Canada’s Future Psychiatrists Are Barely Trained in Infant Mental Health, National Survey Reveals

The earliest years of life, long treated as a developmental black box by much of mainstream medicine, have become one of the most consequential frontiers in mental health science. A new national survey of psychiatry residency program leaders in Canada now reveals a striking disconnect between what the science says about the first years of life and what young psychiatrists are actually taught about them. The study, published in Academic Psychiatry, found that infant and early childhood mental health, often abbreviated IECMH, remains largely absent from the formal training of general psychiatrists across the country, even as every program director surveyed agreed the field is important to psychiatric practice.

The research team, led by Nicole Sheridan and Katherine M. Matheson of the Children’s Hospital of Eastern Ontario Research Institute and the University of Ottawa, with collaborators including Sara Citron, Lara Postl, and Blair Hammond, set out to map exactly how IECMH education is delivered within Canadian residency programs. Between August and December 2023, program directors and associate program directors from every Royal College of Physicians and Surgeons of Canada accredited general psychiatry residency program and every child and adolescent psychiatry subspecialty program were invited to complete an anonymous survey. The questionnaire probed teaching practices, curricular structure, clinical exposure, perceived resident competence, and the barriers and facilitators that shape whether formal IECMH curricula can take root.

Nine program directors ultimately participated, four representing general psychiatry and five representing child and adolescent psychiatry. The numbers are small, but the population is finite and the response pattern is telling. Not a single general psychiatry program reported a mandatory rotation in infant and early childhood mental health, and most reported no dedicated IECMH teaching at all. In practical terms, a psychiatrist completing a five year general residency in Canada could graduate without any structured exposure to the assessment of infants, toddlers, and preschoolers, or to the parent child relationships that shape early emotional development.

The picture brightens somewhat in the subspecialty stream. Child and adolescent psychiatry programs reported greater clinical exposure, with most requiring an IECMH focused rotation. Yet even here, formal didactic teaching, the classroom based instruction that anchors most medical curricula, remained limited. No program of either type reported using e learning modules, a notable gap at a time when digital education has become a standard vehicle for spreading specialized content across geographically dispersed training sites. The result is a patchwork in which clinical exposure varies by institution and structured teaching varies by the enthusiasm and expertise of individual faculty.

When asked how well their programs educated residents in IECMH, the two groups diverged sharply. General psychiatry program directors commonly rated their programs as teaching the material not very well, while child and adolescent psychiatry directors generally selected moderately well. Both groups, notably, pointed to the same primary obstacle: limited faculty expertise. Infant and early childhood mental health sits at the intersection of developmental psychology, attachment theory, neuroscience, and clinical psychiatry, and clinicians with deep training in this area remain scarce. A program cannot teach what its faculty have not themselves been taught, and the survey suggests that bottleneck is now propagating through the training pipeline.

The scientific case for closing that gap is substantial. Decades of research, from John Bowlby’s foundational work on attachment onward, have established that the earliest relational environment exerts lasting effects on psychopathology and health across the lifespan. Adverse childhood experiences are strongly linked to poorer developmental and health outcomes in young children, and disruptions to parenting, including those driven by parental mental illness, are a well documented pathway of intergenerational risk. Neurobiological research on fetal and infant development shows that the brain’s early architecture is shaped by caregiving relationships, making the first years a period of unusual plasticity and unusual vulnerability. Canadian bodies, including the Royal College itself, have increasingly emphasized linking early brain and biological development to psychiatric practice.

Why does this matter for general psychiatrists who will never see a patient under the age of five? Because their adult patients were all once infants, and many of them are parents. Parental mental health disruptions affect parenting quality and child outcomes, meaning every psychiatrist treating an adult with depression, psychosis, or substance use disorder is, implicitly, also in a position to influence that adult’s children. A psychiatrist who cannot recognize early relational disturbance, who is uncomfortable advising a new parent, or who misses the developmental context of a family’s distress is working with an incomplete clinical toolkit. The survey’s authors frame IECMH competence as relevant to psychiatric practice broadly, not as a niche subspecialty concern.

The contrast with parallel fields is instructive. In pediatrics, a related national survey by an overlapping research group examined early relational health training in Canadian paediatric residency programs, part of a growing effort to quantify how well trainees are prepared to support the earliest caregiver child relationships. In reproductive psychiatry, American researchers demonstrated that a national standardized curriculum could effectively set common educational standards across programs. And within child and adolescent psychiatry, prior studies have argued explicitly that all child psychiatrists need infant mental health training and have proposed comprehensive models for delivering it. The Canadian survey extends this movement by documenting, from the program directors’ own perspective, how far psychiatry still has to go.

There is also an encouraging signal buried in the findings. All respondents endorsed IECMH training as important or very important, and all expressed strong interest in scalable, self directed educational approaches. That combination of acknowledged importance and appetite for flexible formats suggests the barrier is not conviction but infrastructure. Existing resources point toward what is possible: the American Academy of Child and Adolescent Psychiatry has developed online curriculum modules on infant and preschool mental health, and the Keystones of Development program has shown that online curricula can successfully teach residents to promote positive parenting in primary care settings. Adapting such models to Canadian psychiatry training, aligned with Royal College competency requirements, could bypass the faculty scarcity problem by delivering expert content consistently across every program.

The study’s limitations warrant honest framing. Nine respondents cannot represent every program with statistical precision, and self reported survey data reflect directors’ perceptions rather than direct measurement of resident competence. The authors note that the underlying data cannot be shared publicly because they contain potentially identifying information, though deidentified data may be available from the corresponding author under research ethics approval. Funded by the Happy Roots Foundation and approved by the CHEO Research Ethics Board, the study was published on 2 October 2026. Its central conclusion, however, is difficult to dispute: IECMH education in Canadian psychiatry residency is variable and inconsistently structured despite widespread recognition of its relevance. For a specialty whose interventions can echo across generations, the survey is less an indictment than a roadmap, identifying exactly where feasible, competency aligned curricula could transform how the next generation of psychiatrists understands the beginnings of the mind.

Subject of Research: Infant and early childhood mental health education in Canadian psychiatry residency training programs

Article Title: Infant and Early Childhood Mental Health Training in Psychiatry Residency: National Program Director Perspectives in Canada

Article References: Sheridan, N., Zarb, S., Citron, S., Postl, L., Hammond, B., & Matheson, K. M. (2026). Infant and Early Childhood Mental Health Training in Psychiatry Residency: National Program Director Perspectives in Canada. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02449-y

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02449-y

Keywords: infant mental health, early childhood mental health, psychiatry residency, medical education, program directors, Canada, curriculum development, child and adolescent psychiatry, attachment theory, early relational health, residency training, faculty expertise