Child Psychiatry is now a well recognized and established sub-specialty in Canada. It has gone through a period of vigorous and healthy growth. Like psychiatry in general it now faces a number of challenges which provide potential threat but which may lead to better definition of priorities and of its most effective function. Other disciplines, medical and non-medical, increasingly compete for a place on the therapeutic spectrum. Within psychiatry the rhetoric between different schools of thought provides ammunition for those who have no use for any form of psychiatry however it may be provided. The challenge is to develop more effective ways of using the skills of the child psychiatrist within a recognition that the number of practitioners will never approach what would be required to have child psychiatry alone cover the treatment needs of children and adolescents. The field requires the adoption of a more flexible metaphor for training and practice with competence in the different schools of theory and of therapy. Attention needs to be paid to the consumer movement, to the impact of better informed parents and public and to the developing of a parsimonious and selective approach to the use of scarce professional time. The healthy growth of research in child psychiatry is a development long overdue and places the discipline on a scientific rather than a clinical practice base. At a time when funding and the cost of health care are crucial issues the development of a secure knowledge base, efficient methods of service delivery and the integration with other mental health care providers are opportunities and grounds for optimism about the future of the sub-specialty.
This essay discusses the position of child psychiatry as a subspecialty in Canada today. Proceeding from a review of a paper written by Dr. Quentin Rae-Grant in 1970 "Adult and Child Psychiatry--One or Two Nations?" the author, using the concept of a nation as a metaphor, explores the evolution of child psychiatry as a subspecialty in Canada. The history of child psychiatry in Canada is reviewed briefly; from its early beginnings to an increased understanding of its uniqueness as a subspecialty, finally through to the formation of the Canadian Academy of Child Psychiatry in 1980. The essay stresses the mutuality of our dependence on the Canadian Psychiatric Association. The author emphasizes our mutual dependence on the greater organizational body of psychiatrists, and encourages a greater participation of child psychiatrists within the Canadian Psychiatric Association. The author also emphasizes the need to have a closer relationship with the Canadian Paediatric Society. In addition, the author discusses in some detail the more complex and controversial relationship between child psychiatry and the Royal College of Physicians and Surgeons of Canada. Finally the author emphasizes the importance of a close working relationship with the American Academy of Child and Adolescent Psychiatry. All of these relationships are emphasized in terms of mutual dependence.
Psychiatrists and other mental health professionals are frequently involved as expert witnesses in court proceedings related to children and adolescents. Their testimony may be based on a therapeutic relationship, but frequently arises because of an assessment conducted specifically for the court process. This two part paper discusses some of the issues that arise when child psychiatrists are involved as expert witnesses in litigation, with specific focus on their role in child custody, sexual abuse and young offender cases. It also offers some practical advice for those who may be called as witnesses. There is controversy in the legal profession about the role of mental health professionals in the court process. While there is recognition of their expertise, there is also a concern about not wanting to have experts usurp the role of the courts. Legal professionals also question the "objectivity" of experts, and the reliability of their opinions. Frequently the opinions of psychiatrists about children and adolescents involved in litigation have inherently speculative and value based dimensions, and not "scientific". Participation in the court process by mental health experts is nevertheless a vitally important role, providing information, analysis and recommendations about what are often very difficult societal decisions. Part two of this paper starts on page 531.