What do you think, is there a gap in this process and which model of training is better? Should there be distinct, separated specializations in C&A psychiatry and Adult psychiatry, or same training and then subspecialization, or something else? It is obvious that we lose some of the patients during transition process and then, after while we get same numbers but different diagnoses.
I think that separate and distinct training in child psyciatry is essential, as child psychiatry is consierably different from adult psychiatry. Child psychiatry emphasizes family and development, factors which are often missing in adult psychiatry training. As you are aware, in the USA, the child psychiatrist has to have adult psychiatry training as well. However, the question which you ask is also a service question. Some child psychiatrists will continue to see their former child psychiatry patients when they are also in their adult years, and not transfer them to an adult psychiatrist. In this respect, the child psychiatrist functions similarly to a family doctor.Seeing former child patients when they are adults, if necessary, also gives the child psychiatrist a perspective on outcome and change over time.
This is a good question. It is true there is a gap. I support the idea of having training in both areas. The adult psychiatrists should have sufficient knowledge of child and adolescent psychiatry and the child psychiatrists should first do adult psychiatry as a requirement. Sub/super specialisation is good for expertise after acquiring basic knowledge.
Of course it is service question. But development does not know administrative or age boundaries. Majority of mayor adult psychiatric diseases start in transition period (or at least their prodromes). Theese couls be the source of considerable obstacles. The services and transition are so different from country to country, even in same country. E.G. in Croatia our Public insurance and health low suport outpatient C&A care till age 21, but if they need hospital treatment only to age 18. We are not strictly forbiden to treat patients after age 21 on individual level, but if we have to many of them we will have serious administrative warnings. I am talking about public health system. So we still have gap problems and lose considerable patients (TRACK study in UK an its replication in Ireland). Personaly I do not know how to resolve this. So I put this question as some probe to see other opinions and start some brain storming.
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