The only medical science society tasked with advocating for children’s mental health has not been invited to present its proposals to Parliament on the controversial Psychiatry Reform Bill.
As they stated in an open letter to the Deputy Minister of Health. Dimitris Vartsopoulos, members Greek Society of Child Psychiatry – Association of Child and Adolescent Psychiatrists, with “surprise and intense displeasure” They realized that they were not invited to the Parliamentary Social Affairs Committee, where the debate on the Mental Health Law concluded last Friday.
draft law Act Finally, today it is voted by the Plenum of the Parliament and Child Psychiatrists did not have the opportunity to present themselves and give their opinion, although the specific bill, as they say, “It brings enormous change and disruption to a particularly sensitive and long-suffering area of Child and Adolescent Mental Health Services.”
“We consider it unacceptable that both the Ministry of Health and the members of the Commission did not apply for official and institutional submission to the Commission. view of the unique medical scientific community aims to promote and protect the mental health of children, adolescents and their families”. Register the members of the society.
The Society for Child Psychiatry: What It Recommends for Psychiatric Reform
However, the scientists submitted their comments and suggestions in writing to Mr. Vartzopoulos, Deputy Minister of Health, which are summarized below.
Based on the analysis of the draft law and the relevant opinions and comments of our members, we identified the following important issues that need to be resolved:
Abolishing the sector concept and replacing it with the Regional Mental Health Services Network (PDYPSY):
The new structure may create difficulties in accessing services, especially in densely populated areas such as Attica.
The sector/sectorization concept, which has worked well in several areas to date, should be preserved and strengthened to ensure the prompt and effective delivery of mental health services to children and adolescents. The replacement of existing Mental Health Sectors with Regional Networks in which the population of an entire Health Center is matched is expected to complicate the accessibility of health services. We believe that special attention is needed at this point. Sectors need improvement interventions and strengthening of scientific personnel, not abolition. That is, to clarify which areas each service serves.
Recommended Management Model:
The new management model, as described, concentrates many responsibilities in the person of the deputy director of the Ministry of Health, which raises concerns for the independence and transparency of procedures. Administrative organization must ensure flexibility and prompt response to community needs, particularly in children and youth services where speed and efficiency are essential. We propose the establishment of an independent and elected control mechanism that will ensure proper functioning and service to society.
In addition, the PES has a large variation in the reference population as well as other parameters (geographical distribution) and it would probably be necessary to restructure the PES before this bill. Also, it is not at all certain that they will be able to fulfill the role that the bill defines for them.
Relationship of Child-Adolescent Mental Health Units to Hospitals
What will be the relationship between Child and Adolescent Psychiatry departments and hospitals (participation in bodies, day-to-day operational issues) in the current scientific, union and organizational framework after the bill is passed? Could it be that an “organic”-“psychological” split will indeed emerge, which will reinforce the phenomenon of mental illness stigma, and finally, the existing dysfunctions actually recorded in several hospitals can be considered “correct functioning”.
Scientific Council on Mental Health (ESSYPSY):
ESYPSY, which replaces the Regional Directorates of Mental Health Sectors (P.Di.TOPSY), consists only of NPDD doctors or university professors, and there is no provision for the participation of private persons or employees in AMKE. representatives of beneficiaries. In order to meet the needs of children and adolescents more efficiently, it is necessary to integrate service recipients, as well as specialists from different fields, including AMKE employees. Local government representation would also be helpful.
Rights Protection Committee:
There is no provision for an advocacy committee at the Health District (HPE) level. It is important to establish such a commission to protect the rights of children and adolescents who need psychiatric help.
Merger of private entities:
Opportunities to establish Mental Health Units by the private sector should be carefully regulated to ensure the quality of care provided.
Financing-AMKE Financing and Uninsured Coverage
The sustainability of the project must be ensured primarily by the proper funding of structures and services of the NHS, which to date have not been funded by the Recovery Fund and have major problems in buildings and infrastructure, and are known to be understaffed. Funding should also cover the need to create new structures for the mentioned deficiencies, as well as new pathologies and needs.
In addition, AMKE funding by EOPYY alone raises concerns about coverage of the uninsured and refugees/immigrants. There should be clear provisions to cover these vulnerable groups.
Provision for Information and Privacy
We welcome the inclusion of provisions for the collection, storage and protection of data in accordance with the GDPR in the draft law. However, we emphasize the need for clear procedures and a competent data protection officer to ensure the privacy and security of service recipients’ personal data.
Need for specialized personnel
We have repeatedly referred to the significant shortage of child psychiatrists and other mental health professionals in all health districts. In order to support the existing mental health services for children and adolescents, it is necessary to ensure sufficient recruitment through the provision of appropriate incentive measures, and at the same time to ensure the training of new child psychiatrists by creating new specialized positions and other staff. and the immediate creation of new structures that are absolutely necessary.
Article 3, paragraph 2
The development of effective forms of deprivation of liberty for minors is noted. We suggest that the purpose of forensic psychiatric services is not (and should not be) incarceration, but to improve adolescent mental health. Special care for juvenile delinquents with integrated preventive and therapeutic measures in the community.
Article 13
The Mental Health Science Board should clearly state that it should include adult psychiatrists as well as child and adolescent psychiatrists. As a result of the use of disjunctive linking, there is a risk that the Board will be represented by only one specialty (and in some HCWs, the specialty of adult psychiatrists due to the low number of child and adolescent psychiatrists).
Article 14
The Department of Child and Adolescent Mental Health is included in the Coordinating Directorate in the organization and staffing of DYPE. This department should be responsible for everything that the Primary Mental Health Department and the Secondary Care Department are responsible for, with a focus on children and adolescents.
Given that Child and Adolescent Mental Health Services are understaffed, there should be a clear arrangement for the movement of staff from PSY to PSY and from PSY to hospitals. It is proposed that this regulation only covers movement with the consent of a mental health professional, because otherwise the service would be weakened on the one hand, and on the other hand the short-term movement of the worker would not solve the problems in reception. field.
Articles 23,24,25 Specialty of child-adolescent psychiatry
We fully agree with the abolition of the ¼ ratio for qualified doctors and propose the increase of specialist posts and specialist training units across the country. Also, the regulation of a one-time placement institute in the specialty of child-adolescent psychiatry should not result in the reduction of specialist positions due to rotation (i.e. being in other clinics).
Article 57, para
Specialties serving the National Telepsychiatry Network have been identified. Child and adolescent psychiatrists, as well as all professionals working in Child and Adolescent Mental Health Services (eg social workers, speech therapists, occupational therapists, etc.) should be explicitly included.
In conclusion, this is a bill that attempts centralized and bureaucratic administrative reforms that may create more problems than it tries to solve.
While not adequately responding to emerging needs in child and adolescent mental health, there are uncertainties in very important areas (sectorization, financing, management and functional interaction of departments). Planning should be accompanied by logistical and operational support for community child psychiatry. We suggest that there are many uncertainties and points that need clarification and perhaps revision.
We hope that our observations and suggestions will be taken into account in order to provide quality and effective mental health services for children and adolescents of our country.