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