Problems of child psychiatry: systemic coordination and interdepartmental cooperation are needed

Data from the National Health Fund show that the number of pediatric patients in psychiatric offices has been growing exponentially in recent years. The coronavirus pandemic has had a not insignificant impact on this. Between 2019 and 2020, there was an 87% increase in the number of people under the age of 13 requiring psychiatric care. In the group of 13- to 18-year-olds, it was even worse: the number of patients increased by 168 percent.

INPATIENT WARDS STILL OVERCROWDED

Meanwhile, the primary concern of the care system has been an inadequate supply of facilities capable of providing care for these people. The answer to this is the ongoing reform of psychiatry. One of its effects is the transition of the system to a model of care provided at three levels of reference. This primary one is community psychological and psychotherapeutic care centers for children and adolescents. Nearly 400 such facilities have already been successfully launched.

- Although more centers are opening, inpatient wards for children and especially adolescents are still overcrowded. We have more and more patients, mainly adolescents, in mental crises, in life-threatening conditions, who require such care," noted Dr. Aleksandra Lewandowska.

As she stressed, in the inpatient setting, cooperation between psychiatrists and pediatricians is extremely important. However, there is a lack of systemic solutions to ensure optimal coordination of such care. Cooperation with educational institutions is also limping along.

- We see that not every school, not every psychological counseling center, and not every educator are willing to cooperate. As a result, we then have a number of difficulties, because we don't know who to contact about the patient. We then have trouble getting the school to implement the recommendations we make for our patient. We also often have trouble discharging children or adolescents from the day unit who no longer require intensive therapeutic care, but who have difficulty returning to mass schools," the national consultant in child and adolescent psychiatry pointed out.

Discussions are underway with the Ministry of Education and Science, which may result in allowing this group of patients to be educated in hospital schools. The issue of young adults being transferred for treatment from pediatric care also remains problematic.

- There are places where coordination between child, adolescent and adult psychiatrists becomes problematic," Dr. Aleksandra Lewandowska noted.

WITHOUT SUPERVISION THERE CAN BE NO COORDINATION

Prof. Jaroslaw Peregud-Pogorzelski, national consultant in pediatrics, meanwhile, stressed that supervision is just as important as coordination.

- We should have highly specialized 24-hour psychiatric care centers with mental health centers for children, adolescents and young adults. This is extremely important, because these centers would deal with providing full-profile care for patients with psychosomatic disorders, with a special focus on all types of addiction. This is extremely important, because the wave of addictions is growing strongly, and the current system of care for these patients is completely ineffective and inefficient," the professor pointed out.

According to doctors, such centers should be established at provincial specialized maternal and child care centers or highly specialized hospitals with pediatric departments.