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Editorial: Debates in scientific practice.

When CAMH’s editor-in-chief Dr Dennis Ougrin asked me to take editorial responsibility for the CAMH debate section, I responded with two questions: ‘Who is the debate section for?’ and ‘What, in your view as editor, is the purpose of debate?’ Dr. Ougrin was clear that the prime function of ‘CAMH debates’ is to be educational. After debating debates at some length, we agreed that our intended audience for CAMH debates included academics, clinicians and commissioners internationally. We also hope that they may be useful to young people and their families. CAMH’s aim is to foster evidencebased clinical practice and clinically orientated research among clinicians and health services researchers working with children and adolescents, and their parents and families in relation to, or with a particular interest in, mental health, and the CAMH debate series shares that aim. When I agreed to take on this task, I did so because I share Dr Ougrin’s view that debates matter. Twenty years ago, as a junior doctor relatively new to psychiatry, I expressed to a consultant supervisor my disquiet at administering ECT. ‘I’m tired of having the ECT debate’, he said, ‘ECT works. I’m not going to debate it’. He was not typical of the many excellent and inspiring teachers I was fortunate to have. Yet the memory of his reluctance to debate, to discuss, to air views, to put prejudices and fears on the table and examine or question them remains a powerful lesson. In the current ‘post-truth’ era, where we are regularly presented with so-called ‘fake news’, exaggeration, or dogmatism, the need for both a culture and a forum for debate is great. Debates matter because they help us form our views and those views shape the world of our clinical practice. Debates are also about power and knowledge. They reveal who is given a platform and whose views are afforded space. As the last issue’s CAMH debate on very early-onset paediatric bipolar disorder exemplified, CAMH debates are not about re-hashing entrenched arguments or having pantomime style ‘he said, she said’ conversations. CAMH debates will strike a balance between subtlety versus fervour. These educational debates will make space for counter narratives to prevailing views which sometime feel uncomfortable. This includes an editorial commitment to avoid silencing views that we do not agree with and to keep open minds. Giving space to opinions that are not universally held or accepted can feel editorially risky. It means publishing views that many colleagues do not agree with, presenting ideas that might make you, our readers, feel uncomfortable, unsettled and possibly even angry. My argument (please do disagree with me) is that it is precisely by being exposed to a broad range of views that misunderstandings can be explored and those certainties that define our practice might also be redefined. Readers may be aware of some of the intensely distressing and sustained trolling that has taken place. We will not publish anything that appears to encourage personal attacks. Trolling is abhorrent. Personal attacks and abusive language are not debate. I would like to consider separately those who frame their opposing opinions in angry terms. This often happens on social media, perhaps because there are few other spaces in which to wrestle over conflicting ideas, especially when there are profound power imbalances. Printed debates in a journal, by their nature, are presented in binary terms. One risk is that we are seen to be ignoring other views. In any topic, there will be eminent and important clinicians and academics whose views are not included, usually because of constraints of space and time. Each side of the debate is one story among many. This issue of CAMH is full of debate and stories. In Narrative Matters, Dr. Gordon Bates’s discussion of the controversial andmuch debated television series ‘13 reasons why’ concludes that this is a series with important lessons about the pressures onWestern adolescents and raises important questions for all of us who care for young people with suicidal feelings. Most CAMH readers will agree with Dr Bates that teen suicide rates are seen as a manifestation of the current crisis in youth mental health. Studying the series has enabled Dr Bates to widen the epistemic genres CAMHS practitioners and academics traditionally draw from, in formulating questions about adolescent experiences. Of course, not everything needs debate. As Price and colleagues demonstrate in their qualitative analysis of transition experiences of children with a diagnosis of ADHD, this developmentally important transition is often poorly managed, and results in suboptimal care and mismanaged expectations, especially among parents who have grown used to being involved with teenagers’ appointments. For these reasons, young people with ADHD who are approaching their legal adulthood, their families and clinicians, as well as those commissioning those services, will appreciate the clear review of a review of guidelines and protocols by Eke, Janssens and Ford. Transition for young people with ADHD who require continued support in adulthood is a current challenge. Linking the NICE clinical guidance for ADHD (NG87) to those on transition of care between child and adult services would provide more comprehensive guidelines for clinicians to ensure smooth and successful transition for young people with ADHD. Young people are at the heart of Child and Adolescent Mental Health. It is encouraging to see their views at the core of so much of the work presented in this issue. We will commission their views as equal participants in some of our forthcoming debates.