More than four decades after child psychiatry emerged as a specialty in the UK, child and adolescent mental health services (CAMHS) have been under intense scrutiny. In this special issue of The Psychologist we review the problems facing child mental health today and consider what has to change if we are to help more children who need our help.
A lot has happened since child psychiatry began here in the UK. In the early 1960s child psychiatrists from other countries were invited over to share their expertise with us, but UK child psychiatry was soon on its way too. By 1965 there were about 100 UK child psychiatrists: now there are over 700 working in CAMHS (Fig 1 ). We set up training programmes and specialist centres and even had our own journal (The Journal of Child Psychology and Psychiatry ).
At child psychiatry’s birth, child mental health problems were considered what does child psychiatry do rare. We now know that at least 10% of children and young people suffer from a diagnosable disorder (Fig 2 ). Also, mental health problems can be chronic: over three-quarters continue into adulthood with the most common conditions being anxiety disorders.
Other child psychiatrists have become influential figures in child mental health service development elsewhere in the world. The UK has played an important role too, but our contribution may not be as positive as it could have been because child psychiatry here has never had the influence it deserves on how services are developed – primarily because child psychiatrists are relatively few in number compared with those involved with mental disorders. Mental HealthTrusts provide child and adolescent mental health services (CAMHS) but child psychiatrists are not the only professionals involved.
The child psychiatry workforce is ageing. The average age of child psychiatrists in training is now 43 years, with few youngsters opting to train as child psychiatrists. Why has child psychiatry lost its appeal? Mainstream child psychiatry focuses on assessment and treatment that can take up to 20 hours per patient, requiring many appointments over three to six months before disorder(s) are diagnosed accurately and appropriate treatment planned. Treatment often involves medication, yet UK policy dictates that CAMHS should put much greater emphasis on psychological approaches because they are less invasive, more acceptable to children and young people, parents and carers – plus there is evidence that they are effective.
The child psychiatrist’s expertise is in diagnosing and treating mental health disorders, but psychological approaches need to be delivered by psychologists and therapists with specialist training. There are now over 3,000 child and adolescent psychologists in the UK, but CAMHS often struggle to find enough staff with the appropriate skills and experience to meet the demand for psychological therapies.
One reason for this shortfall is that child and adolescent psychology has never been given the same level of statutory recognition as child psychiatry. This means that child psychologists do not have the same level of protection as child psychiatrists if they work in CAMHS. It also means that child psychologist posts are much more likely to be cut during times of austerity.