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Architecture and functioning of child and adolescent mental health services: a reply from Slovenia – Authors' reply
Correspondence
Architecture and functioning of child and adolescent mental health services: a reply from Slovenia In the September issue of The Lancet Psychiatry, Giulia Signorini and colleagues1 report an urgent need for substantial improvements in the planning, monitoring, and delivery of mental health services for children and adolescents in Europe. They present data from a 28-country survey in Europe and report that by the end of the quality check, they had been unable to obtain a response from six countries, one of them being Slovenia. According to this report,1 there are 34 child and adolescent mental health services (CAMHS) in Slovenia, which puts our country in second place in Europe (just after Finland) for sufficient services providing outpatient care. In this regard, the Slovenian Association for Child and Adolescent Psychiatry would like to stress that the data for Slovenia were provided by government representatives, who were unresponsive when reminded about the inconsistency of some of the provided data, most likely because of a different interpretation of the methodology. Being a small country, Slovene national professional organisations have access to hand-collected data on professionals working with children and adolescents, which we would like to present.2 According to the Signorini and colleagues definition of CAMHS,1 there are eight services in Slovenia that match the criteria (not 34), sadly ranking us somewhere in the bottom half of all European countries in the study, rather than in second place. At present, there are 27 practising child and adolescent psychiatrists in Slovenia (18 working in regional outpatient clinics, and 9 in hospital departments), some of them
not employed full-time. Fortunately, there are 28 trainee doctors in Slovenia working in child and adolescent psychiatry; however, there are no official guarantees these doctors will have permanent positions by the time they complete their training. Furthermore, there are 26 clinical psychologists working on an outpatient basis with children and adolescents with mental, developmental, or neuropsychiatric disorders, 3 clinical psychologists in psychiatric departments for children and adolescents, and 5 clinical psychologists in paediatric hospital departments, some of whom also work part-time with the adult population. Considering these figures, Slovenia does not have sufficient services for the provision of outpatient care for children and adolescents with mental health problems. As the Signorini and colleagues survey1 is an extremely important paper that could have a huge impact on policy making, we—the representatives of national organisations—would like the above corrected data to be considered by any readers. We declare no competing interests.
*Maja Drobnič Radobuljac, Mateja Hudoklin, Nataša Potočnik Dajčman, Hojka Gregorič Kumperscak [email protected] Slovenian Association for Child and Adolescent Psychiatry, Ljubljana, Slovenia (MDR, NPD, HGK); Medical Faculty, University of Ljubljana, Ljubljana, Slovenia (MDR); Unit for Adolescent Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia (MDR); Section for Child and Adolescent Clinical Psychology, Chamber of Clinical Psychologists of Slovenia, Ljubljana, Slovenia (MH); Department for Psychiatry, Medical Faculty, University of Maribor, Maribor, Slovenia (HGK); and Unit for Child and Adolescent Psychiatry, Clinical Centre Maribor, Maribor, Slovenia (HGK) 1
2
www.thelancet.com/psychiatry Vol 4 September 2017
Signorini G, Singh SP, Boricevic-Marsanic V, et al. Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe. Lancet Psychiatry 2017; 4: 715–24. Drobnič Radobuljac M. The state of child and adolescent psychiatry in Slovenia: a brief report. Eur Child Adolesc Psychiatry 2016; 25: 563–65.
Authors’ reply
We thank Maja Radobuljac and colleagues for highlighting potential discrepancies in the figures in our study1 relating to the availability of Child and Adolescent Mental Health Services (CAMHS) in Slovenia. The numbers suggested by Radobuljac and colleagues are much lower than those provided by key informants for Slovenia—Maja Zorko (National Institute of Public Health, Ljubljana) and Agata Zupančič (Slovenian Ministry of Health)—who replied to our survey. A possible explanation for this discrepancy might be that a different definition has been used for CAMHS. We appreciate all inputs that contribute to a more detailed picture of mental health-care services for children and adolescents in Europe. It is almost 10 years since the UK TRACK series of studies highlighted the shortage of robust and reliable data on CAMHS configuration, caseloads, and outcomes in UK services and it is disappointing to find that the same situation exists across the European Union. The centrality of mental health care in this crucial life period makes youth mental health an important issue, and we hope that European policy makers will take all the necessary steps to achieve effective provision of mental health services.
For more on UK CAMHS see http://www.netscc.ac.uk/hsdr/ files/project/SDO_FR_08-1613117_V01.pdf
We declare no competing interests.
Giovanni de Girolamo, *Giulia Signorini (on behalf of the MILESTONE investigators) [email protected] St John of God Clinical Research Centre, Brescia, 25125, Italy 1
Signorini G, Singh SP, Boricevic-Marsanic V, et al; the MILESTONE Consortium. Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe. Lancet Psychiatry 2017; 4: 715–24.
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Architecture and functioning of child and adolescent mental health services: a reply from Slovenia In the September issue of The Lancet Psychiatry, Giulia Signorini and colleagues1 report an urgent need for substantial improvements in the planning, monitoring, and delivery of mental health services for children and adolescents in Europe. They present data from a 28-country survey in Europe and report that by the end of the quality check, they had been unable to obtain a response from six countries, one of them being Slovenia. According to this report,1 there are 34 child and adolescent mental health services (CAMHS) in Slovenia, which puts our country in second place in Europe (just after Finland) for sufficient services providing outpatient care. In this regard, the Slovenian Association for Child and Adolescent Psychiatry would like to stress that the data for Slovenia were provided by government representatives, who were unresponsive when reminded about the inconsistency of some of the provided data, most likely because of a different interpretation of the methodology. Being a small country, Slovene national professional organisations have access to hand-collected data on professionals working with children and adolescents, which we would like to present.2 According to the Signorini and colleagues definition of CAMHS,1 there are eight services in Slovenia that match the criteria (not 34), sadly ranking us somewhere in the bottom half of all European countries in the study, rather than in second place. At present, there are 27 practising child and adolescent psychiatrists in Slovenia (18 working in regional outpatient clinics, and 9 in hospital departments), some of them
not employed full-time. Fortunately, there are 28 trainee doctors in Slovenia working in child and adolescent psychiatry; however, there are no official guarantees these doctors will have permanent positions by the time they complete their training. Furthermore, there are 26 clinical psychologists working on an outpatient basis with children and adolescents with mental, developmental, or neuropsychiatric disorders, 3 clinical psychologists in psychiatric departments for children and adolescents, and 5 clinical psychologists in paediatric hospital departments, some of whom also work part-time with the adult population. Considering these figures, Slovenia does not have sufficient services for the provision of outpatient care for children and adolescents with mental health problems. As the Signorini and colleagues survey1 is an extremely important paper that could have a huge impact on policy making, we—the representatives of national organisations—would like the above corrected data to be considered by any readers. We declare no competing interests.
*Maja Drobnič Radobuljac, Mateja Hudoklin, Nataša Potočnik Dajčman, Hojka Gregorič Kumperscak [email protected] Slovenian Association for Child and Adolescent Psychiatry, Ljubljana, Slovenia (MDR, NPD, HGK); Medical Faculty, University of Ljubljana, Ljubljana, Slovenia (MDR); Unit for Adolescent Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia (MDR); Section for Child and Adolescent Clinical Psychology, Chamber of Clinical Psychologists of Slovenia, Ljubljana, Slovenia (MH); Department for Psychiatry, Medical Faculty, University of Maribor, Maribor, Slovenia (HGK); and Unit for Child and Adolescent Psychiatry, Clinical Centre Maribor, Maribor, Slovenia (HGK) 1
2
www.thelancet.com/psychiatry Vol 4 September 2017
Signorini G, Singh SP, Boricevic-Marsanic V, et al. Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe. Lancet Psychiatry 2017; 4: 715–24. Drobnič Radobuljac M. The state of child and adolescent psychiatry in Slovenia: a brief report. Eur Child Adolesc Psychiatry 2016; 25: 563–65.
Authors’ reply
We thank Maja Radobuljac and colleagues for highlighting potential discrepancies in the figures in our study1 relating to the availability of Child and Adolescent Mental Health Services (CAMHS) in Slovenia. The numbers suggested by Radobuljac and colleagues are much lower than those provided by key informants for Slovenia—Maja Zorko (National Institute of Public Health, Ljubljana) and Agata Zupančič (Slovenian Ministry of Health)—who replied to our survey. A possible explanation for this discrepancy might be that a different definition has been used for CAMHS. We appreciate all inputs that contribute to a more detailed picture of mental health-care services for children and adolescents in Europe. It is almost 10 years since the UK TRACK series of studies highlighted the shortage of robust and reliable data on CAMHS configuration, caseloads, and outcomes in UK services and it is disappointing to find that the same situation exists across the European Union. The centrality of mental health care in this crucial life period makes youth mental health an important issue, and we hope that European policy makers will take all the necessary steps to achieve effective provision of mental health services.
For more on UK CAMHS see http://www.netscc.ac.uk/hsdr/ files/project/SDO_FR_08-1613117_V01.pdf
We declare no competing interests.
Giovanni de Girolamo, *Giulia Signorini (on behalf of the MILESTONE investigators) [email protected] St John of God Clinical Research Centre, Brescia, 25125, Italy 1
Signorini G, Singh SP, Boricevic-Marsanic V, et al; the MILESTONE Consortium. Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe. Lancet Psychiatry 2017; 4: 715–24.
e20