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20 percent children are at risk of suffering from mental health problems, have low self-esteem and do not believe in themselves, according to the GL Assessment report for the UK. It is even worse in Poland. Every fifth child already has mental disorders. They are largely due to the pressure of parents and teachers to achieve success. The Ministry of Health has developed a rescue plan. Students will receive support at school and social welfare centers, and community therapists will visit children at home. Zuzanna Opolska from MedTvoiLokony in an interview with dr hab. Barbara Remberk, national consultant of child and adolescent psychiatry.
- Child psychiatry in Poland is in a serious crisis: there is a shortage of doctors, and the number of minor patients requiring assistance far exceeds the number of beds in psychiatric wards
- Mental disorders affect nearly 20 percent. children, of which 8-9 percent. requires specialist help
- – Just as we exclude mentally ill patients from society, we have excluded child psychiatry from the health care system – says Dr. Barbara Remberk, national consultant of child psychiatry
- Experts at the health ministry are working on a rescue plan that may start operating from January 2019
Zuzanna Opolska, MedTvoiLokony: We have been hearing about child psychiatry for a long time. Why is it so bad?
Dr. Hab. Barbara Remberk: I think that many factors contributed to the current situation. First of all, under-financing of services means that not only are new branches not established, but XNUMX-hour branches are closed. Secondly, we have a shortage of staff – at least three hundred child psychiatrists are missing. Finally, we can talk about the stigma of psychiatry. Even though it is better than a dozen or so years ago, mental illness is still a taboo subject.
Prof. Agata Szulc in the Positive Manifesto of the Polish Psychiatric Association pointed out that until recently cancer meant a sentence for the patient also in a social sense, today it is mental diseases that condemn them to ostracism. We find it hard to accept that our child may need psychiatric help?
Our patients decide differently. Some keep their illness a secret from everyone except their parents. Even grandparents are convinced that a grandson or granddaughter is in a sanatorium and not in a hospital. Others chat freely with friends and I think they get support from their peers. As for adults, they are indeed more conservative, and many fear that their child may need help. Perhaps because in social consciousness and mass culture, a person with mental disorders is identified with a seriously ill, unpredictable and incapable of being a member of society. I would like to say something else: a lot of children need help, which does not mean that they are seriously ill. Just as no one is outraged by a visit to the dentist, it should be natural to take care of your mental health.
Could the fear of a psychiatrist come from the fact that we feel guilty or fear accusations? Maybe we were not present enough, maybe we demanded too much like the “mother of the tigress”, or maybe we simply did not meet …
I think many of us follow mental shortcuts. If something is wrong with a child: holes in the knees, dirty hair or learning difficulties, we automatically suspect the parents of neglect. Among them, we will certainly find people who, for various reasons, do not fulfill their parental function properly and in this sense may be afraid of contacts with the health or social care system. Most parents, however, do what they can for their children.
We don’t have to run to a psychiatrist right away, we can use other opportunities. What?
First of all, it is worth using psychological help. Even if the child requires a psychiatric consultation, in most cases, treatment begins with psychological interventions, and drugs are, in principle, the next option. Thus, not every visit to a psychiatrist ends with a prescription or a referral to the hospital. There are plenty of other options that are suitable for children who are not very sick and most of whom are in need of help.
It seems that childhood is a carefree period, and even few-year-olds have mental problems. What disorders are characteristic of early childhood?
It is worth noting that in the population of children and adolescents, mental disorders are nearly 20 percent. and not all of them require treatment. Besides, nothing prevents their childhood from being happy. When it comes to mental disorders in the youngest children, psychomotor development disorders and social development disorders dominate. At this age, the most common diagnosis is autism spectrum disorder, but both infants and children under 3 may also suffer from affective disorders, relational difficulties and eating disorders.
And in teenagers?
We can talk about problems typical of adolescence, i.e. mood disorders, eating disorders such as anorexia and bulimia, and experimenting with stimulants. Of course, tiny children with pervasive developmental disabilities become teenagers with pervasive developmental disabilities when they grow up. Self-harm is a social problem that is not a disease but is a symptom of suffering and can be the cause and effect of various difficulties. Suicidal thoughts and impulses may also appear during this period.
What red flags should worry us?
When it comes to the youngest children, these are developmental abnormalities, so if the child sits up later, says it, it is worth taking an interest in it. Of course, you shouldn’t panic right away, which is sometimes the other side of the coin. From the point of view of a psychiatrist, speech delay is particularly disturbing. The second area that is extremely important is the development of social contacts. From the second month on, the child makes eye contact, reacts to adults, is interested in what is happening around. At a time when multigenerational families are rare, it is more difficult for parents to distinguish between what is the correct stage of a child’s development and what should be worrying. Therefore, in case of doubt, it is worth going to a specialist consultation. The first person who can help in this case is the pediatrician.
In the case of teenagers, warning signals can be confusing, when should we turn on the red light?
Generally speaking, the change is disturbing. So if our child did well in one area, from potty to school, and then suddenly or over time, stopped. The alarm signals certainly include the teenager’s suicidal intentions or the content that he or she would rather be dead. You don’t have to panic and call for ambulances right away, but take your fears seriously. Some of our patients express regret against parents whose response was not as expected.
Parents say: this age, it will pass …
This happens especially if we are talking about depression. Indeed, a teenager may be in a very bad mental state one day – have a depressed mood and intense suicidal thoughts, and then have fun on an 18-year-old friend for a few hours. The medical term for a feature of this phenomenon is mood reactivity. This is a feature that distinguishes depressive disorders in adolescents from depressive disorders in adults. Even if our child can become so bright, it does not mean that he or she does not suffer and does not require any help.
We heard that the work on the “rescue plan” for child psychiatry is underway – what would it consist of?
On the reform of the entire system. It has been known for a long time that this is how psychiatry should look, but it is not so easy to implement. First of all, the psychiatric care system should place great emphasis on the care and treatment of the patient in his environment and the availability of these services. We want to create a multi-level system of care, where the zero level would be preventive measures, i.e. support and early intervention at school, in social welfare centers or foster care centers. At this level, an environmental therapist for children and adolescents would play an important role.
This would be a new profession?
Yes, his tasks will include coordination, support and cooperation with specialists from the school. The next level would be outpatient treatment, day wards, psychotherapy and family therapy close to home. Only in health or life-threatening situations should XNUMX-hour departments with an emergency room or an emergency room be available.
So the overcrowded machines remain, but maybe not so many sick people will end up there …
Assuming the children receive treatment sooner in many cases, a hospital stay will not be necessary. On the other hand, if today I was sure that the patient who I write out tomorrow will go to a psychologist, and in three days he will make an appointment with a psychiatrist, I could shorten my stay and discharge him earlier. At the moment, when discharging the patient, I must be sure that nothing will happen to him during a month of waiting “in the optimistic version” for an appointment with a psychiatrist and four months for an appointment with a psychologist. That’s why I act more carefully.
When could the planned changes be implemented?
Unfortunately, these are not solutions that can be implemented immediately. However, we hope that the first changes, mainly consisting in staff training, would be introduced from 2019.
But will it train someone? Why don’t students choose psychiatry?
We can talk about several reasons. In medical study programs, child psychiatry is treated superficially, so some students have no opportunity to get interested in it. The second problem is the small number of centers where specialization training can take place. It is certainly a difficult job, and even more difficult in times of crisis. It requires comprehensive action, often not only the child is treated, but the whole family. Sometimes we are faced with difficult legal decisions that should be the area of uXNUMXb uXNUMXbworking social workers. A child patient requires a lot of time and attention, and in overcrowded psychiatric wards, we do not have the comfort of work. We cannot admit to the hospital those patients who are waiting and, in principle, should be admitted, but are not in a life-threatening condition. We cannot refer the patient to a psychologist if we see such a necessity. We often have nothing but ourselves.
There is no maneuver …
Yes, I think that it is difficult everyday life that deprives students of their enthusiasm. A pity, because in my opinion this is an extremely interesting specialization …
dr hab. Barbara Remberk, consultant in the field of child and adolescent psychiatry