Why a psychiatrist?

Psychiatry is typical thought of as being the last resort, or just for medication; with my practice, and most child psychiatrist in Melbourne the very opposite is the case.

A parent may see a psychiatrist who works with children for any concern they have about the child's health, growth or well-being. Any type of problem that you may see a developmental paediatrician for is appropriate, and many for which you may see an allied health clinician (psychologist, OT, speech pathologist or social worker) are often well or better treated by a child psychiatrist - depending greatly on how they practice and their level of experience. To be clear, many of the best clinicians I have worked with and learned from have not been doctors.

Further to the clinical aspects, funding for each discipline is quite different, and for psychiatry, there is no limit to the number of appointments Medicare will rebate meaning a psychiatrist is typically less expensive than other disciplines over longer time frames, however generally NDIS will not fund psychiatry.

As mentioned, people associate psychiatry with the use of medication primarily - however, medication almost never has a role in my practice due to the therapeutic approaches I use.

Typically, a psychiatrist tends to be the last clinician a child is referred to, often after months or years where various other clinicians have been seen, therapies and medications have been trialed. Through this website, I am hoping to provide information that may prompt a child to be referred to a clinician who practices in the way I do at the outset of the problem, not as a “last resort.” I always work in partnership with a paediatrician or allied health clinicians where necessary.

What types of problems do I see?

As noted, most problems for which one would usually be referred to a developmental paediatrician could instead or in addition be seen by a child psychiatrist. Presenting concerns can be considered according the age and stage of the child:

For Infants

• Babies born with major medical or surgical problems are referred for help with their well-being and recovery from the trauma of surgery and illness, as well as to aide their development

• Premature infants or those who spent time in intensive care or special care nursery; they are at higher risk of developmental and emotional difficulties and much can be done to mitigate this

• Developmental concerns, parallel to their explicit medical needs being met by a paediatrician

• Feeding difficulties, reflux or allergies

• Sleep or settling problems

• Emotional and communication problems

• Parents who are struggling to understand or enjoy their baby should consider an infant mental health referral

Preschool aged children

• Concerns about a child’s development such as growth, toileting or speech delay

• Difficulty with food, sleep or separation

• If autism is suspected - please see the section below for more on my approach to this significant area

• Anxiety, depression, family trauma such as parental separation or family violence

• Medically unexplained symptoms, sometimes called functional or conversion disorders

Primary school aged children

• Any of the above problems

• Difficulties that arise with schooling: struggles with getting to school, friendships and socialisation

• Learning difficulties

• Anxieties of various kinds

• Depression, which can take on rather varying forms in children especially

• Behavioural difficulties of any kind may also prompt a referral, such as children who are "oppositional" or have problems with attention.

For teenagers

• Any problems for which they are typically referred to a psychologist, such as anxiety, depression, self-harm, problems with school or friendships, as well as difficult family relationships.

• These days, teenagers are most commonly referred to a psychiatrist for an opinion regarding medication while continuing with a psychologist. However, since medication has almost no role in my practice due to the therapeutic approaches I use, it would not likely be helpful to see me for that reason alone.

• However if you have a sense that the work with a psychologist may have plateaued and you are considering a change of therapists, an initial appointment may be worthwhile.

In the event of crisis

• Private clinicians are usually not well placed to help a teenager at the point of crisis unless they know the family already - your GP, or phoning your local mental health service at the nearest public hospital is the first point of contact, even though there are often barriers to access.

What to expect

If the referral or question may be something I can help with, I will speak with you by phone to answer any questions, clarify what you are looking for, and find an appointment time.

• I invite the whole family to a first appointment, though sometimes parents wish to come alone or only with the child concerned. At the first appointment, I will hear from you to gain a general impression about the problem and the family, as you will of me and we will make a plan for further work together, or I’ll provide recommendations for treatment elsewhere.

• My stance with children is very low key and non-demanding. I aim engage them with simple questions or through play, without requiring them to be involved on anything but their own terms. From here we will have a sense of whether a full assessment should continue with me over several sessions or if another clinician or service is better placed to help.