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Child and adolescent psychiatric care in Austria inadequate

Study finds too few training opportunities for specialists and too few treatment centres nationwide
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(Vienna, 19 January 2021) Since child and adolescent psychiatry became a medical discipline in its own right in 2007, Austria has seen an improvement in both the training of specialist doctors and the level of patient care. However, huge differences still persist between the federal provinces and there is a great need for reform in general. This is evidenced by a study by the two child and adolescent psychiatrists Rainer Fliedl and Andreas Karwautz from the Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP), which is housed at MedUni Vienna's Department of Child and Adolescent Psychiatry. Alongside the amendment of the "Mangelfachregelung" (underrepresented discipline regulation), a better funding structure and the creation of additional treatment centres are urgently required. The study has been published in the journal "Neuropsychiatrie".

In Austria, "child and adolescent psychiatry" became a separate discipline on medical courses in 2007. The Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP) regularly gathers the healthcare data from all over the country to evaluate the progress that has been made in improving specialist provision. The recent study conducted by child and adolescent psychiatrists Rainer Fliedl and Andreas Karwautz from the ÖGKJP, which is housed at MedUni Vienna's Department of Child and Adolescent Psychiatry, analysed data from 2012 until 2019.

Based on the "Mental Health in Austrian Teenagers (MHAT) Study" (Andreas Karwautz and Gudrun Wagner 2017), the data showed that nearly every fourth adolescent in Austria suffers from a psychological disorder. According to Statistik Austria data from 2014, this affects 170,800 young people, 106,800 of whom require urgent treatment. Therapeutic provision is based on a staged model comprising separate building blocks, including various forms of inpatient and outpatient treatment. Overall, there is a need for interdisciplinarity as well as for provision of resources by the federal provinces, concludes the study.

In 2016, an extra 119 treatment places for inpatient child and adolescent psychiatric care were created throughout Austria. There are currently 12 hospital departments available, six of which have decentralised facilities with an outpatient clinic and five have decentralised facilities with places for day patients. There is also the Psychosocial Service's outpatient clinic and day clinic in Vienna. In total there are 22 outpatient facilities in Austria. Additional locations are urgently required, especially in the larger healthcare areas like Upper Austria and Styria. The proportion of day clinic treatment places has increased slightly since last year and the ratio to inpatient places is now 30% as against 70%. There is also a need to incorporate mobile treatment options such as home treatment, as is standard in many countries, for the diagnosis of eating disorders or autism, if long hospital stays are to be avoided. These services deploy an integrated mix of therapeutic modalities such as psychotherapy, occupational therapy, speech therapy, music therapy and physiotherapy, for example.  

Rainer Fliedl believes that there are many opportunities for development in the area of health-insurance-funded places, since, especially in Burgenland and in Styria, there are currently only private providers, although health-insurance-funded units could be made available immediately. There is also an urgent need to improve the situation regarding training, says Fliedl. It is important to train more than twenty specialists a year on a regular basis. At the moment, however, this quota is not always achieved, since the "Mangelfachregelung" has only resulted in a slight improvement in the training situation.

Fliedl: "Since healthcare planning first and foremost focuses on basic provision, all figures relate to this, but we must not forget that a comprehensive mental health service also requires highly specialised subdivisions for follow-on treatment and these need to be developed and will require extra resources." These resources must additionally be created for addiction treatment, parent-child therapy, psychosis prevention and inpatient psychotherapy, for example.

The fact that the situation is Austria is improving more slowly than in Germany or Scandinavia, for example, is due to historical failings, such as the lack of political will in the post-war years and the conservative attitude that prevailed in paediatric and adolescent medicine at that time. It was therefore a long time before it was possible to separate "Child and Adolescent Psychiatry" out from the regular syllabus as a discipline in its own right. "However, the incorporation of psychotherapeutic medicine into the discipline represents a quantum leap in the evolution of the specialisation and adds an extra dimension to the care provided," says Andreas Karwautz in his summing up.

Service: Neuropsychiatrie
Child and adolescent psychiatric provision 2019 in Austria – healthcare levels, current status and outlook. Rainer Fliedl, Berenike Ecker, Andreas Karwautz. (open access financed by MedUni Vienna)