'At a standstill': Czech child psychiatry in crisis

The availability of mental health services for children in Czechia declined last year, due to a concerning combination of increasing child mental health issues and a decline in psychiatrists nationwide.

Approximately 80,000 children in Czechia are currently being treated for psychiatric issues – an increase of “more than half” in the past 10 years as per VZP data. The country, however, is facing a crisis in psychiatric treatment. Seznam Zprávy writes that there are just 180 child psychiatrists in the whole of Czechia – one of the lowest rates in the whole of Europe. With almost half of currently practicing psychiatrists now at retirement age, the situation is set to worsen.

"Compared to the period before the pandemic, there has been an increase in the number of children with anxiety disorders,” said an expert from the Association of Child and Adolescent Psychiatry (ADDP).

“Isolation,” a “loss of security,” and increased “internet addiction” led to a jump in children’s mental health issues. There was a “45 percent year-on-year increase in the frequency of child mental-health problems” in 2021, according to spokesperson for mental-health charity Safety Line Regina Jandová.

Head of ADDP Tomáš Havelka noted in iDnes a “tremendous increase” in children’s tendencies to self-harm, with “several times more cases” reported in recent years. Cases of anxiety and anorexia have also risen: a 2021 survey from PAQ research found that one-quarter of schoolchildren experienced “mental discomfort.” Alarmingly, about 50 children take their own lives per year, iRozhlas writes.

"Schools are reporting an increase in psychological difficulties and loss of motivation. Crisis lines and services are overloaded. Today, more than ever, children need to experience a safe, supportive environment and good relationships," Lenka Hečková from the Czech Professional Society for Inclusive Education said in Novinky.cz.

“Outpatient pediatric psychiatric care is fundamentally threatened,” the director of the Opařany Children's Psychiatric Clinic in South Bohemia, Michal Goetz told Seznam Zprávy. Children with psychological issues can wait up to eight months for treatment, and even children who have attempted suicide can wait for “several months” for help according to pediatrician Jana Schmidtová from Prague.

Czechia currently faces an acute shortage of child psychiatrists and services. The country has just six psychiatrists per 100,000 child and adolescent patients, one of the lowest rates in Europe and performing extremely poorly compared with the likes of Finland, which has 36 for 100,000 patients, or Italy, which has 20. The entire Central Bohemia region has just five child psychiatric outpatient services. According ČTK, Goetz said that just six or seven child psychiatrists enter the practice every year.

“Children's psychiatric hospitals are so full that they don't actually accept [patients] anymore," just the most critical cases, writes iRozhlas. According to ADDP, there are just 596 beds in child psychiatric hospitals across the whole country. These are unevenly distributed, with Moravia particularly underrepresented.

Several factors can explain the lack of child practitioners in the country. The first is pay: according to Schmidtová, adult psychiatry provides better income (despite the practice being generally poorly paid and funded in Czechia) and offers more financial security due to the availability of more institutions where adult practitioners can work. Further, as ČT24 reports, “reimbursements from insurance companies for child psychiatrists are half of those for adults.”

Charity Safety Line says another reason is the overly long time needed to attain certification to become a child psychiatrist. When doctors do, they often go into private practice, Deník N cites. Additionally, child psychiatry is undertaught in medical schools, resulting in limited interest from prospective students – “psychiatry is usually only taught in the fifth year [of medical school], when many medics already have a comprehensive idea of ​​their specialization,” Seznam Zprávy writes.

An investigation by iRozhlas into a child psychiatric institution in Louny, Ústí nad Labem, found dilapidated conditions, with barred windows, broken toilet doors, a “harsh regime” as well as a shortage of staff. This may well be microcosmic of poorer conditions nationwide in a system that is “underfunded.” 

Matěj Stríteský, a represenative of Czechia’s ombudsman’s office, says in iRozhlas that there is “a lack of educational and therapeutic care” in the country. Children with behavioral problems at school are thus wrongly treated and incorrectly referred straight to psychiatric institutions, further burdening the system.

Psychiatric institutions, inadequately equipped to deal with children’s behavioral disorders, then refer the child back to educational facilities, thus leading to some patients being “tossed around” like a “hot potato.”

The Ministry of Health was "fully aware of the complex situation in the field of child and adolescent psychiatry,” ministry spokesperson Eliška Machová said earlier this month according to iRozhlas.

A few weeks ago, Minister of Health Vlastimil Válek similarly said that Czechia “face[s] a major challenge, which is the care of pediatric patients. Reform activities must be coordinated very intensively.” 

The Health Ministry pledged to “strengthen outreach services” and “streamline the treatment of mental illnesses”. However, the ADDP chief said that previous proposals of bettering the situation, such as increasing staff pay, have been met with replies along the lines of “it’s just not possible.” The government announced in a December press release that it would create “a platform of organizations” that “unites users of psychiatric care,” which would also address the availability of support services for children, ČTK reports. 

Governmental pledges of change, however, should be turned into action – 2023 and the years beyond will be crucial in bolstering Czechia’s resources to combat the dire and worsening situation of the country’s child psychiatric services.