Implementing child and adolescent psychiatry reform will save us from disaster. The community support system is being built from scratch

- Overcrowded wards in psychiatric hospitals, shortages of medical staff, and tragic statistics that say the number of suicides by the youngest is steadily rising are more than warning signs. They are a diagnosis that we have really little time left if we want to avoid an epidemic of mental and psychological illnesses," says Supreme Audit Office Chairman Marian Banaś.

It is estimated that each year nearly 40 percent of Europeans face conditions of this mental nature. The scale of psychiatric and psychological illnesses in children and adolescents does not portend a change in this trend, and in fact suggests that it is growing. Data obtained by the NIK from the police show that over the past five years, the number of deaths from suicide attempts in the under-18 age group has increased by 9 percent, and the number of suicide attempts: by 51 percent. In 2022, a tragic record was set for suicide attempts by children and adolescents. There were 2031 of them, including 150 that ended in death. Realistically, there could have been more of these attempts, as the data only includes those that were reported to law enforcement.

Meanwhile, a reform of the system of psychiatric and psychological care for children and adolescents is underway in Poland. As part of it, the implementation of three levels of reference is underway. It is crucial to build the first of these to provide community-based care.

- Already there are about 400 entities nationwide at the first referral level. It is very important that, as a rule, psychiatrists are not supposed to work there, because it is on the shoulders of psychologists, community therapists or psychotherapists that the burden of taking care of patients and their families in the close area rests. At the same time, within the framework of an EU project, we are developing organizational and therapeutic-clinical standards for all three levels," points out Marek Stanchuk, head of department at the Public Health Department of the Health Ministry.

As he points out, funding for the child and adolescent psychiatric care system has increased by 400 percent since 2019, and the number of specialists in the field is steadily increasing. In implementing the reform, however, coordination of support and care between those involved in helping the child is key.

- Without coordination, we won't be able to do much, and coordination is not only treatment, but also prevention. Behind the stories of all the patients who are in the wards and outpatient clinics are various factors that contribute to their needing help. If our country had a system of interdepartmental coordination and uniform prevention, most of these patients would probably never have entered the system. These stories are duplicated: children face a lack of understanding on the part of adults and a lack of attentiveness. There is also no cooperation among the various entities in implementing the recommendations, admits Dr. Aleksandra Lewandowska, national consultant in child and adolescent psychiatry.

As Dr. Lewandowska adds, the implementation of the reform is all the more important because a key element of the reform, community care, was not functioning before.

- If it weren't for the fact that a new system of care was being implemented, we would have had a disaster. There would be no places where patients and their families would get help. We talk about reform, but we are actually building the system from scratch. Until we started implementing the community care system, it did not function in our country," the national consultant stresses.

Currently, the Supreme Audit Institution is conducting two nationwide planned audits. They concern psychiatric care for children and adolescents and psychological and psychotherapeutic assistance for children and adolescents. The results of these inspections will be known at the end of the third and beginning of the fourth quarter of this year.