In the article by Appleton et al 2022  data from over a thousand young people was analysed to give four themes to help GPs in their thinking about supporting young people with mental health consultations for depression. These themes were:

1. Trusting relationship

2. Clinician to show empathy and take concerns seriously

3. Young person is given time to talk

4. Barriers still remain for young people in accessing mental health support and care

During the COVID-19 pandemic many consultations moved to an online format and some research featuring large numbers of patients suggested that consultations for certain conditions like depression could remain on line. Hagi et al (2023) published in the British Journal of Psychiatry a paper showing that consultations for depression online showed therapeutic improvement form the point of view of improvements on rating scales measures. However the authors also considered that for conditions such as eating disorders the data would lean more towards having face to face consultations.

Both of these papers have been conducted in richer first world settings with English language as the main language.  

One of the key aspects of care for young people with depression is the development of trust. In the beginning a young person needs to have an opportunity to meet someone who can hold their hopes for a better future. They need to feel that a good change will come after meeting the clinician. The development of a shared understanding of the extent of depression and risks of suicide and neglect, harm to others and exploitation and abuse, can help a young person move forward. Young people need to know that they can have a confidential conversation with a clinician and that there are boundaries in confidentiality.  If the clinician feel that a young person's life is at imminent risk from suicide, risk of harm to others and at risk of sexual abuse or other harm then the clinician must explain to the young person that they have to break confidentiality. In doing so the clinician must be clear about the plan to create safety with the young person. This will involve discussion with parents and other senior clinicians in order to come up with a plan. If the clinician understands from the young person that this cannot be done then further plans needs to made in consultation with other colleagues and social services. In the meeting this extension of the discussion to involve other people can be very stressful for a young person. Therefore as the meeting continues the clinician will need to be clear with the young person and communicated in such a way as to retain trust with the young person, although confidentiality is being broken.... or actually shared within a trusted professional network.

Already we can see how a face to face meeting will support child protection and safeguarding  more effectively than a remote consultation in which issues are not brought forward easily from behind the screen.  In the remote consultation the transaction of mental health consultation could be minimised to solvable problems that can be measured. However in the face to face meeting we can explore more deeply, look at intangible problems and have a better chance of revealing dilemmas, the heart of the matter, what a young person really want to talk about and have a better chance of revealing risk and danger to a young person which will lead us to more effective child protection and safeguarding practice.