I love my job: Choosing a career in child and adolescent psychiatry

In this blog post Dr Elaine Lockhart, Faculty Chair, and Dr Tze Hui Phang, a higher trainee in Scotland, talk about the rewarding, inspirational experiences they've had working in child and adolescent psychiatry.

Child and Adolescent Mental Health Services (CAMHS) have been in the news a lot recently, with the coverage often painting a despairing picture. The impact of the pandemic on the mental health of children and young people has resulted in unprecedented demand on already-stretched services. Coverage of the crisis in CAMHS is critical to helping us make the case for greater investment, but we must not be ignorant of the effect it can have on staff wellbeing and putting trainees off choosing or continuing a career in psychiatry. While we campaign for more government support for mental health, we also have to offer reassurance to current and future colleagues that a career in psychiatry, and CAMHS, can be a fulfilling and exciting one. As child and adolescent psychiatrists at very different stages in our careers, we can confidently say that we love our jobs and want more brilliant people to join us.

The potential for early intervention and long-term impact is one of the main reasons that many child and adolescent psychiatrists chose their specialty. Recent data has shown a significant increase in the number of children and young people struggling with their mental health, with rates of probable mental disorders having increased from 12.1% in 2017 to 18% in 2022. While those numbers are worrying, we need to remember that most children will bounce back with the right support, making early intervention even more important. Practically, that means closer collaboration across services, including with schools, social care and public health.

Never boring

A day in the life of a child psychiatrist is never boring – imagine changing the world for a 7-year-old child who was previously seen as the naughty kid after managing their ADHD effectively; then working alongside the psychologist to treat a teenager’s depressive disorder and using evidence based medicine to put a stop on psychotic symptoms for a distressed young person – all in a day’s work! You pick up skills on talking to families in a non-judgemental manner, on gathering information from teachers on how the child is doing in school and then liaising with social services on how to support a young person in the community. This is the biopsychosocial model in action, and with the greater integration of health and social care around the corner, a career in psychiatry promises to be even more varied and stimulating.

As a trainee rotating between placements, Fifi is constantly inspired by her colleagues, and their kindness and thoughtfulness in the face of challenging situations. The need to adapt diagnostic approaches to the precise developmental stage of a patient and the opportunity to work closely with parents and carers to understand and meet a child’s particular needs mean that no two days are the same. Working in a children’s hospital for over 20 years has allowed Elaine to use her medical training and expertise in mental health into improving the clinical care of individual children and to support more holistic service developments through teaching, training and service developments. The considerable opportunities for leadership are also exciting. The role of a calm and competent leader is especially important when the system is under pressure, and consultant psychiatrists play a critical role in leading multidisciplinary teams, shaping patient care and developing services that deliver impact.

We are also reassured by the increased funding flowing through the system. When Elaine joined the psychiatric workforce, there was relatively little hope of the long-term underfunding of CAMHS being corrected. We are in a very different position today, with the Five Year Forward View and NHS Long Term Plan in England having marked a massive leap towards parity of esteem. Public and political awareness of children’s mental health has reached unprecedented levels with increased funding and policy commitments across the whole UK. There is of course still a long way to go, particularly considering the dramatic increase in demand in recent years. The forthcoming waiting time standards across CAMHS in England offer enormous scope for progress by introducing a patient-relevant way of measuring demand and performance, enabling us to make the case for investment and policy changes more clearly than ever before.

Shaping the services of tomorrow

Things are also moving in the right direction in other areas. For example, continued scientific advancements are giving us greater insight into treatments and how they work, making psychiatry an exceptionally stimulating field to work in. There are endless high-impact research areas to explore for academically-minded trainees, including the potential of new digital tools. At the same time, we have also seen training and employment options become much more flexible. Less Than Full Time training opportunities and an exciting new run-through pilot for child and adolescent psychiatry mean that many more brilliant and diverse doctors will join the workforce in years to come.

We don’t wish to minimise the challenges being faced across the mental health system – indeed, it is critical that we acknowledge these and campaign for things to get better. Yet workforce shortages are one of the biggest barriers to progress, so it is vital that, while we continue to campaign for more psychiatry training places, we also offer encouragement and reassurance to the young medical students and doctors who will shape the mental health services of tomorrow. With all the changes on the horizon, this is an exciting time to become a psychiatrist. Help transform the life chances of children and young people who need our input. We love our jobs – come and join us.

Dr Elaine Lockhart, Chair of the Faculty of Child and Adolescent Psychiatry, RCPsych

Dr Tze Hui Phang, ST5 in Child and Adolescent Psychiatry, Higher Trainee in West of Scotland