Child Psychiatrists as Leaders in Public Mental Health Systems: Two Surveys of State Mental Health Departments

OBJECTIVE: The purposes of the study were to document the administrative roles that child psychiatrists play in the development of policy in state departments of mental health and to identify barriers to their participation. METHODS: A survey was sent to the director of the department of mental health in each U.S. state and territory to determine the administrative duties of child psychiatrists who work in the department's central administration. A follow-up survey was sent to directors of children's services in state departments of mental health to determine what skills child psychiatrists would need to develop to increase their likelihood of being selected for administrative leadership positions. RESULTS: Nine of the 31 departments of mental health that responded to the first survey had formalized central administrative roles for child psychiatrists as either an administrative consultant or a children's medical director. The 19 respondents to the second survey indicated that to play a role in the central administration of state departments of mental health, most child psychiatrists needed improved knowledge in cultural competency, organizational dynamics, how government functions, the use of an asset-based approach to dealing with families, and use of interventions other than inpatient units, outpatient medication, or psychotherapy. CONCLUSIONS: To improve the leadership role of child psychiatrists in public-sector systems, training opportunities should be developed to increase their knowledge and skills in areas needed for effective participation in policy development. Training should include formal didactic instruction and clinical experiences that focus on the wide range of interventions used in public-sector systems and on the administrative skills needed for leadership positions.