Dr. Aleksandra Lewandowska: Child and adolescent psychiatry is changing significantly. Now we need interdepartmental cooperation

In your opinion, how is the situation in child and adolescent psychiatry in Poland changing in recent years?

Over the past few years, developmental psychiatry is changing significantly. Our dreams of community-based care, which until now did not function at all in our country, are coming true. The number of facilities of the first level, i.e. those closest to our patient's place of residence, is already more than 400, while there are more than 150 at the second reference level. There is also a third reference level, in which inpatient units have entered. Care is divided according to the competence of the team. There is no psychiatrist in the first level. What we lack is a social campaign. There are still very often misconceptions in operation regarding, who to go to with a child who has a problem.

What is still worth dwelling on, in terms of challenges, is infrastructure. We have great, committed teams in many places, but many psychiatric wards and hospitals need dramatic changes. In psychiatry, especially child and adolescent psychiatry, it's important first and foremost to make contact, establish relationships, build space and a sense of security. It is this intimacy that is very important in terms of a child's stay in an inpatient unit. It's about, for example, not overcrowding the rooms, not putting children in the hallways. This intimacy is also lacking in contact with the doctor or with a psychologist or psychotherapist. This is because there is a lack of offices, places for group work or meetings with the family during the stay.

Another challenge we are working on is cooperation not only in the area of child and adolescent psychiatry itself, but especially interdepartmental. The patient, whether child or adolescent, very often also requires not only health care, but the establishment of cooperation with the educational system, that is, with the kindergarten, school or with the psychological and pedagogical counseling center, social welfare or with the superintendent.

In your opinion, what is the most difficult barrier to overcoming on the way to improving the situation? What do we need, and in what time horizon can this happen?

Openness is very important. It's about changing the way we work, including the teams that have worked in the area of child and adolescent psychiatry so far. In some places it was happening and this cooperation, exchange of information, establishing contact with each other were present. Unfortunately, but not everywhere. Now we have such an obligation, because it is written into the coordinated care of the patient. What is needed is a public campaign dedicated to the public, but also the training of medical staff working in this area. This, too, is already happening, and it is very important, because it has been possible to develop organizational and substantive standards that are dedicated to each reference level. Training is already being conducted within the framework of these developed standards.

We also have new professions, like community therapist for children and adolescents or specialization in child and adolescent psychotherapy. This cooperation, this mutual openness is undoubtedly there. I often say that there is an important human factor in our work. There is talk of queues for child and adolescent psychiatrists. This is, among other things, related to the fact that very often a patient or guardian enrolls a child in a psychiatrist because, for example, in the school so recommended. Then it turns out that this child needs care, support or diagnosis, for example, psychological, and yet access to the first reference level is much greater.

You also said about the need for inter-ministerial cooperation. Particularly important is the education ministry, well, and teachers....

Cooperation with all ministries is very important, but undoubtedly the priority for us is the Ministry of Education. Every child, that is, every patient of ours, is covered by compulsory education. Meetings and discussions on this cooperation and division of competencies were started several months ago . What is needed is a thorough remodeling of the systems of cooperation between us, but also in my opinion - the very formula for educating our children, if only in the context of introducing more classes that develop the emotional area and social competence. For us, the Ministry of Education is very important, because this prevention, let's be honest, is almost non-existent. There are such initiatives in some regions, but not in others.

Another issue is queues. Undoubtedly, some children are sent to a psychiatrist for the reason that a diagnosis is needed. A visit to a psychiatrist is also needed, for example, to complete various formalities related to educational jurisprudence. This gives rise to further consequences. For us, it is very important that in the educational law, in the context of decisions on the need for special education or opinions issued by psychological and pedagogical clinics, there should be more space related to the functional diagnosis of the child. In the education system, it is necessary to give the student appropriate support, depending on the deficit, dysfunction and needs that we see, and not depending on the diagnosis, which in turn forces a visit to a child psychiatrist.