My jokey title, like most jokes, incorporates a serious truth. The truth is that, despite the apparent clinical expansion and academic wellbeing of our subject, the experience of being in a senior position within it is that it is under threat as a medical enterprise. The sense of threat is felt mostly from the stagnation of the retrenchment in the physical and human resources needed to mount a real service, although I grant that consultant numbers have increased. Management will opt for the least costly alternative when they are presented with a broad range of advice of apparently equivalent worth which is available from various professionals within the subject. Indeed, given the degrees of diversity of views that exist, managers might at times wonder what it is that purports to be the subject. It is not difficult for child psychiatry to achieve a negative image within health management since a number of negative stereotypes naturally accrete around people with serious problems of living and coping, or developmental failure, mental impairment, or chronic sickness. Combined with small size, often a single representative in a District, and dealing with small people who suffer lack of political clout, the management case for neglect of child psychiatry when faced by harsh choices may be overwhelming. Further, child psychiatry arose from a triune of social work, psychology and psychiatry and their quite proper individual professionalisation has afforded the possibility of splitting, not only as among psychiatrists but between psychiatrists and other professionals. In the current political climate and faced with resource shortages those splits are likely to accentuate in ways which leave managers rather than practitioners in control.
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