These days I have been reminded of my career milestones when people congratulated me in LInkedIn for my work anniversary: in the beginning of March 2009 I started to work as acting professor of adolescent psychiatry in University of Tampere, to be formally nominated in the position only a month later. This has been a most inspiring assignment indeed. Finland is to my knowledge the only country where adolescent psychiatry is a separate medical specialty. This arrangement was established in 1999. Before that, adolescent psychiatry was a sub-specialty which those specialized in psychiatry or child psychiatry could obtain with two more years of specialist education.

Actually, our hospital, Pitkäniemi, nowadays the Division of Psychiatry in Tampere University Hospital, was the first to open and adolescent psychiatric unit in Finland in 1959. Since then there have been special psychiatric services for adolescents in the country. In 1978, the sub-specialist education in adolescent psychiatry was established, and in 1987, the then Administrative Medical Board outlined that all central hospitals should have an adolescent psychiatric outpatient service.

This was the start of systematic service development which now comprises adolescent psychiatric inpatient and outpatient services in all hospital districts in the country, not to mention that adolescent mental health work actually extends from primary care (school health services and youth mental health teams on municipal level, and mental health work in child welfare services) to secondary (specialist) level services mainly provided by hospital districts and to tertiary level adolescent psychiatric services in two national adolescent forensic units and two national adolescent gender identity units.

I had the privilege to participate in the process of establishing one of the two adolescent forensic units, and later one of the two adolescent gender identity units. Actually, I had another work anniversary this week, related to the adolescent forensic unit: in 3.3.2003 we started the staff training period for the country’s first adolescent forensic unit, to take in the first patients four weeks later in April. We started the work pretty much in the spotlight, torn by contradictory expectations of and attitudes towards work with young people we would try to help. Some thought the bad teenagers only need discipline and punishment, and we would be too soft for this. Some thought that secure care is too luxurious for the bad teenagers and that the expenses of a secure unit would be better used in prevention.

The fact is, the young people referred to out unit proved out to be more seriously ill than anybody imagined. Instead of substance use, gang involvement and organized crime we are facing aggression related to florid schizophrenia, severe mental disorders in context of autism, victimization to abuse, neglect, inability to connect to other people and hopelessness. But adolescent development can always turn to more positive track. An adolescent has more personal capacity than a child, and is less rigid than an adult.

I dare say we have made several important steps in developing the assessment and treatment of adolescents with severe mental disorders and violent and non-compliant behaviors. We were for example the first to systematically adopt the Aggression Replacement Training (http://www.suomenart.com/) as well as to start using adventure education (http://www.seikkailukasvatus.fi/fi/etusivu/) in this level of care in Finland, and we have also been influential in promoting evidence based violence risk assessment in adolescent psychiatry in the country. I was so nervous in March 2003! But I have been so happy to work with such a great team.