Proposition 52K1477

Proposition de résolution relative aux droits des enfants et des adolescents séjournant en hôpitaux ou en services psychiatriques.

General information ¶

Authors

Ecolo Muriel Gerkens
Groen Tinne Van der Straeten

Submission date

Oct. 14, 2008

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

child resolution of parliament psychiatry children's rights medical institution

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP Open Vld N-VA LDD MR VB

Contact form ¶

Do you have a question or request regarding this proposition? Select the most appropriate option for your request and I will get back to you shortly.

Discussion ¶

Dec. 3, 2009 | Plenary session (Chamber of representatives)

Full source

Ms Katia della Faille de Leverghem, rapporteur, refers to her written report.

My presentation will be short. First and foremost, I would like to thank my colleagues, the initiator, Mrs. Gerkens, and all the committee members who positively participated in the debate. It supports the resolution on the rights of the sick child on which we voted here before the holiday in the plenary session.

We focus our attention on the most vulnerable group, especially the children in psychiatry. Child and Youth Psychiatry is a very old one. It has been on the political agenda for more than a decade, but on the ground it is unfortunately not sufficiently visible. Although huge progress has been made in this sector, there is still a whole catalog of shortcomings and gaps that have been addressed in an extensive hearing.

I will limit myself to the most essential gaps that we are trying to remove with this resolution. The problem of waiting lists can be quite overwhelming. People who are faced with a child, a younger or an adolescent with psychiatric problems know that waiting times from six months to one year are no exception. This is ⁇ the most obvious hassle point.

Second, we must bear in mind the huge shortages: a lack of respect, a lack of incentives to make this sector attractive to enough people, not only to psychiatrists, but of course also to nurses and psychologists. Therapies should be able to float seamlessly together.

Third, one of the challenges is the continuity of care. After all, it is not obvious that a young person with, for example, suicidal tendencies is included in a crisis situation, but after that crisis situation does not find connection in an appropriate therapeutic setting. Unfortunately, this often has dramatic consequences for the child, the environment, the family and all involved parties.

That need for continuity was also one of the major troubles during the discussion.

The painful problem of forced capture versus voluntary capture has also been addressed, but we cannot, of course, resolve that with a resolution. Of course, this also requires the contribution of colleagues from the Committee on Justice.

However, we have not moved around this topic. On the contrary, it has been very clearly discussed. It is obvious that children cannot be included in a department intended for adults. That is not only theoretically beyond the rights of the child, it is also an allegation of proper assistance.

I would also like to pause on the needs, as Professor Deboutte expressed them very clearly. That is, the care and supply-driven policy that is still used today is transformed into a demand-driven policy, especially when children and young people are involved.

If one sees that there are often recalls that would not be needed if the material and social context had been resolved, then it is clear that an offer-driven policy is no longer of this time. We are very clearly calling for a question-driven policy, with the necessary attention to adequate alternative forms of care such as outreaching.

During the budget discussion in the committee, the minister also said that funds would go to outreach projects. It would also be good that these are no longer outreach projects, but an essential part of care in pediatric psychiatry.

Another point that was new to most of us, not least to the sector itself, is the differentiation on the department. Currently these are age-related groups. This should evolve into maturity-related groups. I think this also matches the demand for continuity and care on measure.

Ladies and gentlemen, I could end with this. I think I have listed a catalog of the most crucial troubles. I am pleased that this has been put again on the agenda by the colleagues. All colleagues in the Public Health Committee have worked on this. Work has been done for a long time.

I think that the honour also belongs to Ms. Gerkens for the synthesis of the various proposals of the various factions that she has made into a text behind which everyone could square.

Let us hope that this is the last time that we should put the problem of pedopsychiatry, of youth and child psychiatry on the political agenda, but that one can join with an offer and an appreciation for all the people who in this sector give the best of themselves, because they are pioneers and almost piece by piece volunteers who are dedicated to this sector with heart and soul.

First of all, I would like to thank Mrs Avontroodt for starting the work on better taking into account the needs of sick children.

We had agreed to separate work and political review from the situation of such care for children suffering from mental or psychiatric disorders because this is a ⁇ sensitive situation. It is quite surprising to see how these mentally ill patients are so discriminated against other people. This phenomenon is already seen in children.

In 2006, a royal decree of 13 July on pediatric care programs provided interesting answers to improve childcare in hospital pediatric services. Children suffering from mental disorders were, however, not taken into account by this decree because they perform the so-called services K. This means that 60,000 children are taken care of by these services or psychiatric hospitals each year.

At the beginning of our work, there was little unanimity on the subject. If we started them, it is that UNICEF Belgium had conducted an investigation that led in 2008 to recommendations highlighting that the rights of these children were not respected, that they were little involved in the choice of treatments that concerned them, that it was difficult for them to maintain the connection with their families, that these families were often perceived as an obstacle and that it was unusual to involve them in the treatment that concerned them.

Therefore, we organized hearings. It turned out clearly that the actors, all those who work with these children and adolescents on a daily basis, felt indispensable to adopt such a resolution. The resolution recalls the foundations of their intervention. They allowed us to clarify both the problems encountered, the analysis of these problems and the solutions that could be adopted.

In summary, we must consider that children, including those in service or in a psychiatric hospital, should benefit from the rights included in the United Nations Convention on the Rights of the Child, but also in the Patient Rights Act. These laws and conventions imply that they are informed of what happens to them and the treatments that will be offered to them. These explanations and implications must be made through a language and a way that enables them to understand, to be co-actors or to participate in the decision made about them.

Especially because among these children, some are placed by force. Some children are in these services, for having committed a crime, a fact qualified as an offence for minors; others, because they are threatened by the family due to problems of abuse or violence; others more because they are considered dangerous for themselves or for others. These children, assigned to services called for K, are obviously even more vulnerable than others in terms of respect for their rights and the involvement necessary for them to participate in the treatment that is offered to them. The same goes for their family.

During the hearings, what appeared obviously is the need for better coordination between hospital services, outpatient mental health services, from mental health centers to day care centers for example, but also all services that do not depend on Health. This is the case with teaching, for which the hearings showed us that if children stay longer than agreed in hospital services, it is because they could not enroll in a school in the middle of a school year.

Certainly, we are out of the field of federal competence, but it is important that we can – that is what the resolution calls for – collaborate with federal entities to allow, for example, the enrollment of children during the school year, which would allow them to continue their school course and leave that hospital or specialized services.

It was also apparent that the connection with the youth assistance and protection services also needed to be improved, so that these children could reintegrate into their living environment. Through these interventions, which depend on federal entities, they will no longer be obliged to stay in or to resort, in a mandatory manner, to the psychiatric service in hospitals.

Another problem has emerged sharply during the hearings; it is the training of pediatric psychiatrists. It is missing. This lack is due in particular to the fact that the conditions for internships are ⁇ strict and allow only a very small number of candidates to train; in fact, internships can only be carried out in hospitals. As with other doctors, these are university hospitals and a few peripheral hospitals.

Therefore, in accordance with the request that has been addressed to us, we request in the resolution to expand the framework of possible internships for pediatricians who specialize in psychiatry so that they can work in institutions, mental health centers or day care centers.

It is quite surprising to find that it is such elements that prevent the satisfaction of these children’s needs. But other difficulties exist, such as, for example, encouraging young graduates to work in emergency services that welcome patients in crisis. Indeed, young pediatricians in training are less likely to exercise in these services.

Furthermore, as Ms Avontroodt has already pointed out, it is important to set up spaces in hospitals reserved for children and adolescents, and to set up them by providing living units that correspond to the developmental capabilities of these children and adolescents. Indeed, if you have fixed age-based categories or categories so wide that children aged 3 to 15 meet together, it is difficult to meet their needs.

The need for all actors to address this problem has also emerged, whether it is specialized hospitals or not, with the option or not of units for children with mental health problems, external health services, outpatient services or open environment assistance that depend on federated entities. Action should be taken by developing a real mental health program for children. It is impossible to meet their needs and provide varied and complementary answers without adopting a broader vision and without taking into account the difficulties encountered, the needs, partners and how to respect the rights of children and the family dynamics indispensable for their reintegration.

I have therefore presented to you all the requests expressed in this resolution.

I would like to thank all members of the Health Committee for accepting to work on this text. The work was not easy. Indeed, the subject was complex, the prior awareness was quite low, and the whole had to be dealt with in a difficult budgetary context. Among parliamentarians who are better aware of the subject, or who sometimes manage hospitals, there was a sense of concern over the demands made in the resolution as they require budget adjustments and a distribution of envelopes within hospital structures. I would like to thank them for overcoming these fears in order to lead to this text.

I also thank the Minister of Health for incorporating in his 2010 general policy note a study requested by the Kenniscentrum on the mental health of children and for planning to extend the pilot outreach projects. These are two small elements that allow to embrace on the ambulance and on the use of the network. Finally, this may also allow you to have a comprehensive view of the needs and responses to be brought.

In conclusion, I would like to thank again my colleagues for accepting to work on this text for months.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. In my turn, I would like to thank her very sincerely. In fact, starting with a proposal for a resolution on the rights of children hospitalized in pediatric psychiatry, which was inspired by the call of UNICEF Belgium of 9 April 2008, it allowed a very broad debate on the care of young people in all areas of mental health.

This is how we were able to organize, on his initiative, ⁇ edifying hearings on the current policy of care as well as on the many reflections that should allow us to better understand the specificity of psychiatry for children and adolescents.

We were able to discuss with prominent professors and heads of hospital services, who confirmed the need to respect the rights of hospitalized children – which was the initial vocation of the proposed resolution – but who also and above all expressed their concerns and recommendations to complement and coordinate child care at all levels.

And I would like here, in the plenary session, to warmly thank all those professionals of childhood and adolescence who have devoted many hours of their precious time to explain to us the difficulties and the specificity of their heavy task.

We talked about the rights of hospitalized children, of course, but we also talked a lot about the recognition of the professional specialty of child care, the legal framework or rather the absence of an appropriate legal framework for the forced treatment of children in mental health, the duration of the stay of hospitalizations and the need for an informed consent of parents, the need to provide for the reception of the child after his hospitalization, from the beginning of it, the institutional multiplicity in terms of responsibility in the care of children, the programming of the services and institutions for the care of children and adolescents, which is unfortunately no longer adapted to the real needs, the possibility of taking care of the child after his hospitalization, in order to avoid a degradation that would lead to hospitalization, the absence of standard for an appropriate place in the course of a school year in a hospital and even for the training of specialized schools and rejuvenation, the possibility of alternating psychiatrists to find the most possible but especially the lack of specialized care.

In conclusion, dear colleagues, this is indeed a concerted global programme of mental health that we need to establish as soon as possible. And I think I can say that the Minister has heard this call since she talks about this necessity and her willingness to move forward in her 2010 general policy note.

As for our committee, we unanimously decided to extend the subject of the resolution to all the psychiatric services and to develop precise recommendations on all the topics that have been addressed.

I would like to conclude this speech by thanking all the members of the committee for their sincere contribution to this important reflection. It is undoubted that my group will enthusiastically support the draft resolution as amended and voted today. We will therefore observe with the greatest interest the practical measures that will be developed by the government in consultation with the sector in the coming months.

I would like to join the previous speakers, who mainly pointed out the ⁇ constructive cooperation and the ⁇ enlightening, interesting hearings on the current, important topic.

Members of the Committee on Public Health have devoted no less than ten meetings to the preparation of the present consensus text, across party boundaries. The text is more than worthwhile. After all, mental health care in general and the problem of children with psychiatric problems in particular deserve more attention.

Turn it or turn it as you want, mental health care remains partially in the taboo sphere and must urgently be removed from that taboo sphere. The supply of care should be aligned as much as possible with the demand for care. In particular, there should be sufficient space for individual treatment and guidance paths.

Adults and especially children and adolescents who are in some form of psychiatric care should be fully appreciated and respected.

Compared to somatic health care, mental health care is still too little addressed. Mental health is often also a complex given, in which, in addition to biological factors, also relational factors, family conditions, work and other contextual factors play a role. Therefore, mental health care is given a complex. Often, networks are needed to deal with the complexity.

The classic concept of hospital beds is insufficient and a new care concept is needed. Article 107ter of the Hospital Act, which has also been frequently discussed during the committee meetings in recent months, provides in the aforementioned framework and with regard to financing the possibility to switch from the static data of the nursing day price to the flexible data of care networks and care circuits around the patient.

The aforementioned system is also conceived around age groups. In addition, a specific approach for children and young people will be possible.

The fact that the aforementioned article is currently being implemented and has received much attention in the policy note creates new possibilities. We want to emphasize that this is a good thing.

Furthermore, as already cited, we believe that the profession of child psychiatrist should be appreciated more, starting with creating more opportunities for internship.

Our group has proposed fifteen substantive text amendments to the proposers of the resolution, after attentively listening to the concerns of the pediatricians and chiefs of services heard in the committee. As mentioned earlier, we would like to expressly thank them for the precious time they have invested in the above-mentioned hearings and for their explanatory and, above all, motivated presentations.

For CD&V it was important that the present resolution addressed the following four aspects.

First and foremost, there is the aspect of talking about children and adolescents, given the possible differences in the treatment and approach, including in the way the patient is informed. It is a right that is incorporated in the Patient Rights Act of 2002 and that also applies to minors.

Second, we emphasized that the care offer should be aligned as best as possible with the care demand with individual treatment and guidance paths.

A third aspect was that sufficient autonomy should also be given to hospital services so that they can provide appropriate care in close consultation with the outpatient care. It should be a shared care, not two care circuits side by side.

Finally, we also asked attention to the forensic K-beds, places for minors who have committed an act defined as a crime.

The authors took these concerns into account and hopefully the consensus text has become a sufficiently strong signal that there is an urgent need for a coherent mental health policy, ⁇ for children and adolescents.

Finally, we reiterate our appreciation for the way this has been worked very constructively, across party boundaries.