Child and adolescent psychiatrists need to be experienced in working in multi-professional teams. Their training must capture this essential feature. Our training should allow us to achieve the prerequisites for leadership and management of large and multidisciplinary teams who focus on children and adolescents with complex mental health problems. The development throughout training of curiosity and the willingness to learn from others’ perspectives, as well the ability to share knowledge and skills are crucial in building fruitful co-operations.
Taking roles in a stepped care system
At the level of national mental health care programs the delineation of increasingly sophisticated and cost effective tier levels of mental health care is ongoing. We need to train child and adolescent psychiatrists to understand their roles in such a stepped care system. These competencies need to be carefully thought through and incorporated into training programs. Relevant issues include (i) the role of child and adolescent psychiatrists in direct clinical and secondary consultation to other professionals in a stepped care system, (ii) clinical leadership in some specialist services, (iii) balancing patient-centered care with population-based care including the sharing of resources, (iv) training and mentorship to improve the capacity of other professionals, and (v) health care system management skills. Each of these roles needs further specification of the competencies, for instance to decide what should be included in training of consultation skills (e.g., written and summary skills for other professionals), the capacity to review treatments, training and overseeing others and leadership in clinical systems. We need to enable future child and adolescent psychiatrists to reach out to government and other professionals/institutions in the field to improve the overall management of youths with mental disorders; to be capable advocates for policy and to learn the skills of collaborative approaches with experts by experience (often ex-patients), parents and carers as well as with other professionals. We need to more systematically provide child and adolescent psychiatrist with the relevant skills including public health analysis and advocacy and developing patient friendly care systems. Many child and adolescent psychiatrists will not be involved in this type of work on a daily basis but many find themselves in this situation from time to time in their careers.
Prevention and early intervention
Societal factors such as poverty, poor living conditions, abuse and many other factors increase the prevalence of mental health disorders. They have a marked effect on the economies of our countries, let alone the distress and impairment caused. Much is said about prevention and early intervention; while evidence exists for particular intervention, good examples of successful broad upscaling of programs are limited. Child and adolescent psychiatrists need to understand the differences between mental health promotion, prevention and various levels of early intervention. All child and adolescent psychiatrists should receive some training to support health promotion, prevention, resilience and early intervention in their communities.
Assure transition to adult psychiatry
Transitioning to adult psychiatry services represents a critical time for young people with mental health disorders. Continuity of psychopathology does not match the current structures of mental health care systems; the gap between adolescent and adult services is a major barrier that does not serve our patients well. Transitioning is particularly needed for neurodevelopmental disorders and early onset psychoses but also for the large proportion of adult mental health disorders that commence in adolescence. The introduction of a shared mandatory transition training for CAPs and adult psychiatry trainees that follows a developmental approach would greatly assist. Further, identification of the optimal amount of child and adolescent training in adult psychiatry and vice versa should be urgently considered, as well as a harmonization of curricula, which in Europe appear to be very heterogeneous [5, 15, 16].
Teaching and learning skills
Educating and sharing our knowledge is important for our young patients and their parents as well as with other adults who contribute to their welfare including teachers, nurses and our other medical colleagues. Further integration of psychiatric, psychosomatic and psychological contents into medical training is urgently warranted to support a holistic bio-psycho-social approach early in the career of every physician. Such efforts will boost the collaboration between medical specialists and ensure that every specialist has a solid knowledge of mental functioning and mental disorders and how to address these in his/her interaction with patients. Physicians need to be trained to decide when the input of a child and adolescent psychiatrist is required to avoid delays in assessment and treatment of an underlying or contributing mental disorder.
Through promotion of the bio-psycho-social approach within our medical schools we generate interest, understanding and enthusiasm among medical students for our field. The future of child and adolescent psychiatry critically depends on a sufficiently high influx of capable physicians with the desire to train and continuously shape our field. We need to ensure child and adolescent psychiatry is a highly rewarding and attractive field and expose medical students and junior doctors to our exciting profession. Interest for our field will benefit from the substantial advances in the neurosciences which remind us that symptoms of the mind, like other medical symptoms, originate from an organ (i.e., the brain). These advances in neuroscience deserve credit for placing the brain central in recent developments in child and adolescent psychiatry. They require CAPs to have sufficient neuroscience training to understand advances in the field and the teaching skills to interpret these findings for others who live and work with our patients.
Training to manage twenty-first century risks and vulnerabilities
Current global challenges may impact the mental health of children and young people. Prominent examples include migration, wars, and terrorist attacks which all have obvious implications for the mental health of children. Fridays for Future has developed as a youth based movement; the fears related to climate change but also the slow progress with respect to environmental changes to reduce carbon dioxide emissions is already beginning taking its toll on vulnerable adolescents. It seems likely that climate change and its impacts will affect tomorrow’s mental disorders and require child and adolescent psychiatrists to respond to an evolving challenge. There are other risks and opportunities in the ever changing social media. Gender dysphoria is becoming more prominent. In summary, we need to prepare trainees in our field for these challenges, to come up with innovative strategies to help young people who develop serious disorders associated with these challenges.
Recent European history has revealed that migration is a world-wide issue that does not stop at our borders. It is hard to envisage that migration will NOT continue over the next decades. It has become evident that it is by no means easy to provide effective treatment due to for instance language or cultural barriers. We need to train child and adolescent psychiatrists to provide culturally sensitive mental health care to immigrant and refugee children and their families, who often face or have survived the additional stressors of exposure to the traumas of war, torture, persecution, or natural disasters, the process of immigration, and changes in family structure and dynamics forced by these events. Unaccompanied minors are a particularly vulnerable group of refugees in need of special protection and support. Contextual understanding of psychosocial, cultural challenges they face are relevant to clinical issues and psychopathology they might exhibit. Teaching our trainees to be sensitive, to and have the skills to address these are imperative in working with them directly or in providing consultation to a system of care for them. Trainees need to learn the skills of mental health in the context of culturally-regulated child-rearing practices, expected roles, patterns of communication, acceptable behavior, and coping mechanisms, when interpreting the meanings of behavior in order to avoid misdiagnosis and misguidance. This is a challenge to us all to learn these skills to an effective level.