Dr Sloane Madden (adolescent psychiatrist): Hello, I’m Sloane Madden, I’m a child and adolescent psychiatrist working at the Children’s Hospital at Westmead in Sydney.
So an adolescent psychiatrist is a doctor, so he or she are the member of the team who are medically trained. So we’re able to look at a range of different treatments, so not only the talking treatments but also medication as well. So we’re often looking at the whole picture, and then sometimes co-ordinating the different sorts of treatment a young person may get.
So to see a child psychiatrist, so a specialist as I am, they need to be referred, but there’s a number of different ways children can get to see us. So certainly departments such as ours, or community child and adolescent psychiatry services will take referrals, either directly from parents, from general practitioners or the young person’s doctor, and sometimes directly from school counsellors.
Often I guess, by the time I get to see young people, they have been seen by other professionals who are looking after adolescents, and I’m often asked to see them for another opinion or because the condition that they have is more severe and probably requires a range of different treatments, not only the talking treatments but perhaps medication. In other cases, particularly where I work at the Children’s Hospital, you have young people with chronic or complicated medical illnesses, and I guess my role is to help sort of bridge the gap between the sort of underlying medical difficulties and the psychological or mental health difficulties that they may have.
So if a young person has a medical condition, their medical condition, the medications that they may be on for their medical condition, can all impact on their mental health, and I guess one of the roles that a child psychiatrist has is, because of our medical training, we’re able to weight up all of the different circumstances for that young person. So are their medications affecting their mental health problems? Does that change the sort of treatment we need to give them? So that’s kind of our role, is putting that sort of all together.
So the first thing we’ll often do is we’ll go through the information we have, so a letter perhaps from the referring doctor, information we’ve had from other clinicians who are been seeing and treating the young person, so we’ve got a lot of background. Generally I’ll meet with both the young person and their parents together to explain what to expect, what we’re going to do during the appointment, and to go over things, particularly issues of confidentiality, which is particularly important to young people. Then I’ll generally meet the young person by themselves, meet the family afterwards, and at the end bring everyone together to try and sort of pull everything together and discuss what we think is happening and where to now.
When I meet a family or a young person for the first time, I guess I’m really trying to introduce who I am, why I understand they’ve come to see me, and a little bit about what we’re going to do. Rather than generally diving in to tell me what’s the problem and why are you so sad, I try and find out a little bit about the young person and their life. So who’s at home, what are the different people at home doing, what’s happening at school – particularly for young people at school – how are things going with the teachers, with friends? Try to find out about some of the things that they like to do so I get a broader picture of the young person. While it’s important to know about problems they may have with mood or worry or other difficulties, it really is critical to get an idea of the bigger picture, and different things in their life which may be playing a role in why they’ve come to see me today.