A career in child and adolescent psychiatryBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4983 (Published 19 September 2016) Cite this as: BMJ 2016;354:i4983
- Thomas Burden, specialist trainee year 6 in child and adolescent psychiatry
Child and adolescent psychiatry offers a fascinating and rewarding career with good future prospects, says Thomas Burden
What is child and adolescent psychiatry?
Child and adolescent psychiatry involves the assessment and treatment of mental health disorders in children and young people up to the age of 18. It has a strong and developing academic base and there is an increasing awareness of the importance of early detection and treatment of mental health disorders in this age group. Many adult mental health disorders originate during childhood1 and emotional and behavioural problems in childhood are linked with difficulties throughout adult life.2
Child and adolescent psychiatrists manage a wide range of emotional, behavioural, and psychiatric disorders, including mood disorders, anxiety, neurodevelopmental disorders (such as attention deficit hyperactivity disorder and autism spectrum disorders), behavioural problems, and eating disorders.
Therapeutic interventions used are wide ranging and include individual and group psychological therapies, family therapy, and drugs. Providing liaison and consultation to other professionals is an important aspect of the work.
Most child and adolescent psychiatrists work in a specialist outpatient multidisciplinary team alongside nursing staff, clinical psychologists, occupational therapists, and other professionals.
Who would be suited to this specialty?
Child and adolescent psychiatry would be a good career choice for people who enjoy working with children and families but who do not want to work in the hospital orientated setting of paediatrics.
Important attributes include an ability to engage and communicate clearly with children and their families, an aptitude for team working, leadership and management skills, and the ability to manage complex presentations and risk. Having an interest in psychological therapies and child development is also essential.
The training pathway
Applicants for higher training in child and adolescent psychiatry must complete core psychiatry training beforehand. This is a three year training programme that is usually undertaken after the foundation programme. Many core psychiatry training schemes offer a six month placement in child and adolescent psychiatry. During core training, you must pass the Royal College of Psychiatrists membership examinations (two written papers and a clinical examination).
Entry into higher training in child and adolescent psychiatry is through national recruitment coordinated by Health Education North West. All eligible candidates are invited to interview.
The interview consists of three 15 minute stations: portfolio review; audit and leadership; and a clinical scenario with a simulated patient.3 You must bring your portfolio which should include your CV, career history, assessments, clinical audit, presentations, publications, and teaching. The interviewers will be looking to see that you meet the essential and desirable components of the person specification.4
You should demonstrate enthusiasm and commitment to the specialty. If you have limited experience of child and adolescent psychiatry, it may be helpful to demonstrate your interest using examples from other posts where you have been involved in the care of children with mental health difficulties, such as treating young people who have self harmed.
In 2016 there were 70 applicants for 68 posts, while in 2015 there were 61 applicants for 63 posts.5 Higher training is for three years, with a range of placements that usually last 12 months. The first post is usually with a community team to give a broad range of clinical experience. Most schemes include at least six months attached to an inpatient unit. Two sessions weekly are allocated to research or special interest in addition to a regular academic programme.6
It is very rewarding to help young people and their families through emotional distress and difficult times in their lives, and seeing them recover. Day-to-day work in the specialty is interesting and varied. Clinic schedules usually allow a good length of time with each patient.
There is a relatively good work/life balance. Clinical work is mostly Monday to Friday from 9am to 5pm with a non-resident on-call out-of-hours. Being on-call is typically less onerous than other acute medical specialties, often consisting of telephone advice. Less-than-full-time and flexible working is common and well supported.
There has been more pressure on child and adolescent mental health services in recent years, with an increase in the number of referrals and public demand. However, this is certainly not unique to child and adolescent psychiatry, with similar difficulties occurring across many other specialties and areas of the NHS. The increased awareness of the importance of child and adolescent mental health has also led to some increases in funding and the development of new services.
It can be challenging working with young people with high levels of emotional distress, adverse social circumstances, or risky behaviours. Good levels of supervision and team support help to address these challenges.
I have read and understood the BMJ policy on declaration of interests and declare that I have no competing interests