Availability and accessibility of primary mental health services for adolescents: an overview of national recommendations and services in EU

Abstract

Background Mental health problems in adolescence can profoundly jeopardize adolescent current and future health and functioning. We aimed to describe existing recommendations and services regarding the delivery of primary mental health care for adolescents in 31 European countries. Methods Data on the availability and accessibility of primary mental health services were collected, as part of the Horizon 2020-funded project Models of Child Health Appraised. One expert from each country answered a closed items questionnaire during years 2017–18. Results All 31 participating countries had some policy or recommendations regarding the availability and accessibility of primary mental health services for adolescents, but their focus and implementation varied largely between and within countries. Only half of the participating countries had recommendations on screening adolescents for mental health issues and burdens. Merely a quarter of the countries had ambulatory facilities targeting specifically adolescents throughout the whole country. Just over half had some kind of suicide prevention programs. Same-day access to primary care in case of -health emergencies was possible in 21 countries, but often not throughout the whole country. Nineteen countries had strategies securing accessible mental health care for vulnerable adolescents. Conclusions Overall, around half of European countries had strategies securing access to various primary mental health care for adolescents. They frequently did not guarantee care over the whole country and often tackled a limited number of situations. EU countries should widen the range of policies and recommendations governing the delivery of mental health care to adolescents and monitor their implementation.

Developmental monitoring: benefits of a preventive health care system

“…The Dutch PCH system may thus be a valuable example of a developmental monitoring system for other countries. Such an example is especially needed, since the pediatric primary care system in many European countries is suboptimal due to 1) a relatively poor use of guidelines for mental health assessment [21], 2) limited availability of strategies securing access to various primary mental health care for adolescents [22], and 3) a shortage of school health professionals, who if available also frequently lack specific training in prevention [4]. Given this variation across Europe in pediatric primary care systems [21], our findings can in particular be considered benchmark data if assessing other pediatric primary care systems.…”

The Impact of COVID on Adolescent Mental Health, Self-Harm and Suicide: How Can Primary Care Provider Respond? A Position Paper of the European Academy of Pediatrics

“…( 9 , 22 , 35 , 37 – 40 ). The purpose of this scoping review is to outline how they can identify depression, self-harm and suicidal behavior in their everyday practice, taking into account the availability of specialized services and institutions ( 2 , 41 , 42 ). The content is based both on available evidences and the clinical experience of the authors.…”

“…In critical high risk situation, the most important measure to take is to ensure the short-term safety of the adolescent e.g., not leave her/him alone and removing potential means to die from suicide; this exploration should be carefully carried out and tackle all potential available means. Not all countries have a health care system that provides immediate access to specialized mental health facilities ( 41 ), and in some instance, this is not mandatory. If no psychiatrist is immediately available, with the support of the parents, sometimes the school staff, other trusted adults, it is possible to build a network and develop a plan that is accepted by the patient and other involved persons.…”

The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study

“…Compared with typical developing children/adolescents, underprivileged individuals living in disadvantaged socio-cultural environments (e.g., orphans, de facto unattended children/adolescents, "left-behind" children/adolescents, "single-parent" children/adolescents, and children/adolescents in especially difficult circumstances) experience greater psychiatric burdens and suicidal risks, 19 but are more likely to "dropped out" from primary healthcare systems, as the fact that healthcare centers or service providers are geographically limited to economically developed urban areas, as well easily accessed for children/adolescents who are under well-parenting only. 20,21 Therefore, we still need evidence to show whether underprivileged children/adolescents in LMICs equally benefit from psychological healthcare, examining whether such system provides equitable mental health rights int he real-world practices. In June 2022, the Nanchong, one of biggest lower and middle-economic-status city including over 60% children/adolescents who are in underprivileged conditions in the western China, instigated a citywide primary psychological healthcare system (the Psychological Health Guard for Children and Adolescents Project of China, CPHG) for all eligible children/adolescents, especially in five underprivileged cohorts (i.e., children/Adolescents in especially difficult circumstance, CEDC, "Single-parenting" children/adolescents, "Left-behind" children/adolescents, de facto unattended children/adolescents and orphan).…”