Psychiatry: The provision of medical care to children and adolescents is severely inadequate

During the COVID-19 pandemic, the mental health of children and adolescents has deteriorated worldwide. Targeted and effective care for children and adolescents with mental illnesses is particularly important in order to minimise the – in some cases severe – personal consequences for those affected. The illnesses often persist into adulthood and can lead to reduced gainful employment. This can result in long-term costs in the sectors of health care and social services. There are strategies in place in Austria to counter this, but their implementation is lacking, as the Austrian Court of Audit notes in the report „Child and adolescent psychiatry – care planning and implementation“  („Kinder- und Jugendpsychiatrie – Versorgungsplanung und Umsetzung“), published today. For example, social security services for children and adolescents receiving clinical psychological and psychotherapeutic care should be expanded according to their needs. Furthermore, the ACA sees a need for action to ensure multi-professional care coordinated between medical specialists and other healthcare professions involved in patient care. The audit period principally covered the years of 2017 to 2023.

The current state of child and adolescent psychiatric care in Austria

According to a study by the University of Vienna, less than half of children and adolescents with mental illness were receiving treatment in 2014. After the introduction of the specialised field of child and adolescent psychiatry in 2007, appropriate diagnostic and therapeutic services were developed insufficiently and too late. Therefore, their availability is inadequate.

The Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (Österreichische Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, ÖGKJP), the Austrian Institute for Health Technology Assessment and the Ombudsman Board have all called attention to inadequate care in the field of child and adolescent psychiatry. In 2023, the then Minister of Health also assumed a very high unmet need for care, as was in the past.

Insufficient care in twelve of 32 regions

In 2022, according to the assessment of the Ministry of Health, at least 12 out of 32 health care regions were experiencing inadequate outpatient services. In 2024, the results of mystery calls carried out on behalf of the Vienna Medical Chamber showed that, in Vienna, the average waiting time for an appointment with a child and adolescent psychiatrist contracted to the health insurance funds was 90 days.

Strategy documents without clear objectives

After the introduction of the specialised field of child and adolescent psychiatry, the Ministry of Health and the social security system expressed, through strategy documents, their intention to improve the care of children and adolescents with mental health disorders.

In those documents, the Ministry identified the following areas to work on: rapidly expanding inpatient structures as well as increasing and fully utilising their training capacities, creating new positions contracted to the social insurance system for specialists in child and adolescent psychiatry, extending care provision to multi-professional settings by involving multi-professional facilities and therapists in private practice who have received training in working with children, and establishing networks between all services.

However, clear goals, benchmarks, and concrete implementation measures were lacking. These would be particularly necessary to address the insufficient care provision and to develop care structures.

Expanding social security services in accordance with the needs 

The Ministry of Health responded to these shortcomings with the project „Healthy out of the crisis“ („Gesund aus der Krise“), which aims to strengthen the psychosocial health of children and adolescents in the wake of the COVID-19 pandemic by providing prompt temporary care.

Funding of 50.12 million euros was approved for the project. It was designed to be separate from the standard care financed by social security and was therefore not included in the planning of care provision.

With this project, the Ministry wanted to create an easily accessible free service in order to be able to respond quickly to the increased demand for psychosocial support for children and adolescents. Affected children and adolescents were able to receive 15 free sessions with a clinical psychologist, a health psychologist or a psychotherapist.

The ACA acknowledges the efforts made, but criticises the fact that the Ministry of Health used funds from the federal budget to finance services that fell within the remit of social security. It therefore recommends a need-based expansion of social security services in the clinical psychological and psychotherapeutic care of children and adolescents.

The ACA stands by this recommendation, even in the face of the precarious financial situation of the Austrian Health Insurance Fund, as mental illnesses in children and adolescents often persist into adulthood and can lead to reduced gainful employment and result in long-term costs in the sectors of health care and social services.

Improving the coordination between healthcare professions involved in patient care

Additionally, the ACA recommends improving the coordination between medical specialists and other healthcare professions involved in patient care, such as psychotherapy and clinical psychology, sociotherapy and occupational therapy. This would also be in line with the multi-professional care planned by the Ministry. Furthermore, a specialization in child and adolescent psychiatry in other specialized fields such as paediatrics, adolescent medicine, general practice and family medicine, should be examined. Further work is also needed in the area of preventive services, which should be, for example, expanded in schools.