The discussion of the draft of the Concept of Improving Psychiatric Treatment of Children is currently underway. On the whole, psychiatric (psycho-therapeutic treatment) is a burning issue for our citizens. According to the data of the Association of Psychiatrists, over million Ukrainians need psychiatric treatment, with only every fifth person asking for such aid. Besides, we have 800,000 alcohol and nearly 100,000 drug addicted people (according to official stats). The number of children who need consultation of a specialist or medical treatment is not decreasing either: three percent approximately need to see the doctor on a regular basis. Besides, according to Ukraine’s Ministry of Health, every fifth child is suffering behavioral, cognitive (mental), or emotional problems. Many children also need support of a psychologist or a speech therapist.
The reforming of mental health care consists in improving the quality of service. One of the main drawbacks of the present-day system is the lack of treatment at the primary stage (“the organization of mental health care services for children in Ukraine is outdated: they are not delivered to children at the primary stage, whereas the main resources of the service are located in the department of child psychiatry in psychiatric hospitals,” the Ministry of Health specialists assess the situation). Therefore the reforming envisages a distribution of mental health care services between three stages (like in the whole sphere of health care): primary, secondary, and tertiary. The primary stage is when a child is diagnosed with certain mental deviations by the family doctor (who gives treatment or sends the child to a psychologist or psychotherapist); the secondary is when the specialists provide the patient with an ambulatory biosocial treatment (in the centers of development and rehabilitation); the tertiary is a hospital treatment. The main emphasis in the concept is made on the prevention of deviations of early development when it is necessary – the biopsychosocial model of psychiatric treatment (preferably psychotherapy and psychosocial aid). Ideally, the children should be tended by qualified personnel able to work in new conditions, family doctors who specialize in children’s psychiatry, and children’s psychiatrists who work with the questions of psychotherapy, in particular, family, gaming, and cognitive-behavioral issues. At the moment, Ukraine has over 500,000 positions of children’s psychiatrists, which are taken by somewhat over 400 persons (the hospitals are over 70 percent staffed).
COMMENTARIES
Oleksandr FILTS, Doctor of Medicine, head of the Psychiatry and Psychotherapy Department at the Danylo Halytsky National University of Medicine in Lviv, vice-president of the European Association of Psychotherapists:
“Presently the combination of biological (medicamentous) and non-biological (psychotherapeutic) treatment is considered as the most up-to-date model of treatment and rehabilitation connected with any mental disorders. For children it is also important for the reason that they, even if they get ill, have a higher plasticity of the central nervous system, which is actively developing, so this pedagogic-psychotherapeutic influence is of immense importance (it helps to correct the development of the brain and psychic apparatus, even when it is disordered). Psychotherapy all over the world is a compulsory method of treating all disorders. In many countries, where the insurance medicine is widely practiced, it belongs to paid services. We have psychiatrists who master psychotherapy on their own, besides with the help of the European Association we have got new educational-studying projects which refer directly to child psychiatry and psychotherapy. I think Ukraine now has nearly 100 people quite highly qualified in this profile. In this context, the situation in Ukraine is not hopeless. I think in reforming of child psychiatry it would be good to follow in footsteps of the financially secure countries, by establishing consultation centers for children and teenagers. They are good because people who come there with certain questions have an opportunity not to enter the system of psychiatric treatment at once. They can decide afterwards whether they need to see a psychiatrist or not. The main idea I want to bring to the public is that any reform (in psychiatry too) is not a reshaping of the institutions (reducing the number of beds or not), this is giving a new shape to the traditional understanding of treatment which exists in every country. For instance, the British work according to the model of ‘moral management,’ which is a specific system, when everything is based on the patient’s personal responsibility for his/her actions (the whole system of rehabilitation is working in this way). The French make an emphasis on giving the patients certain freedoms with certain restrictions. The German model is a model of total medicine invalidity (patients are viewed equal to other disabled persons, with maximum life conditions being created for them). Ukraine should as well create its own model, which is needed under the present-day circumstances, no way beginning with destroying what we already have.”
Semen HLUZMAN, head of the Association of Psychiatrists of Ukraine:
“According to the Concept of Improving Psychiatric Treatment of Children, the basic psychiatric treatment must be provided by a family doctor. This way it is done in all civilized countries. I have recently gotten acquainted with the work of general practice doctors in London. When we asked one doctor how much time psychiatry took in his practice, he replied, 20 percent. Moreover, when we talked to him about our specific psychiatric drugs, it turned out he knew everything. So, he performs an essential part of the primary psychiatric treatment, and when he sees a complicated case, he passes it to narrow specialists. Another thing is that we have a disastrous situation with family doctors in our country. When we developed this concept we took not the present-day realities of health care system, which is in the state of collapse, but the situation as it will be in 5-10 years. We need to cover this way. Speaking about the number of narrow specialists such as a child psychiatrist, there cannot be thousands of them. These are highly-paid specialists we need to school for a long time. For this they have to complete studies in a medicine university, then work as a family doctor or general practice doctor for a while, undergo mental health care training, and finally, child psychiatry. And we have lived to The Day when Iran and Malaysia have refused to recognize Ukrainian medical diplomas (and these sorry excuses for a doctor provide treatment to people in our country). The reform should be started with the universities of medicine: the departments and qualification of teachers should be revised. The reform is being sabotaged now by nomenklatura officials who want to retain this obscure model, when the skills are not needed, however there is a possibility to steal.”
