Child and Adolescent Psychiatry: The Next 10 Years
By Thomas F. Anders, MD |
May 1, 2008
Dr Anders is distinguished professor of psychiatry and behavioral sciences, M.I.N.D. Institute, University of California, Davis, and immediate past president, American Academy of Child & Adolescent Psychiatry. He reports that he has no conflicts of interest concerning the subject matter of this article.
To summarize, about 300 residents currently enter child and adolescent psychiatry training each year. These numbers are likely to increase to about 400 over the next decade. The increase will result from earlier exposure of medical students to the field and a broader set of training pathways that will satisfy their interests. There will also be a much larger group of interdisciplinary practitioners providing primary mental health care for children and their families, including prevention and early intervention. There will be more formal collaborative networks, supported by interactive electronic communication, that use the scarce child and adolescent psychiatrist as both a consultant and an educator.
As the workforce becomes more interdisciplinary and collaborative, involving peers and consumers, mental health and health services will be truly integrated in local communities. Community systems will become more prominent, providing a continuum of care in the least restrictive environment. More home-based services, integrated classrooms, and wrap-around programs will keep children with mental and developmental disorders in the mainstream. Parent support groups and peer counseling programs will grow. The silos of professional isolationism and noncommunicating/collaborating agencies, buttressed by misinterpretations of the Health Insurance Portability and Accountability Act, will break down as families assume an ever more active role in partnering with professionals and participating on community boards.
I anticipate that child and adolescent psychiatrists will become more skilled in integrative, consultative, and collaborative roles. They will become better adult learners and educators, and they will become more engaged in prevention and early intervention, as well as better trained for leadership and building teams and for managing systems of care characterized by shared governance.
In short, access will be significantly facilitated by teamwork using child and adolescent psychiatrists in new roles. Electronic, Web-based, and interactive information transfer, including telepsychiatry consultation between well-resourced sites and more remote sites, will expand. Further, I envision that the AACAP, through public education campaigns focused on risk and resiliency, developmental milestones, prevention, and early intervention, will organize prospective parents who will become advocates of healthy emotional and psychological development. Starting in pregnancy, parents will receive information from the AACAP through each stage of their child's social and emotional development. Timely educational materials about typical cognitive, social, and emotional milestones, combined with information about early warning signs of disturbance, will be distributed to parents at specific points pertinent to their child's development—times when they are most receptive to learning and growth.11 An ongoing relationship with a group of families, built over time but starting in the prenatal period, that emphasizes prevention and early intervention will reduce stigma, foster positive therapeutic alliances with the field of child and adolescent psychiatry, and ultimately lessen the demand for higher-level specialty services later. Finally, I predict that the AACAP will develop Web-based iterative and interactive services that will guide both parents and professionals to better evidence-based information.
Stigma regarding mental disorders, especially in children, has been an effective barrier to receiving treatment. On one hand, parents are reluctant to bring children for care; on the other, insurance companies have "carved out" mental health benefits inequitably and have prescribed how different mental health professions should practice. Stigma also exists in school systems, where children in need may be overlooked or labeled inappropriately, and it remains among our medical colleagues who counsel bright medical students interested in psychiatry to choose a more "rigorous" specialty. But over the past several years, a reduction in stigma at all levels has occurred. Our research advances have provided more and better treatments. Parent advocacy groups have become more strident and politically active. Over the next decade, alliances between parent groups and professional organizations will become stronger. Joint lobbying efforts and public awareness campaigns at the federal, state, and local levels will become ever more popular.
The AACAP executive team has formed a national summit of partners that includes executive leadership teams from the National Alliance on Mental Illness, Children and Adults with Attention Deficit/Hyperactivity Disorder, the Autism Society of America, the National Mental Health Association, the Federation of Families for Children's Mental Health, and the Child and Adolescent Bipolar Foundation. The group meets twice yearly to work on issues of mutual interest, with discussions often focused on access and stigma, and jointly visits Capitol Hill on an annual basis. The APA has developed a comparable program of collaborative lobbying. The Paul Wellstone Mental Health and Addiction Equity Act is likely to become law and will certainly contribute to the reduction of stigma. In the next 10 years, these national partnerships will spread to regional levels, with local parent groups partnering with local child psychiatry and pediatric professional groups. I also expect that universal health care with mental health parity will come to pass. The stigma of mental illness and substance abuse will largely vanish.