MENTAL WELLBEING OF CHILDREN IN EUROPE PLANS AND PERSPECTIVES

Epidemiology

• no recent epidemiological studies
• prevalence of psychiatric conditions (adult & child population) in 6 months around 20%

Indicators suggesting significant higher values for the last decade in incidence of mental health disorders:

• general deterioration of the people’s health condition
• increased number of abuses, addictions to psychoactive subst
• a higher suicide rate,
• overwhelming social stress factors (eco­nomic decline, high unemployment rate, low quality of life)
• expansion of agressive and violent be­haviors, all reflecting an alarming mental health status¹⁾.

Peculiarities

• Former decades of pretending the Jack of social problems” and mandatory child-bearing in the political regime resulted in an unfortunate partial overlapping of „Child Neuropsychiatry” with poor, low-quality social services.
• Low quality medical care of pregnancy and delivery, child abandonment and chronic deprivation in orphanages resulted in a high incidence of consecutive neuro-psychiatric disorders.
• Even now, after 18 years of change, we still confront long-time sequelae of this phenomenon.
• Nowdays, children live and learn in a world undergoing significant social and economic changes
• The experiences in early childhood, powerful influencing the child’s development, take place frequently in a restricted, precarious and agressive social environment
• Parents divorce, work all day long or go abroad to work, becuase of severe finnancial problems

1) – Mental Health Policy of the Romanian Ministry of Health, 2006, www.ms.ro

A. Health Promotion Services

Clinics for Child and Adolescent Psychiatry and Neurology Timişoara (Child Emergency Hospital „Louis Turcanu”)

inpatient service: 50 beds Multidisciplinary team 5 specialist doctors, 2 clinical psychologists, 1 social worker, 1 speech therapist, 1 kinetother Counseling and psychotherapy (family therapy,  logotherapy,  existential analysis, cognitive-behavioral therapy) Psycho-sensorio-motor stimulation Speech therapy Mototherapy

Special school (specialised teachers in assessment and treatment of school failure, academic disorders) outpatient service:

Centre of Child Mental Health: 50 places Multidisciplinary team 1 specialist doctors, 1 clinical psychologist, 1 social worker, 1 kinetother

Counseling and psychotherapy (family therapy, logotherapy, existential analysis, CBT)

Psycho-sensorio-motor stimulation

Speech therapy Mototherapy

Special school (specialised teachers in assessment and treatment of school failure, academic disorders)

externalised community based Centre for Autistic Children:

15 places in day-time care

15 places for home-based interventions.

2 Multidisciplinary teams 1 specialist doctor, 2 clinical psychologist, 1 social worker, 1 speech therapist, 1 kinetotherapist, 6 special educators

specific therapies (CBT, ABA, TEACCH, sensory integration)

family counseling and video-intervention training parents

Psycho-sensorio-motor stimulation

Speech therapy

Mototherapy

Special school based on TEACCH approach

B. Screening services:

network of family doctors, screening for pervasive developmental disorders with standardised instruments

C.  Prevention services

Secondery and tertiary prevention, provided by mental health professionals active in variousclinicalandcommunity-basedcentres, govemamental and non-governamental.

D.  Education services mental health professionals: trainees in Child and Adolescent Psychiatry, Psychotherapy, Psychology, Social Work, Special Education.

University Department Child and Adolescent Psychiatry

Family and Child Centre Audio-Video Research and Education Lab in Family Therapy and Child and Adolescent Psychiatry. Therapeutic sessions can be watched, supervised and discussed (one-way mirror, computerised audio – video recording system). Resource base in Child and Adolescent

Psychiatry, Family Psychopathology and Theraputic Techniques.

Department of School Psychology and Cognitive Develoment with psychologic diagnostic tools, for a complete psycho-educational assessment of children with learning disorders, school failure, ADHD, conduct disorders.

The Lecture Room with audio-videosystem Statistics department for creating and using the databases

E. Early intervention services

• Clinics for Obstetrics – screening and intervening in cases of risk deliveries and complicated deliveries (neurologic injuries)
• Clinics for Child and Adolescent Psychiatry and Neurology
• Screening and early intervention (< 3 years of age) in deviant development (pervasive type) – Community-based Centre for Autistic Children
• Early intervention in cases of attachment disturbances, child abandonment and child maltreatment – NGOs as House with Open Windows, promoting a professional suppleant family
• Early intervention in case of sensorial impairment (network with otho-rhino-laringology clinics, to promote cochlear implant and consecutive rehabilitation speech therapy)

F.  Services for children and young people who have long-term needs

Special schools:

• For mental retardation
• For visual impairment
• For auditory impairment (kindergarden, school)
• For autistic children
• For behavior disturbed – delinquent adolescents

day – time care with rehabilitation programme

• –       Community-based  Centre for Autistic Children, NGO’s as “Speranţa” (“Hope”) for children, “Pentru Voi” (“For You”) for young people.
• – Home-based intervention service for autistic children

G. Plans for young people’s transition to other services

• After 18 years of age, patients in Child and Adolescent Psychiatry are transferred (if necessary) with a special letter containing all important issues in their clinical evolution, to adult services.

Training

• Qualified specialists : 270
• Senior trainees: 70
• Academic departments – 3 (Timişoara, Cluj, Bucharest)
• Type of training (5 years: teaching, clinical stages, research).

Candidates have to spend four years in child and adolescent psychiatry and one year for complementary studies (paediatrics, child and adult neurology, adult psychiatry, endocrinology, neurosurgery, functional explorations, community-based services)

To practice the speciality is necessary a final examination (a written and a practical phase, with a case presentation).

Recent developments in Romanian Mental Health Policies and Legislation

Principles of Mental Health Policy in Romania:

1. The responsibility of the community-based team
2. Participation of the community
3. Accessibility of services
4. Balance among the system components
5. Continuity of care
6. Minimal restrictive alternatives
7. Accent on rehabilitation
8. Specialization of care
9. Involvement of beneficiaries and their families in care process
10. Evidence-based clinical and communitary practice

Priorities

• Antistigma program
• Community mental health centres
• Quality improvement of hospital services
• Training and education Users involvment
• Implementation of the Law on Mental Health and Protection of People With Mental Disorders
• Establishment of National Center for Mental Health within the Institute for Health Research and Development
• 110 monitors of patients rights in mental hospitals
• Funds allocated for improving living conditions in 7 hospitals
• Establishment of 10 community mental health centers

The Revised Action Plan for implementing the Mental Health Reform Strategy in Romania

Main strengths of the CAMH system:

• ongoing implementing of the new Mental Health Strategy

Main weaknesses of the CAMH system

• no governamental department for child and adolescent psychiatry
• Still, adult psychiatry is far more preva­lent and finnanced (compared with child psychiatry) in National Programmes
• Postgraduate training in psychotherapy is not compulsory
• The specialists number is insufficient[1]
• The specialists distribution is inequal all

over the country Romania has 22,810,035 inhabitants (4,800,000 <18 years , 21%). From 11 Medical Faculties, only 3 have the Child and Adolescent Psychiatry discipline: Bucharest, Cluj and Timişoara (also Centers for postgraduate training). To 1 specialist child psychiatrist, correspond around 24,000 children. Lack of associated proffesionals and connected services reduces the quality and the complexity of the medical efficiency.

Future Perspectives

• Training of qualified personnel in multi-professional teams
• Orienting toward community-based care
• Sectorising through schools monitohsed by team: school psychologist, school doctor, social worker; relevant cases transferred to specialists in Centers of Mental Health
• National Programmes for Autism and ADHD
• New approach of care in multiprofes-sional teams, aiming to change old men­talities.
• Establishing and organising Centres of Child and Adolescent Mental Health