Child and adolescent psychiatry in Africa: luxury or necessity?

329 The issue of sub-specialization within a developing world setting has been raised as an issue for developing world psychiatrists. 1 The current editorial poses the question as to whether sub specialists in child and adolescent psychiatry are a luxury or a necessity. In a continent where over 50% of the population are children and adolescents and one in five will have a mental health problem 2 , how appropriate is this question? Yet the question needs to be answered if effective Child and Adolescent Psychiatry (CAP) services are to be developed and extended in Africa. Historically, psychiatric disorders of children and adolescents have been slow to be recognized, with those of infants being last of all. Generally, CAP services developed in Africa only in the second half of the 20th century. Invariably medical professionals established the kind of psychiatric services they were familiar with in the English-speaking countries of the northern hemisphere, or in France, Portugal and Spain. At the risk of oversimplification of the status of CAP in post-colonial Africa, the continent can be divided into three areas: South Africa, North Africa and the rest of sub Saharan Africa. South Africa has provided a complete 2 year postgraduate training in Child and Adolescent Psychiatry for general psychiatrists since 1983. This training is available at several universities. At the time of writing, there are over 30 Child and Adolescent Psychiatrists registered with the Health Professions Council, more than half of whom are working in the public sector, mostly in joint academic/health department posts. 3 CAP services are generally tertiary level outpatient clinics, with some centres providing day and inpatient services. Programs in Infant Psychiatry are developing strongly in one or two centres. All universities recognize that Psychiatry is one of the 'big five' undergraduate academic subjects, and dedicated training time for Child and Adolescent Psychiatry is provided. The South African Association for Child and Adolescent Psychiatry (SAACAPAP) was established in 1978, and holds biennial congresses featuring international keynote speakers. SAACAPAP established the peer-reviewed Journal of Child and Adolescent Mental Health in 1989. Today the journal reflects a rapidly growing output of cutting-edge research from all over Africa, with an increasing number of contributions from outside the continent. In 2014 SAACAPAP will be hosting for the first time in Africa the World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP). National Policy Guidelines for …