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The Royal College of Psychiatrists Improving the lives of people with mental illness

Child and adolescent psychiatry

Background to child and adolescent psychiatry

Child and adolescent psychiatrists specialise in working with children and young people (usually up to the age of 18 years) who have mental health problems. They work as part of a multidisciplinary service that may include other child mental health professionals such as child psychologists, nurses, occupational therapists and others. It also involves liaison with other agencies such as schools and social services. Most of the work that they do with children, young people and their families is done in out-patient clinics, but there are opportunities to work in a variety of settings. Inpatient services are limited but are available for those young people in crisis or with serious mental health problems. Increasingly there is more and more specialisation in areas such as eating disorders, working with young offenders, and children who are looked after.

Child and adolescent psychiatrists deal with a wide range of mental health problems, including emotional and psychiatric problems. A large part of a child psychiatrist's work is to identify the problem for the young people and advise about what may help. Child psychiatry highlights developmental aspects given the age range it deals with. It also requires an ability to understand issues from a range of perspectives as it usually involves working with the child/young person’s carers as well as the child or young person.

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Personal perspective

The great thing about studying medicine is the breadth and diversity it covers. One minute you are in an operating theatre holding open a woman’s abdomen, the next you are peering down a microscope at tissue samples, feeling an elderly gentleman’s prostate or trying to make a sick child laugh. As a final year medical student, one of the hardest decisions to make is which of these things you’d like to be doing for the rest of your life, particularly if, like me, you enjoyed several disciplines undertaken at medical school.

 

Although I enjoyed the buzz and adrenalin of doing cardiology and the satisfaction of putting broken bones back together in my stint in orthopaedic surgery as a pre-registration house officer (foundation year equivalent), the thought of whether this was what I would like to do “forever” weighed heavy on my mind. In particular, the anti-social hours were tolerable in my early twenties, but would that still be the case in my forties? It is difficult at age 23 years to consider ever having children, a family, a dog, less energy, ageing parents, but I realised early on that these would be things that were likely to become reality 10 years later. I therefore made my career decisions around this and chose psychiatry, in particular child psychiatry.

 

Exposure to child psychiatry as a medical student is limited. However, child psychiatry is a fascinating specialty which is undersubscribed in comparison to paediatrics, with which it has a large cross-over. In some jobs there is little distinction between the work of community paediatricians and child psychiatrists (e.g. diagnosing and treating autism and attention deficit hyperactivity disorder), yet the numbers of UK graduates entering paediatrics versus psychiatry are markedly different. Child psychiatry naturally also has a large cross-over with adult psychiatry (e.g. psychosis, eating disorders, depression, obsessive compulsive disorder), but seeing children rather than adults has several advantages, mainly that identifying disorders early means that you have a better chance at successful treatment and, in some cases, cure. It is difficult to overstate the impact of mental health problems in childhood as it has an enormous impact on child development and the future outcome of affected children. The stress and impact on families is also immense. By treating and curing children with mental health problems, not only can pain be quelled, but whole life trajectories can be altered. In a similar way that surgeons or hospital paediatricians may get satisfaction from thank you cards from grateful parents saying “You saved our child’s life”, I gain immense satisfaction from receiving cards saying “You’ve changed our daughter’s life”, and hearing about patients that have overcome their mental health problems to go on to read medicine at University.

 

It has to be recognised that the working hours in psychiatry and child psychiatry are less anti-social and less intensive than in some other medical disciplines. This allows pursuit of other career advancing and rewarding activities, such as teaching and research, and it is possible for able graduates to reach clinical lecturer status before age 30 years, which is very unlikely in other disciplines. Psychiatry, and in particular child psychiatry, may be viewed by the ill-informed as “fluffy” and “woolly”. However, the UK boasts one of the top three academic institutions worldwide in academic psychiatry. The same cannot be said of other medical disciplines which are usually trounced by well-funded American institutions. The Institute of Psychiatry is a world leader in research involving neuro-imaging and qualitative and quantitative genetics, subjects that are not synonymous with “fluffy” and “woolly”. Unlike other medical and surgical disciplines, where much is already known, psychiatry is a comparatively fledgling science, with a large cross-over with neurology, making it a dynamic and fascinating field of research to be involved in. It is a tragedy that the majority of lecturer posts at The Institute of Psychiatry Department of Child Psychiatry are held by non-UK graduates.  

 

In addition to active engagement in research, the sociable working hours allows time for life and family life. I am now mother of one and mother-to-be of two and am continuing to work full-time in both clinical and research work. The people in child psychiatry view children as valuable and are aware of the importance of mothers in the development of children. This means that my consultants and professors have been invariably supportive of my family life and I have not been required to work on-call during pregnancy. The same cannot be said for my colleagues in medical and surgical disciplines who have had to do weeks of nights and extended days throughout pregnancy. It might be difficult to imagine this as a problem, but ask anyone who has been pregnant and they will tell you that it is very unpleasant. Problems continue on return to work, and I have friends in medical and surgical disciplines who have had to continue the anti-social hours following maternity leave, meaning that sometimes they do not see their seven month old babies for weeks on end, save for a few minutes each morning. Aside from the emotional aspect of this, the childcare costs are also immense. Some of these colleagues are seriously considering changing career to general practice to regain their work-life balance, which seems a waste of all the years of specialist training and examinations. This same work-life balance, as well as an interesting, rewarding and stimulating career, can be well-afforded by a career in child psychiatry.

 

Holan Liang

Specialist registrar and honorary clinical lecturer   

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Personal perspective

I have always been interested in people and their minds so it was inevitable to me that I would become a psychiatrist. I have, however, been surprised to find myself a child and adolescent psychiatrist because I have never been one of those people who coos over babies or ‘LOVES’ children. Nevertheless, my choice makes sense to me when I reflect upon it.

Although it may appear a narrow specialty, psychiatry is, in my view, one of the broadest specialties in modern medicine, because we have to treat the whole person, not just their brains; we have to think about them as biological entities but also ones with minds, feelings, values and relationships, who live in a wider society. Child and adolescent psychiatry takes things further because, in working with children and young people, we rarely treat an individual patient, treating instead the whole family unit which needs help and support, often including wider systems such as schools.

Children and adolescents are a joy to treat as they tell things as they are, without fear or favour; and when they and their families are given the right help, support and understanding, things often come right and suffering can be alleviated in a rapid and very gratifying way.

Jacinta Tan

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Page updated on 8 December 2010

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