat
their abnormalities
at an
earlier stage.
Upper Gordon Road, Camberley, Surrey GU 15 2HJ 37
CHILD CARE IN THE COMMUNITY
SIR,-Dr Nicoll and his colleagues (March 15, p 606) recognise the need for altered strategies in running a child health clinic in a
deprived area. They have extended the role of their clinic, and improved communications between clinical medical officers, health visitors, and general practitioners. They emphasise the importance of long-term placement of members of the primary health care team. By taking this process a little further we have improved uptake of health care in our child health clinic, in a poor inner-city area of Bristol, St Pauls, with its large coloured population, racial unrest, and high unemployment.
1. Hendrickse WA How effective 575-77
G. D. ROBERTS are our
child health clinics? Br MedJ
1982;
284:
CAN INCREASED SURVEILLANCE PREVENT SUDDEN INFANT DEATHS?
SIR,—Dr Beaven (March 22, p 682) has rightly questioned the value of increased surveillance introduced by some health districts for infants deemed to be at high risk of sudden death (SIDS). The basis of this increase, as he points out, is the so-called "at risk" factors scored at birth, as in the Sheffield study1-factors which
i
SIR,-We were intrigued to read the letter by Dr Ellis and Susan Walsh (March 22, p 686) reporting an increase in admissions to an East London hospital with deliberate self-poisoning in the week after the BBC television character Angie was shown to have taken an overdose of tablets on the popular soap opera Eastenders. Angie appeared to be in hospital for less than 12 hours; presumably she underwent gastric lavage (not shown), and when she was allowed home later that day she looked only slightly the worse for wear. Subsequently, her wayward husband Den has appeared to be more in tow, and thus Angie might rightfully consider the overdose to have had the desired effect. At about the same time, Channel 4 was showing, on its own soap opera Brookside, the very emotionally charged break-up of the relationship between Lucy Collins and an older, married man. Although she did not resort to self-poisoning, tension built up around a locked bathroom door; her parents were unable to obtain a response from her for a long time. This eventually resulted in a wave of sympathy for her from her parents. To see whether the screening of such events on television might have had as much effect in the north of England, where there is’ likely to be just as much pressure on beds for medical admissions as in the south, we have looked at the number of admissions with selfpoisoning to the accident and emergency department of the University Hospital, Nottingham, during the 10 weeks before the screening of the overdose in Eastenders on March 2, 1986 (mean 23; range 14-30), the week after the screening (43), and the same week over the past six years (mean 23 - 5; range 20-28). Thus it is clear that in Nottingham, as well as in east London, there was a considerable increase in the number of patients presenting to casualty during the week after Angie’s overdose was shown in Eastenders. We conclude that a rise in the numbers of patients presenting to the casualty department after a deliberate overdose, in the north of England as well as the south, may well be related to the incidents screened in television soap operas and the "favourable" outcome for the "victims". At a time when television companies and government are investigating the link between violence depicted on television and in real life, this is a warning that should be heeded. Departments of Medicine and Accident and Emergency, University Hospital, Queens Medical Centre, Nottingham NG7 2UH
DAVID A. SANDLER PATRICIA A. CONNELL KEN WELSH
SIR,—At
the time of the NHS junior doctors’ "work-to-rule" made of an apparent change in the incidence of parasuicide, as revealed by hospital admission figures. On that occasion it was said that would-be overdosers could not be certain of recovery because of the absence of junior staff. While not denying the influence of television on our society, I can report that the experience of Dr Ellis and Susan Walsh was not repeated in Northampton. Although there may be a geographical explanation for this, other factors should be borne in mind before the British Broadcasting Corporation is accused of irresponsibility. ’Seasonal changes, atmospheric pressure, and the vagaries of emotional experience are only some of these factors. much
was
Accident and Emergency Department,
Northampton General Hospital, Northampton NN1 5BD
R. G. DANIELS
We have taken three important steps. First, one of the five general from the health centre is the clinical medical officer, and M. R. is a paediatrically qualified general practitioner trainee. We are well-known to all the patients, and work very closely with the health visitors. Second, since 1982 we have made our clinic open access; before this clinic attendance was poor. We had been encouraged by our success in bringing to the clinic a large group of Rastafarians, once we had established a good relationship with them; this followed a screening programme in which we identified and treated 7 cases of nutritional rickets in 42 children.l,2 All children presenting to the clinic are seen and we offer a treatment and counselling service (27% of patients) as well as routine clinic surveillance and immunisations. In this way we attract many children who would otherwise not attend the clinic. Third, by combining clinic and practice notes, opportunistic screening is possible. Where necessary we do clinic procedures in surgery time. Since 1982, clinic attendances have more than doubled and uptake of immunisations has increased by 15%. Of the patients registered with our practice 95% are up-to-date with diphtheria, tetanus, and polio immunisation; 93% have been immunised against
practitioners (J. J.) working
measles.33 Accepting that clinical medical officers are generally appointed from outside the general practitioner services, Nicoll and colleagues have made excellent improvements in their clinic. If child health clinics were run by suitably trained general practitioners a more integrated and comprehensive service could be made available. Uptake of health care in deprived areas will only improve when
patients are offered a service that meets their needs. JOHN JAMES CAROL CLARK MICHAEL ROSSDALE
Montpelier Health Centre, Bristol BS6 5PT
PS, Drakeford JP, Milton J, James JA. Nutritional rickets in Rastafarian children. Br Med J 1982; 285: 1242-43. 2. James JA, Clark C, Ward PS Screening Rastafarian children for nutritional rickets. Br Med J 1985; 290: 899-900. 3. James JA, Clark C, Rossdale R. Improving health care delivery in an inner city well baby clinic Paper to be presented at the British Paediatric Association Meeting on April 16, 1986. 1. Ward
SIR,-The article by Dr Nicoll and colleagues, contrary to their assertion, is strong evidence in favour of the primary health care team undertaking developmental surveillance of the preschool
population.
The
their
clinic!
were
improved results since the previous study from achieved by using "the same nursing and medical team to maintain continuity of care". These are the features that pertain in such clinics run by interested general practitioners. The other major change was to see children referred by other agencies rather than attempting to screen the whole population. Not surprisingly this resulted in a striking rise in disorders detected at these non-routine checks, but the question of what abnormalities lay undetected in the unscreened population remains unanswered. They state that: "Of 158 medical consultations for routine checks only 44 detected an abnormality requiring intervention". This abnormality rate of 28% in itselfwould seem to justify the extension of routine checks beyond the age of 18 months. Perhaps the newly developed team spirit could be used to encourage parents to bring their children for these additional checks and thereby detect and treat
their abnormalities
at an
earlier stage.
Upper Gordon Road, Camberley, Surrey GU 15 2HJ 37
CHILD CARE IN THE COMMUNITY
SIR,-Dr Nicoll and his colleagues (March 15, p 606) recognise the need for altered strategies in running a child health clinic in a
deprived area. They have extended the role of their clinic, and improved communications between clinical medical officers, health visitors, and general practitioners. They emphasise the importance of long-term placement of members of the primary health care team. By taking this process a little further we have improved uptake of health care in our child health clinic, in a poor inner-city area of Bristol, St Pauls, with its large coloured population, racial unrest, and high unemployment.
1. Hendrickse WA How effective 575-77
G. D. ROBERTS are our
child health clinics? Br MedJ
1982;
284:
CAN INCREASED SURVEILLANCE PREVENT SUDDEN INFANT DEATHS?
SIR,—Dr Beaven (March 22, p 682) has rightly questioned the value of increased surveillance introduced by some health districts for infants deemed to be at high risk of sudden death (SIDS). The basis of this increase, as he points out, is the so-called "at risk" factors scored at birth, as in the Sheffield study1-factors which