Liaison psychiatry in a child development clinic.

Children with mental handicap and other developmental disorders are normally cared for by their families. This represents an important shift from the previous practice when psychiatrists in large hospitals for the mentally handicapped provided total care and organised medical support. The medical and educational needs of such children are now met by resources in the community. This has often meant that the psychiatric needs of mentally handicapped children and their families were ignored. In 1968 the Sheldon Working Party recommended that district handicap teams and child development clinics should provide a comprehensive diagnostic and therapeutic service for mentally handicapped children. The Court Report stated explicitly that psychiatric consultation should be readily available to children and families seen by such services.1 Some new job descriptions require child and adolescent psychiatrists to accept this responsibility, yet many of them feel inexperienced in this area of clinical practice. It has been recommended that child and adolescent psychiatrists in training 'must have the opportunity to participate in the work of a service to psychiatrically disturbed mentally handicapped children'.2 In practice, arranging suitable experience has proved difficult. Although most children with mental handicaps and complex developmental disorders are known to their local child development clinic or district handicap team, and are the patients of the local developmental or community paediatrician, there is not often much liaison between developmental paediatricians and child psychiatrists. A senior registrar post in child and adolescent psychiatry was therefore established at St George's Hospital with special responsibility for children and adolescents with complex developmental delays and mental handicap (figure).