As adolescent forensic services continue to develop, their success will in part depend on the expertise of consultant psychiatrists who have the necessary training to work in this specialist area of psychiatry.
As of 2007, only 17 members of the College were registered as having dual CCT qualifications in child and adolescent psychiatry and forensic psychiatry. There is, therefore, an ongoing need to dual train psychiatrists in order to meet service demand, albeit at relatively small numbers.
The SIG are keen to hear from any trainee interested in training in adolescent forensic psychiatry – please feel free to contact us
Despite this service need and the desire from some trainees to dual train in child and adolescent and forensic psychiatry, training opportunities have become extremely limited over the past 2 years. There are a number of reasons for this, the greatest being the introduction of Modernising Medical Careers (MMC).
Although there continues to be the scope to provide dual training under the MMC framework, it is unclear how this will be facilitated. Access to dual training will continue to be at the deanery level but it seems likely that it will be increasingly linked to service provision. The lead-time of 5 years for higher dual training means that trusts and deaneries will require long-term vision.
Alongside these changes, the College is continuing to consider how best to accommodate the increasing specialisation within psychiatry training. Options include increasing the number specific curricula (either via more CCTs or more sub-speciality endorsements) and it is possible that adolescent forensic psychiatry may become an individual speciality in the future.
The move to competency-based training may facilitate this development, as it is likely to become easier for doctors to demonstrate achieved competencies across psychiatric specialties.
It is at present unclear to what extent dual training opportunities will exist within the new structure of MMC. Indeed, it appears that there are very few specific dual training schemes being offered at ST4 level at present, and none to my knowledge in child & adolescent and forensic psychiatry.
It has been suggested that training in a second psychiatric specialty may occur after the first CCT has been achieved and I am aware of one trainee with a CCT in child and adolescent psychiatry who has been appointed on a forensic psychiatry training scheme at ST4 level.
It is unclear at present whether this will be the solution to the lack of specific dual training schemes, and raises a number of issues, most crucially surrounding the funding of additional post-CCT training. Deaneries would have fulfilled their responsibility to provide training to CCT and may be reluctant to fund training beyond this.
An alternative solution is that special interest sessions could be used to obtain competencies in a specialty other than that in which the trainee will obtain their CCT. This would require careful planning and cooperation between trusts and training programme directors and it is unlikely to be a sufficient alternative to full dual training.
It is clear that the combination of child & adolescent and forensic psychiatry remains crucial to the provision of adolescent forensic services and appropriate training must therefore exist to ensure that there are specialists in this area.
However, traditional dual training appears to be under threat and adaptations need to be made to the new structure of postgraduate training to allow trainees to develop the necessary competencies across specialties.
The rhetoric surrounding MMC promised greater flexibility of training and it is of paramount importance that this is developed in order for trainees to achieve the broad and diverse range of competencies that are required by these developing services. This will allow us to meet the needs of our patients and deliver the best possible care.
For more information please see the following article published in the Psychiatric Bulletin:
Oakley C, White OG & Bailey S (2009). Dual Training in Psychiatry: Which way now? Psychiatric Bulletin 33: 231-234
The Taboo Diagnosis: Personality Disorder in Adolescence - Forensic Perspectives
Monday 03 February - RCPsych, 21 Prescot Street, London
Save the date- booking opens shortly
AFPSIG Event: AFPSIG Day Conference: A Stolen Childhood: Gangs and Grooming
Monday 19th November – RCPsych, 21 Prescot Street, London
Attendees heard from consultant psychiatrists and A&E physicians working to reduce harm caused to and by gang members, young people who have been involved in gangs and Anne Coffey, MP, chair of the All Party Parliamentary Group for Runaway and Missing Children and Adults who completed an independent survey on County Lines.
Please see the full timetable (doc) for what was covered.
The AFPSIG also holds its own conferences, and also meets regularly at each of the following: