Organization of Services

Pediatric psychiatric consultation in Australia is provided by multidisciplinary teams within children's hospitals under the leadership of a child and adolescent psychiatrist. The multidisciplinary teams, often referred to as consultation-liaison teams, are situated within departments of psychological medicine and consist of medical practitioners, including the consulting psychiatrist, psychiatry registrar (psychiatrist in training), and, increasingly, a pediatrics registrar (pediatrician in training). In addition, teams may include clinical psychologists, social workers, specialist psychiatric nurses, and transcultural mental health workers.

Although the prevalence of mental disorders among children and adolescents in Australia is around 14%, only 25% of those with clinical problems access any mental health service, including consultation with pediatricians (Sawyer et al. 2001). In fact, pediatricians see 11% of children with a mental health disorder, making them an important part of the assessment, treatment, and referral process for such children.

Consultation-liaison services in pediatric hospitals generally provide a range of services, including consultation on clinical issues and liaison with medical teams through attendance at medical team meetings. For disorders with a strong comorbidity between physical and mental health, such as eating disorders, specialized medical-psychiatric units operate in the hospital. Psychiatrists may also directly admit patients to medical wards for investigation or management, for example, to rule out diagnoses of conversion or factitious disorder. In addition, the consultation-liaison team often provides outpatient services, which may include services provided to hospital patients, services for those in the local community, tertiary-level consultation for patients outside of the hospital catchment area, or specialized clinics for children with specific mental health disorders, especially those with physical health implications or comorbidity.

All children's hospitals in Australia have direct links with specific universities, often offering conjoint clinical academic positions to university staff who have responsibilities for teaching, research, and clinical care. In addition, clinical academic appointments are common wherein hospital-employed clinicians are recognized by the university with an academic title and are expected to contribute to university teaching and supervision. University treatment clinics are often located within the hospital.

Mental health services within hospitals are dependent on local conditions in each hospital. In practice, trust has been built up over many years as a result of active attempts on the part of departments of psychological medicine to provide a useful service to hospital patients. This is often individualized and depends on local professional relation ships. Services are coordinated on a local basis in each hospital. Larger departments may have individual consultation-liaison teams that provide services to particular medical and surgical teams to facilitate referral and professional relationships.

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