The geographical distribution of psychiatrists in Canada: unmet needs and remedial strategies.

Many efforts are underway to rationalize the process of manpower planning in psychiatry. A wide variation in the geographic distribution of psychiatrists remains. A multidimensional assessment of the needs of a population is recommended, based on the epidemiology of mental disorders, professional and institutional needs, consumer estimates, and the requirements of subgroups. Counting the number of vacant positions for psychiatrists can be misleading. Professional norms for the optimal access of a population to psychiatric services and standards for the quantity and/or quality of services provided need to be developed. Potential outcome measures are suggested, along with a three-tiered system of estimating geographic needs. Deterrent factors to an optimal geographic distribution of most professionals are reviewed, along with factors specific to our residency training programs. In the short term, the benefits and limitations of recruiting foreign-trained psychiatrists are compared with those of recruiting Canadian specialists. Complementary long term strategies include the provision of financial incentives, optimal working conditions, relevant training and maintenance of competence issues, and community support.

The inability to name a child.

A patient, whose presenting complaint is the inability to decide on a name for her child, is presented. A review of the literature on the significance of names is included, and comments are made on panelists from psychoanalytic and phenomenological perspectives. Management of the patient's depression is discussed.

Moderating the morbidity of divorce.

Divorce is frequent in our society. It is a "marker" of high stress periods that precede and follow it. The events surrounding it have clear negative effects on the physical and mental health of all those involved. The issues and the reactions, different for fathers and mothers and for children, are determined by the sex and developmental stage. The effects are interactive and events subsequent to the divorce influence the restoration of competent functioning. This paper examines these differential effects, methods of helping in the resolution process and opportunities of preventive work with this high risk population.

Child psychiatrists in the 90's: who will want us, who will need us.

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.

Psychological problems in the medically ill child.

The author discusses family reactions to chronic illness including sibling reactions. The management of the chronically ill child is covered with a special emphasis on separation, and the importance of peer relationships, support groups, and the role of the professional.

Current issues in child psychiatry: a dialogue with John Bowlby.

A condensed account of Bowlby's work, particularly his advocacy of an ethological approach and of attachment theory, is followed by comments by three child psychiatrists. His work is critically discussed and ranges from questions concerning the theoretical status of Bowlby's work, to concerns about the de-emphasis of constitutional and temperamental factors, and to concerns that current realities render impractical (and perhaps unnecessary) the traditional models of child rearing. Dr. Bowlby responds to each discussant. In this three days at Lake Couchiching, John Bowlby was the most available and charming of guests. He welcomed discussion with delegates in his every free moment, including mealtimes. It was a privilege to have him in dialogue with us.

Psychosocial aspects of a Tay-Sachs screening clinic.

The authors administered questionnaires to participants in a Tay-Sachs screening clinic. They received 322 responses. Although the majority of the respondents expressed anxiety about the possibility that they might be carriers, most indicated that this anxiety brought them to the clinic. The authors conclude that a well-publicized and well-organized screening clinic can function successfully and deal with the issue of anticipated loss without producing mass fear. An important factor in their clinic was the fact that they were able to offer an alternative to a Tay-Sachs child through amniocentesis.