Tackling child psychiatrist decline

NHS workforce figures show that at the end of July 2016, there were a total of 955 staff listed as working in the field of child and adolescent psychiatry - this is the lowest number since data collection began in September 2009.

The figure represents a fall of 2.4 per cent on the March 2015 figure of 978 staff - the month in which the government pledged a "complete overhaul" for children and young people's mental health services to address poor access and support.

It is a real concern that, at a time when there is much rhetoric coming from the government about improving services for young people with mental health difficulties, child psychiatrist levels have dropped so low.

There are similar concerns when looking at the training figures. In 2015, NHS trusts were unable to fill a third of their trainee posts in the first attempt. This problem was particularly bad for those who want to recruit a trainee into child and adolescent mental health services (CAMHS), with around half of vacancies unfilled.

A report by the General Medical Council shows that the figures are getting worse, with psychiatry seeing a drop of 10 per cent in the number of doctors in training between 2012 and 2015.

The new junior doctor contract does pay a premium for those choosing to train in harder to recruit to specialties such as psychiatry, so this may have a beneficial effect, although one would hope that it would be more than the lure of some extra money that would attract trainees into the specialty.

Job satisfaction

Research by the Education Policy Institute found that 83 per cent of trusts that responded said they had experienced CAMHS recruitment difficulties and the same proportion had needed to advertise posts on multiple occasions to fill them.

When a job is rewarding and satisfying, retention improves. But when services are being stretched to breaking point and CAMHS staff feel unable to meet the overwhelming need, then recruitment and retention will suffer and we are seeing the results of this in these figures.

In my opinion, child and adolescent psychiatry is the most interesting and rewarding sub-specialty of psychiatry. You get the chance to work with both children and their families to really make a difference in young people's lives. If you can intervene early and effectively, a clinician can help prevent a cycle of further problems through the generations.

Children and young people have their whole lives ahead of them and I have always felt that this is one of the most appealing aspects of working with them - if you can make a difference, it can have far-reaching impacts. The problems are less entrenched and there is often more hope of positive therapeutic change.

It is a problem that many medical students do not actually meet consultant child and adolescent psychiatrists during their studies and in recent years, many medical curricula seem to have cut time devoted to this crucial area.

Encouraging students

Medical students are influenced by consultants who they meet during their studies.

Consultants feel less positive about their jobs due to the enormous demands and pressures, but when students do meet us, it is important we are able to communicate the joys and rewards of the specialty.  

Investing in good educational opportunities for medical students is crucial.

Similarly, there need to be more posts in child and adolescent psychiatry during the foundation years.

At Great Ormond Street Hospital, we regularly accommodate foundation years doctors having a "taster" week in this specialty and they may potentially develop a life-long interest as a result of such an experience.

We have also run initiatives such as recruitment days where students and junior doctors with an interest in the field can attend a variety of lectures by clinicians in the field to hopefully stimulate their interest further.
I think local initiatives that link in with local schools and universities would have the best chance of success, whereas national initiatives sometimes have less direct benefits.

Child and adolescent psychiatrists are often clinical leaders in CAMHS teams and they have the benefit of a broad training encompassing neuroscience, psychopharma­cology and a range of psychological/therapeutic modalities.

We need dynamic and effective leaders in CAMHS to address and meet the many challenges we face today and for the benefit of young people with mental health difficulties across the UK.

Further information on the specialty can be found on the Royal College of Psychiatrists website at www.rcpsych.ac.uk