Concerns about the provision of care

There is room for improvement in the psychological and psychiatric care of children and adolescents, both in this country and elsewhere, as Wolfgang Wladika, chief physician at the Department of Neurology and Psychiatry of Childhood and Adolescence and Heather Foran, professor at the Department of Health Psychology, both agree.

Mr. Wladika, to what extent do you or your colleagues find the time to conduct research alongside your daily work?

Wolfgang Wladika: The level of reflection is principally of great importance in our work. It is generally very difficult to gain objective insights about the success of treatment methods in psychiatry. There are always numerous factors that have an effect on the patient’s condition; consequently, it is often impossible to deduce individual causes. What is more, we do not have any biological values that we can compare. Nevertheless, in the last twenty years or so there have been several epochal leaps in development in my field, many of which have resulted from collaborative efforts between research institutions and practitioners. In our current situation, with very low staffing levels, I see very few opportunities to draw on our work to generate research activities. The daily work with the children and young people and their families requires our full attention and all our time.

Ms. Foran, your scientific work is heavily practice-oriented. Why is that so important to you?

Heather Foran: I fully agree with Wolfgang Wladika: Yes, we have seen much progress in psychology and psychiatry. But there is still a lot of scientific knowledge that is not used or cannot be used in practice. We conduct comprehensive studies with selected samples, but still have far too little knowledge about how to convert our insights into useful treatments in the practical setting, to help real people facing a wide spectrum of real problems. The main focus is on practicable and smoothly functioning models that are accepted both by practitioners and by the children and young people concerned, as well as by the people in their surroundings. We need methods that are effective, but also cost-efficient and that benefit a large number of people.

How would you describe the current psychological and psychiatric care situation in Austria?

Wladika: I’d say there is room for improvement. In recent years, considerable efforts have gone into ensuring that inpatient care in the hospitals is reasonably adequate. Our big problem, however, is the provision of care beyond the hospital walls. In Carinthia, for example, there are only half as many practising child and youth psychiatrists as we actually need. The situation is particularly drastic in areas that are less densely populated: In the long term, it simply isn’t reasonable to ferry a child to Klagenfurt from Wolfsberg for a weekly psychotherapy session. And yet, in many places there is virtually zero local provision to date. Unfortunately, we have not yet managed to persuade politicians and health insurance funds of the urgent need for psychiatric or psychotherapeutic care.

What are the consequences of this lack of provision?

Foran: It is extremely important to intervene early on and comprehensively, in order to prevent children and adolescents from having to live with mental illness in the long term, once they are adults. We must ask ourselves: Which scientifically verified measures can be applied in a meaningful and convincing way? Ultimately, the commitment to the mental health of children and adolescents is also a valuable proposition for health insurance companies and politicians, as it can help people to contribute to society autonomously, avoiding the pitfalls of criminality and addiction.

Wladika: Economic studies now show us that interventions can yield a return on investment of 1:4 to 1:7, for example in the area of social behaviour disorders. In this way we can often prevent drug use, criminal behaviour or prison sentences.

Ms. Foran, you have investigated the effects of intervention programmes in South Eastern Europe within the scope of an EU project. What did you learn from this?

Foran: Programmes of this kind require the involvement of all stakeholders: Politics, insurance companies, educational authorities, teachers, parents and many others must all contribute to the development of offers that involve as few obstacles as possible and appeal to many people. Families, in particular, play a major role here, though it is often difficult to attract them to such programmes for socio-economic reasons. Here, we try many different approaches to counter the stigma associated with psychological or psychiatric care. In addition, especially in countries where many people live in poverty, there are numerous other hurdles, such as providing transport to the respective facilities. It is part of our research to investigate whether incentives can help to encourage parents to take advantage of such services. Once we find out what is efficient, also in terms of the costs, then it becomes easier to convince other stakeholders.

Wladika: The study “Mental Health in Austrian Teenagers (MHAT)” revealed to us that, at the time of the investigation, approximately 24 percent of children in Austria demonstrated psychologically conspicuous behaviour; in the age span from 0 to 18 years, almost 35 percent of children and young people are affected. However, only 4-5 percent of these are visible, and these tend to be highly acute cases due to suicidal tendencies, self-harm or serious illness. In other words, we are not reaching the vast number whose suffering is less obvious. Much like Heather Foran, I see an essential and important leverage point in considering those who are regarded as at-risk families due to their financial and social situation. After all, as we know, poverty is one of the main drivers of child and adolescent psychiatric disorders.

Are there clinical patterns that occur more frequently today than in decades past?

Wladika: Large-scale epidemiological studies permit only few comparisons. There are, however, certain segments that are growing significantly: Eating disorders, forms of addiction – including non-material addictions – and the aforementioned disruption of social behaviour. In the field of addiction, in particular, we will be facing major challenges in the next five to ten years, because children today are comprehensively exposed to high risk at a very early age due to games that promote addiction.

What do children and young people need to ensure a psychologically healthy upbringing?

Foran: They need stable relationships with their primary caregivers, be they mothers, fathers or other persons within the family system. Adults should act in a supportive manner, should not inflict mental or physical abuse and should provide sufficient positive opportunities for learning and discovery. It is also necessary to establish rules and boundaries, to help children successfully learn how to navigate the world. Of course, other basic needs must also be met. In our study, for instance, we also explored the connections between hunger and domestic violence. In general, families need effective supporting structures to give their children a good start in life.

Wladika: I completely agree and would also add: We need adults in politics and in decision-making institutions who have the courage to put into practice the knowledge we have gained. We know a great deal today about how schools can function and yet we make so little use of these insights. We know so much about mental illness and its prevention and yet we do so little. The limitation often lies in the conservative thinking of the older people. More courage to innovate would do us all good.

for ad astra: Romy Müller
translation: Karen Meehan