“After leaving the day hospital, they are semi-abandoned”


The emergencies and psychiatric units of hospitals experienced a barrage of sick Due to worsening mental health which caused the pandemic. Young people are one of the most affected groups. The day hospital for children and adolescents of the Hospital Clínic de Barcelona mainly takes care of minors, between 8 and 17 years old, with serious mental disorders (psychosis, depression), eating disorders (ED) and autism spectrum disorders.

The huge increase in ATCs occurred mainly during the pandemic; now growth has stabilized. But there is one thing that particularly worries specialists: the lack of continuity of mental health care of these minors once released. Hospitals stop the first shot, because they contain the most acute cases. But what happens once they get out?

“What worries me the most is availablity and the ability to immediate support from the support system minors. The boys and girls who are here have a very intensive treatment It gives them the structure they need. When unloaded, the community network -family, living conditions, school and social services-, which must contribute to keeping them in their environment, often You don’t have the resources or the organization. to do it. Many families they just can’t, and the social protection system doesn’t always go at the pace we need,” says Astrid Morer, from the Child and Adolescent Psychiatry and Psychology Service of the Clinic and who works in the centre’s day hospital.

According to Morer, this unit treats “acute convulsions” and tries to bring the minor to “reintegrate” his community life. “But, despite the efforts that are made, often we lack attention to diversity. We lack a social network that facilitates the transition to rehabilitation in society,” explains this psychiatrist.

Clinic day hospital increased from 20 to 30 places for users (mostly girls) with eating disorders once covid-19 hit. Currently about 25 are covered. The Department of Health “has invested” in community mental health programs (for example, it has hired more psychologists for CAPs) which are starting to operate “now”. The strain still exists, but is “more distributed” between the assistance devices, Morer said. However, it still lacks “more community networks” and “more trained professionals in child and adolescent mental health”. Hospital emergencies are a “good observatory” where to see the weak points of the system.

Lack of psychologists

subscribe to this idea Sara Bujalance, director of the Association against anorexia and bulimia. “There are girls with a serious eating disorder who are lucky enough to find themselves in a unit like the Clínic, where there is a Specialized team. But when they leave those units, they go to community care, child and adolescent mental health centers the CSMIJ [que atiende a casos menos graves o leves y que hacen de enlace entre el hospital y el CAP] and here great lack of resources and support. What worries Dr. Morer is also a concern of schools notes Bujalance.

Continuity of care is a “problem” and “challenge” to achieve. Upon discharge from hospitals, many of these children with mental health issues find themselves “semi-abandoned”, in the words of Bujalance. “The community must coordinate with the highly specialized unit and that they have resources and professionals,” he insists. “The problem is that there is a lack of psychologists. In the CSMIJ, they normally do follow-up once a month and therefore it is difficult to shake the patient’s hand, ”he assesses.

The risk of readmission

Nor is it a lack of schools (“teachers already have a sufficient workload”), but it is “deinstitutionalize” mental health. “All the work that can be done outside of the hospital setting, the better,” said Bujalance. Also, one of risks leaving specialist care and not finding outside support is end up going home again in a hospital. “On a daily basis, we see patients who leave and who stay abandoned. If it is true that re-entry does not have a single specific cause, but that its origin is multifactorial”.

However, bald rose, coordinator of CSMIJ Eixample, which falls under the Clínic, points out that many of these problems are not only “clinical”, but also “social and school”. At school, for example, there are problems with “social character”. In the residential centers for educational action (CRAE, which are centers for minors of the Generalitat for supervised children), there is a “the continuous rotation of educators”, with whom minors “have no referent”. bald claims “more social resources”, What support teachers to be able to unfold the classrooms and help to be able to carry out hobbies.

“Lost” and “neglected” cases

“Every time there is a leap between services (from hospital intensive care to the CSMIJ), continuity is at stake”, values ​​for you Bern Villarreal, coordinator of the Institute of Education, Research and Innovation of the Fundació Pere Claver. The jump, he assures, is more important when the young person reaches 18 years or more and must access a adult mental health center (CSMA). “The lack of continuity when this change happens is one of the obstacles in the network,” he says. Some of these cases remain “lost” or “neglected”.

When a teenager is released from hospitalization due to a mental health disorder, he must receive priority care at the CSMIJ, in a maximum 15 days. But that is not the problem, specifies Villarreal, since it is a deadline generally held. The difficulty lies in the “frequency” of subsequent visits, derived from “resource underfunding” in primary care.

No therapeutic link

Another aspect that hinders the continuity of mental health care is the professional changes who care for the minor. “If a teenager who has managed to make himself understood by a professional finds himself taken care of by someone who does not feel the same way, he stops going there. It has nothing to do with the lists of expectation, but rather a qualitative issue and obtaining a therapeutic link“.

“Years ago you could treat cases of serious mental illness with much more often than now. From 2007 or 2008, coinciding among other things with the economic crisis, there was already a considerable increase claims to the CSMIJ”, declares Roser Casalprim, former coordinator of the CSMIJ of the Nou Barris Foundation for mental health.

This CSMIJ has as a reference hospital for hospitalizations of children and adolescents in Sant Joan de Déu (Esplugues de Llobregat). A decade or two ago, a CSMIJ professional could treat a case two or three times a week if it was necessary, but now it is no longer possible due to the increase in demand and also the lack of clinical psychologists and psychiatrists. Currently, priority is given to more serious cases.

8 psychologists per 100,000 inhabitants

And what about cases that may be consider lighter? “There is a waiting list at the entrance, with the consequences that this has on certain periods of childhood, and the frequency has decreased visits,” says Casalprim. Many CSMIJ visit once a month or every five weeks.

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“There are no clinical psychologists or psychiatrists. In Europe there are about 18 psychologists per 100,000 inhabitants. In Catalonia, eight,” he explains. Furthermore, he also underlines the difficulties that the CSMIJ often encounters in admitting patients to referral hospitals due to the “high demand” andThe high rate of emergencies they receive and the some beds which they have.

“It has been happening for a long time and with the pandemic it has gotten worse due to increased suicide attempts or suicide attempts, eating disorders, isolation, panic attacks, etc. All this generates a lot of discomfort and dissatisfaction between professionals and families”, specifies Casalprim, which ensures that “saturation is of both parties”.

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