We have interviewed the director of the Federació Salut Mental Catalunya, Marta Poll, to talk about the report “Child and adolescent mental healthcare attention in Catalunya” that has been published in conjunction with the Federació Pere Tarrés.

  • What is the state of child and adolescent mental health in Catalonia, Spain?

There is a relevant fact that says that 78% of mental disorders appear before 18 years of age. Therefore, all aspects of prevention and promotion before this age are fundamental. Something we’ve found in Catalonia is that we currently don’t know what types of promotion and prevention programmes are taking place. We know that there are many, but there isn’t a roadmap to identify and evaluate them. We have to know which ones work best and which ones do not, and consider the possibility of expanding them in the whole area.

This is one of the key elements included in the report, and that’s what we’ve shared with the different ministries/conselleries of the Government of Catalonia.

The European Plan 2020 indicates that prevention is essential. In Catalonia, investment goes to other issues of mental healthcare instead of prevention. For instance, we know that there are more resources in hospitalization, which means when we have already identified the problem we allocate more resources there, but there are fewer resources in early prevention. In addition, the report states that it is very important to mobilise more resources in prevention and promotion of mental health because, probably, we will save more resources than in others in the long term.

There have been 7% more cases cared for in child and adolescent mental healthcare centres in the last year. If we move further back in time, there has been an increase of cases in the last decade. This shows that we are better at detecting the situations, which is very good and is a good news, but we have been incapable of providing more resources to the mental health network to improve care in these situations. Therefore, the report demonstrates that we have an overcrowding problem: we have more capacity to detect cases but are less able to adequately attend to them.

Therefore, we think that one issue is to review not only child and adolescent mental healthcare centres, but also in a cross-sectional way across the whole health and education system. The role of support and psycho-pedagogical oriented teams is noteworthy, although they have a limited capacity to attend and support families and teachers in schools and secondary schools and also in early care.

Another problem that comes up is patients’ risk factors, relatives and the context where these children and adolescents live that may determine, somehow, a greater likelihood of suffering from a mental health problem.

  • How has the economic crisis impacted families’ mental health?

We have data that shows that in primary care there have been increased cases of anxiety and depression in adults. The report mentions that in those families where there are some risk factors related with the economic crisis, such as difficulty in accessing housing, keeping a job, parents’ anxiety in addressing daily difficulties…, have an obvious impact on children. In situations where social support is reduced because of the crisis, it is important to increase the care they receive.

  • Do children and adolescents find barriers in accessing mental healthcare?

One of the challenges mentioned in the report is access. One barrier is the stigma, the problem in asking for help when there is a mental health problem, the refusal in these situations by relatives. Another barrier is that we do not have territorial equity and there are regions where there is a lack of resources. It is more difficult to access them when they’re not available in the area. Also, there is the situation where there are areas with resources but with less economic maintenance that hampers access.

In this case, we are not speaking strictly about mental health resources, but about any resources that care for children. For example, the supporting primary care system, which is very relevant, support by professionals from all areas of healthcare, in this case paediatricians, to identify correctly these situations and attend to them adequately. This programme is only implemented in 30% of the area of Catalonia. Therefore, the majority of areas do not have this support and this hampers paediatricians from detecting mental health cases.

We are continuously stating that it’s not just accessing the resource or the service, but that by accessing patients can find the care that they really need. This is an approach that enables a real and total response to people to be provided, and that also facilitates access from a more therapeutic approach: psychological support, educational support and all the aspects that also facilitate access to care.

  • How can the integration of physical and mental health contribute to achieving all the goals the report proposes?

This is another key aspect of the report: the need to integrate the various healthcare networks. Some weeks ago, the journalist, Carles Capdevila, mentioned that we can’t slice people into cubes and take care of one part, one finger, one foot, because the human body is a whole. The report highlights the great difficulties in the health system of working in a network. That means that we reach agreements to assess a preliminary, joint, approximate diagnosis, that identifies what children’s needs are, and establish a common work plan and use joint assessment tools.

All these are still done separately; thus, this integrated approach is vitally needed. The report pointed out the need to establish a functional unit, not only to coordinate us and divide up the work, but also to work together with a common work plan, sharing goals and putting the individuals at the centre of the approach.

Another challenge included in the report is how we involve families and children to participate in this integrated team: how they get engaged, participate and how do we understand their needs. We still find these difficult to do. Often, we’re not capable of visualising their real needs. We see what I as a professional can see or those seen by another professional, which may be different, but not the ones seen by patients. It is even difficult for us to share the work plan with them.

  • As part of the suggested roadmap of resources, do you also recommend collecting the educational background of professionals?

One thing identified is that professionals have to be trained adequately to work with children and adolescents. One curious thing that the report shows is that mental health professionals have great knowledge on mental health, and teachers have deep knowledge on all educational aspects and educational tools…

If all the agents could know a bit more on the other’s professional field, we would be more capable of implementing this integrated approach. Joint training sessions are need to understand better what role each professional plays, to use a common language, to share information and knowledge.

  • Has the report got any impact on the public administration?  

We are relatively satisfied. The report has been received positively by the authorities. Representatives from different ministries of the Government of Catalonia attended the release of the report. They have also given us their verbal commitment to implement some of the recommendations.

They’re also aware of many of the weaknesses identified and they’re committed, for instance, to improving the capacity of children’s and adolescents’ mental health centres, and to revising the education model on mental health, which is not a specific model. Currently, we attend children taking care of their special needs, which is good, but we must think more deeply on what to do with these children. We will see if these verbal commitments are reflected in firm proposals and in a serious political project.

In regard to promotion and prevention of mental health, we do understand that is more complex, but we would like a commitment from the authorities to improve them. Our goal is to advocate to achieve the goals of the report.