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Youth Anxiety ‘Epidemic’ Shows Need for Paradigm Shift in Czech Mental Healthcare

Released on the eve of World Mental Health Day on October 10, a study by the Czech National Institute of Mental Health (NUDZ) made for difficult reading across the country.

It found that as many as 40 per cent of Czech ninth-graders showed signs of moderate to severe depression, and 30 per cent symptoms of anxiety – two distinct ills which can overlap.

While girls appeared twice as likely to exhibit such symptoms, they might simply “be more willing to talk about these issues”, surmised child therapist Iva Hadj Moussa on Czech Radio, while boys of the same age may be less prone to admit it, let alone talk about it openly.

More broadly, one in five kids aged 3-17 could be suffering from a mental illness, according to Czech psychiatric experts, and their numbers, especially among adolescent girls, have been skyrocketing over the last few years with sometimes tragic consequences.

The number of children with suicidal and self-harm tendencies has been following a similar upwards trend, and now manifests itself at a younger age than before, at about 13-14 years old. About 40 to 50 children are estimated to commit suicide every year in Czechia.

Pandemic repercussions

COVID-19 lockdowns, evidently, worked as a catalyst, with thousands of children developing mood swings and exhibiting acute symptoms of depression in the wake of the pandemic, according to the Czech Association of General Practitioners for Children and Adolescents.

But the factors to explain the general feeling of gloom seen among both young and old are manifold, spanning across the developed world with Czechia being no exception: the pandemic, war in Ukraine, daily bombardment of distressing news, cost-of-living crisis, in addition to more long-term trends linked to the overuse of technology and social media.

“You don’t inherit the disorder, but you get a predisposition for some trait,” psychotherapist Barbora Hrdlickova explains to BIRN, referring to the complex mix of biological, psychological and sociological factors at play.

In Czechia, young people aged 18-24 are considered the adults most prone to exhibiting symptoms of anxiety and depression, alongside women with children.

Confirming that feeling depressed is not the mere prerogative of confused adolescents, at least 700,000 Czechs are overall believed to suffer from clinical depression requiring treatment.

“Having a low mood or feeling sad and having been diagnosed with depressive disorder are two different things,” psychotherapist Barbora Hrdlickova stresses to BIRN. “As with all psychiatric disorders, there is no clear line between health and illness – meaning it’s not that one day you’re healthy as a horse and the next mad as a hatter. It doesn’t work like that. There is a continuum from positive mental health through mental distress to mental disorder.”

Acknowledging the difficulty of clearly differentiating between various degrees of anxiety and depression, she highlights the crucial role played by parents in the mental wellbeing of their children.

“Maybe the reason our children are so stressed is because we are so stressed as parents,” suggests child therapist Iva Hadj Moussa, an assessment that rang particularly true during months of lockdown isolation, and today at a time of economic and financial hardship for many.

With Czech adults themselves exhibiting high rates of depression and anxiety symptoms and among Europe’s most eager consumers of antidepressants, further infused with the greater negative stigma surrounding mental disorders than younger generations, they may in many cases not be the most discerning judges of their own mental wellbeing, let alone that of their children.

Near breaking point

The Czech mental healthcare system, which frontline workers and experts have long warned was fast reaching breaking point, appears unable to address what some now are calling “an epidemic”.

“I would describe the situation in child psychiatry as being at the absolute most critical point it can possibly be at,” Jan Uhlir from Ostrava University Hospital told Czech Television.

“Patients with mental health problems are increasing and the existing network of services, especially in outpatient clinics and psychiatric hospitals, is at the limit of its capabilities,” acknowledged Ondrej Jakob, a spokesperson for the Health Ministry.

A key reason for that is Czechia’s staggeringly low rate of child psychiatrists – only 180 of them according to Seznam Zpravy, including about half close to retirement age.

Requiring long studies, physically and psychologically gruelling working conditions, and suffering from a “not-so-stellar reputation within the medical field”, according to representatives from NGO Fokus Praha, the discipline is not attracting droves of new candidates.

“The health and social care system is facing a huge challenge on how to keep its good people, how not to let them burn out or run away somewhere else,” assessed Milan Pilat from the Department of Child Psychiatry at the Faculty Hospital in Brno.

With less than 600 child psychiatric beds for acute cases, scattered between the country’s three specialised child psychiatric hospitals and children’s wards in adult or psychiatric hospitals, Czechia is also suffering from an acute shortage of space.

At the same time, about 80,000 children were being treated for psychiatrist issues in early 2023 – the tip of the iceberg of those needing care, according to experts, who point to the months or even yearslong wait for an appointment for those actually seeking psychiatric treatment.

Diagnosed with mixed anxiety-depressive disorder (MADD) at the age of 17, Miriam, now a 23-year-old student at Prague’s Charles University, tells BIRN of her continuous ordeal to find appropriate therapeutic and psychiatric support.

“I once had to call about half a dozen psychiatry offices, but it’s very hard to find those that still accept new patients. Only one returned my call, and at the time I was already running low on the anti-depressants prescribed by a previous clinic,” she recounts, adding that she had to borrow some from a friend who was on the same medication in order not to run out completely.

Pointing to an overall negligent system of care often relying on quick medication to the detriment of long-term therapeutic treatment, Miriam describes how her last psychiatrist simply broke off contact once she informed her of her intention to gradually get off the medication – a process commonly requiring vigilant psychiatric supervision and follow-up.

Petr Winkler, head of the National Institute of Mental Health, warns direly that the acute shortage of psychologists and psychiatrists in Czechia “cannot be solved even with the best of wills and significant investments within the next few years”.

Echoing the general state of gloom, a damning 2022 report by iRozhlas.cz on the child psychiatric clinic in Louny, northern Bohemia, put the spotlight on years of neglect, bad practices and inhuman treatment towards patients – prompting widespread condemnation and calls for reform.

Paradigm shift

“The support of the [child psychiatric] field must be as massive as it has been neglected for decades,” Health Minister Vlastimil Valek has said, pledging to accelerate the government’s planned reform plans in view of the situation.

Key to the government’s push is a plan to expand the current network of 30 mental health centres – hybrid institutions comprising both health professionals and social workers that are designed to act as intermediaries between frontline doctors and specialised clinics.

Drawing on the success of the project’s early years, authorities hope to create a network of 100 of them by 2030, both for children and adults, and use them as a basis for wider reforms of the country’s mental healthcare system.

While experts worry that the funds and political will to follow through are already lacking, they appear generally positive about the plan. “The strength of these centres lies in a multidisciplinary approach that enables comprehensive support for clients in their place of residence and their community,” representatives from Fokus Praha, one of the leading NGOs in the field of mental health, tell BIRN.

“In the Czech Republic, there are still many people who are hospitalised in psychiatric hospitals, even though they could live at home and use the services provided by mental health centres,” they add, hinting at a necessary but difficult “paradigmatic shift that would be more effective for client recovery and from an economic point of view”.

The authorities are also considering building crisis care centres in every Czech region by 2030 – there are currently two in Prague and one in Brno – and improving the training of general practitioners and paediatricians to identify mental health issues among their younger patients.

NGOs focused on child therapy and psychiatry, like the House of Three Wishes (Dům tří přání), strive to offer appointments within a few weeks and the services of a therapist for several months. Others like Fokus Praha mainly focus on people older than 16 years old, and run prevention programs for teachers, pupils and students to prevent younger people from prematurely ending their studies as a result of a serious mental illness or temporary psychological crisis.

Alternative offerings implemented by or in cooperation with the private sector are also increasingly trying to bridge the gap with online therapies, crisis centres or investments in new facilities, like the Center for Mental Rehabilitation which recently opened in the Beroun Rehabilitation Hospital.

Nipping it in the bud

According to Petr Winkler from the National Institute of Mental Health, the key is to nip the problem in the bud with early intervention – mental health problems manifest themselves before the age of 14 in half of the cases, and three-quarters of mental illnesses in adults begin before turning 18.

“If there can be an effective network of psychological help in schools to identify problems at an early stage or before the onset of the illness, it would be money much better spent,” Milan Pilat from the Faculty Hospital in Brno told Seznam Zpravy.

Acknowledging that the educational system is not prepared to deal with the rise of ill-at-ease children, the Education Ministry’s commissioner for child welfare, Ferdinand Hrdlicka, insisted that every school should have a psychologist at hand to help.

Prevention, early detection and a strong community-based network of care and support are at the heart of the government’s reform plans, but require a radical paradigm shift in a country known for its culture of institutionalisation, hospitalisation and mental illness marginalisation, which experts note as a legacy of Communism seen across Central and Eastern Europe.

“Based on ideological reasons, the Communist regime [in Czechoslovakia] supported asylum-like psychiatric hospitals and excessively long hospitalisations of people with severe mental illnesses, encouraged stigmatising attitudes and centralised decision-making,” reads a 2021 study on the topic.

And while the stigma attached to mental health still keeps many from seeking professional help, an indirect and somewhat unexpected impact of the COVID-19 pandemic might have been to break social taboos about anxiety and depression, psychotherapist Barbora Hrdlickova explained to Czech Radio.

“The stigma of mental illness can be characterised as the feeling that such an individual is weak and just can’t cope. But COVID-19 [impacted] all of us. It [formed] a sort of shared experience to which people can empathise,” raising awareness that any and all can experience feelings of anxiety and depression, and that seeking help, whether from peers or professionals, is nothing to be ashamed of, she said.

“Nobody knows exactly the reason why young people report anxiety and depression symptoms more than earlier generations,” Hrdlickova admitted, positing the impact of COVID-19, social media and the ability to talk about it more openly.

“But the good news is that most young people don’t feel overwhelmed by it. It’s an excellent opportunity to launch preventive programs for students and teachers,” she added.

While a positive development, less stigma associated with mental illness puts an increased strain on an already overstretched and obsolete healthcare system. Until new solutions are found, the distressed call of its youth is only bound to grow louder.

Source : Balkan Insight