Is it time for child psychiatry to grow up?

The COVID-19 pandemic, psychologists' professional quality of life and mental health

Background

Psychologists are at known risk of work-related stress, secondary trauma, and burnout. The COVID-19 pandemic increased stress and anxiety for communities worldwide and corresponded with an increased demand for mental health services. Our study investigated the impact of COVID-19 on psychologists' professional quality of life, psychological symptoms, and work-related stress in Aotearoa, New Zealand (NZ).

Method

Ninety-nine registered psychologists were recruited via NZ professional psychology organizations, representing 3% of the total workforce. Survey data collected included symptoms of compassion fatigue and satisfaction, psychological symptoms, COVID-19-related stress and resilience, and professional and personal circumstances during the third year of the pandemic, 2022.

Results

Seventy percent reported that their work stress had increased, and 60% reported that their caseload intensity had increased during the COVID-19 pandemic. Psychologists reported receiving little to no additional personal or professional support, while 55% reported increased personal responsibilities during the pandemic (for example, closed childcare and schools during lockdowns). High rates of compassion fatigue (burnout and secondary traumatic stress) and low resilience were reported. We observed that psychological distress was higher than the community averages before the pandemic and comparable with frontline healthcare professionals. Compassion fatigue was associated with COVID-related stress, psychological distress, years in practice, and more frequent supervision, but not with working with at-risk clients, levels of personal support, or having children at home. Despite these difficulties, high Compassion Satisfaction scores were also reported, with over 90% indicating they had no intention of leaving the profession in the foreseeable future.

Conclusion

Psychologists' compassion fatigue appears to have worsened during the COVID-19 pandemic, as have their symptoms of psychological distress. Increased workplace and clinical demands, telehealth difficulties, stress relating to the pandemic, inadequate support, and increased personal responsibilities were reported by psychologists. Mental health workforces are not immune to the personal and professional impacts of crises and are at risk of burnout and secondary traumatic stress. We hope that increased awareness and understanding of psychologists' own difficulties during COVID-19 can be used to better tackle future crises and support mental health professionals.

Distress, waitlists and unmet needs: parents' reports of child psychological difficulties in Aotearoa New Zealand

OBJECTIVE

Demand for children's mental health services has increased in New Zealand, yet little is known of young children's experience of psychological difficulties and treatment. This study investigated psychological symptoms and treatment experiences among primary-aged children.

METHOD

An online survey of parents assessed children's anxiety, depression, attentional, emotional, conduct and peer problems, and experiences seeking psychological treatment.

RESULTS

Based on 382 parental reports, between 24.9 and 34.6% of children experienced abnormal-range symptoms. Older children had higher distress, depression, and anxiety. Boys had more conduct, hyperactivity, and peer problems. Ethnicity was not associated with the incidence of symptoms, but parents of Pākeha/European children reported greater impact than Māori parents. One-third of children had been referred for assessment; more often older children, and those with higher hyperactivity, impact, and anxiety. Parents reported difficulties accessing assessment, common barriers included waitlists (53%), cost (43%), and not knowing who to contact (36%). Following intervention, only 51% of parents reported improvements.

CONCLUSION

NZ primary-aged children are experiencing more symptoms of psychological distress than previously reported and extensive difficulties accessing treatment.

IMPLICATIONS FOR PUBLIC HEALTH

There is a need for further screening and increased access to treatment to prevent worsening mental health outcomes in children.

Short research article: COVID-19 and its impact on child and youth mental health service demand in the community and emergency department

BACKGROUND

To explore changes in child and youth mental health service (CYMHS) demand in Brisbane, Australia, following the COVID pandemic.

METHODS

The number of monthly presentations and referrals to respectively the emergency department (ED) and community CYMHS were compared among 2018, 2019 and 2020.

RESULTS

The study shows a marked increase in referrals to ED starting from July and in the community from May 2020. In the population referred to as community teams, the proportions of Indigenous children and those from lower socio-economic areas decreased.

CONCLUSIONS

The COVID-19 pandemic has aggravated the supply and demand disparity in CYMHS, with the largest effect on the most vulnerable families.

Young people don't tend to ask for help more than once: Child and adolescent psychiatrists' views on ailing mental health services for young New Zealanders

OBJECTIVES

To explore the views of New Zealand doctors working in child and adolescent psychiatry regarding the state of public mental health services.

METHODS

All practicing child and adolescent psychiatrists/advanced trainees were electronically surveyed in August 2021. Quantitative and qualitative analysis of feedback was undertaken.

RESULTS

Almost 100 specialists responded, an 80% response rate. High levels of dissatisfaction with current services and future service plans were identified. Content analysis identified an overarching theme that child and adolescent services were under great pressure, with subthemes of increased demand, a stretched workforce and social issues driving complex presentations. Recommendations were made for addressing workforce, service design and wider issues.

CONCLUSIONS

Multiple measures are needed to improve currently ailing child mental health services, including urgently expanding the number of psychiatrists and other clinical staff.

The making of child and adolescent psychiatrists in Australia and New Zealand

Child and adolescent psychiatry has an opportunity to adapt alongside the advancements in medical knowledge, post-graduate training, epidemiological realities and clinical service models. Here, we are guided by the mental health needs of our community's young and their families in our review of child and adolescent psychiatry training in Australia and New Zealand. We recognise that training must respond to clinical demand and service reform while ensuring a range of clinical and educational experiences to deliver expectable competencies in order to produce child and adolescent psychiatrists that meet the communities' needs now and in the future. We argue that training programmes be subject to rigorous evaluation by embedding continuing cycles of improvement including regular review and international bench marking.

Arguments for Keeping Child & Adolescent Psychiatry Focused on Persons Under 18 Years of Age

Child and adolescent psychiatrists and their associations are grappling with the idea of restructuring their subspecialty to including transitional age youth (TAY), sometimes operationalized as persons 18-25 years of age. This consideration is currently before the Canadian Academy of Child and Adolescent Psychiatry (CACAP). This essay identifies several concerning and potentially harmful consequences of widening the age range of child and adolescent psychiatry. A key concern is the consequential and substantial increase in the population mandate which will significantly dilute already strained and limited child and adolescent psychiatry resources. Furthermore, the nature of some of the needs of TAY may preferentially divert resources away from younger patients. The change in age range will also disrupt existing partnerships which facilitate multidisciplinary care and needed efficiencies for the child and adolescent population, such as close working ties with pediatrics and schools. This is not to say that there may not be merit in child and adolescent psychiatrists contributing to the care of TAY, just as our members already contribute to other areas of mental health outside our immediate mandate. However, to advance such a mandate change, a threshold of evidence of a net beneficial impact including a systematic evaluation of potential harms and opportunity costs is needed. Unfortunately, such an assessment has not yet occurred and therefore a mandate and name change is premature. We recommend a much more deliberate evaluation of the role child and adolescent psychiatrists and their associations might play in contributing to the needs of TAY.

Same proof, different pudding: comparative views of New Zealand child psychiatrists, child psychologists and child psychotherapists regarding a proposed national child and adolescent research network

OBJECTIVES

This study was undertaken to evaluate the views of New Zealand clinicians regarding a proposed national child and adolescent mental health research network.

METHODS

Child psychiatrists, child psychologists and child psychotherapists were invited to participate in an electronic survey describing their previous experience of research, current interest in research, barriers to undertaking research and interest in a national research network.

RESULTS

Responses were received from child psychiatrists (N = 33), child psychologists (N = 58) and child psychotherapists (N = 8), many of whom were clinicians and few of whom were researchers. Although most clinicians were interested in participating in future research, areas of interest differed between clinical groups. Clinician barriers to research included lack of time, lack of confidence and lack of research skills. Researcher barriers included lack of funding, time and administrative support. All groups were supportive of the development of a national research network.

CONCLUSIONS

Despite some different areas of interest, there appears to be sufficient combined support from New Zealand child psychiatrists, child psychologists and child psychotherapists to pursue the establishment of a national child and adolescent mental health research network.

A needs-based workforce model to deliver tertiary-level community mental health care for distressed infants, children, and adolescents in South Australia: a mixed-methods study

BACKGROUND

High-quality mental health services for infants, children, adolescents, and their families can improve outcomes for children exposed to early trauma. We sought to estimate the workforce needed to deliver tertiary-level community mental health care to all infants, children, adolescents, and their families in need using a generalisable model, applied to South Australia (SA).

METHODS

Workforce estimates were determined using a workforce planning model. Clinical need was established using data from the Longitudinal Study of Australian Children and the Young Minds Matter survey. Care requirements were derived by workshopping clinical pathways with multiprofessional panels, testing derived estimates through an online survey of clinicians.

FINDINGS

Prevalence of tertiary-level need, defined by severity and exposure to childhood adversities, was estimated at 5-8% across infancy and childhood, and 16% in mid-adolescence. The derived care pathway entailed reception, triage, and follow-up (mean 3 h per patient), core clinical management (mean 27 h per patient per year), psychiatric oversight (mean 4 h per patient per year), specialised clinical role (mean 12 h per patient per year), and socioeconomic support (mean 12 h per patient per year). The modelled clinical full-time equivalent was 947 people and budget was AU$126 million, more than five times the current service level.

INTERPRETATION

Our novel needs-based workforce model produced actionable estimates of the community workforce needed to address tertiary-level mental health needs in infants, children, adolescents, and their families in SA. A considerable expansion in the skilled workforce is needed to support young people facing current distress and associated family-based adversities. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.

FUNDING

National Health and Medical Research Council (Australia), Department of Health SA.