Proposition 53K1258

Proposition de résolution visant à améliorer la prise en charge des patients dans le domaine de la pédopsychiatrie.

General information ¶

Authors

MR Daniel Bacquelaine
PS | SP Colette Burgeon, Marie-Claire Lambert, Alain Mathot, Yvan Mayeur, Franco Seminara
Vooruit Maya Detiège

Submission date

Feb. 25, 2011

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

health policy young person child resolution of parliament psychiatry medical institution

Voting ¶

Voted to adopt

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

Voted to reject

VB

Contact form ¶

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Discussion ¶

Nov. 17, 2011 | Plenary session (Chamber of representatives)

Full source

The rapporteurs are the ladies Van Moer and Van Den Ende.

Mr. Speaker, Mrs. Van Den Ende and I refer to the written report.

Mr. Speaker, Mr. Prime Minister, this is an important proposal. In fact, it refers to a concrete and sensitive problem that is the help that the community, society, public authorities and the whole health sector can provide to people, including children, who suffer from psychiatric or behavioral pathologies. Therefore, it seems to me that we should support this resolution, which is initiated by Marie-Claire Lambert.

This initiative seems to us indeed happy: it tends to call for the mobilization of the executive power with regard to a subject directly affecting the existence of some of our youngest citizens.

This resolution proposal will undoubtedly require consultation with the federated entities, and this is where the quick execution of the resolution is somewhat compromised. In fact, this problem is multiple: it concerns schooling, the management of mental health centers, the programming of K services in hospitals, youth assistance, and I pass, that is, areas that depend on different instances. It is important to rely on sincere consultation to solve this problem that affects suffering children and adolescents and to help the field professionals who take care of them.

The proposal for a resolution looks at programming, i.e. the updating of the programming criteria for K beds, indispensable to best and objectively meet the needs of the population. We know that the programming of health needs is constantly evolving. In pediatric psychiatry more than elsewhere, the updating of criteria is important; I think of the availability of K beds, but also of their actual allocation.

Indeed, it is found that, very often, beds that should be reserved for pediatric psychiatry are occupied by adults sometimes suffering from other pathologies. Young people sometimes land in adult psychiatry or even in hospital beds that have nothing to do with psychiatry. There is therefore a profound deficiency in the response to the request for care and the rights of children and adolescents that are, de facto, limited – lack of adequate care. The lengthening of waiting lists leads to unsupported take-offs. The urgency is great.

We are also concerned about the lack of pediatric psychiatrists, probably due to the lack of places for internships, but also to the insufficient attractiveness of the activity. You know that many medical professions suffer from conditions for exercising the profession. Beyond the quotas and the numerus clausus questions, there really arises the problem of the adequacy between supply and demand in several health sectors.

In order to optimize pediatric psychiatric care, we must also focus on the establishment of hospital synergies, which already exist – especially in Liège, Mrs. Lambert – but the situation must ⁇ be improved. In the province I came from, eight hospital settlements have presented an action plan in this area. These infrastructures joined forces to improve the supply of psychiatric care for children and adolescents. The aim is to provide better reception, guide patients suffering from abuse, family mourning, suicidal tendencies, eating disorders, school phobias, etc. Many behavioral pathologies need to be taken into account. In the future, the number of K beds will also be increased.

After all, post-hospital follow-up is extremely important. It is important that children continue to be monitored after a possible hospitalization, both by the psychiatrist and by the entire team. In terms of continuity of care, it can also be interesting to organize an alternation between home care and hospitalization. We must be attentive to this.

For all these considerations, the MR group will support this text.

Various actions are proposed to ensure that children and adolescents affected by a pediatric psychiatric problem can benefit from quality hospital care.

Mr. Speaker, the proposal for a resolution on improving patient care in pediatric psychiatry raises a problem that the Public Health Committee concerns almost every legislature. A coherent distribution of hospital care is ⁇ relevant. I would also dare to advocate for a good geographical distribution, because accessibility in childcare is an important fact.

With this resolution, we focus on hospital care, but I think we should also pay attention to permanent follow-up and good guidance of children after their dismissal. After all, this personalized care, that guidance and follow-up can significantly reduce the influx of child psychiatry in hospitals. I would like to refer to the statements of prof. Destroyed during the previous legislature. Referring to the projects within the framework of article 107 of the Hospital Law, this must ⁇ become a point of attention and we can also look at the impact on hospital admission.

In the discussions, several colleagues have rightly pointed out the need for good cooperation between the various services across the borders of the various governments. Its importance can hardly be overestimated. I think that the experience we gain with those projects will also have to play a role in any adjustments to programming and recognition standards.

Finally, I ⁇ support the need for scientific research on child and youth psychiatry. As for the attractiveness of the profession of child psychiatrist, I would therefore like to agree with the years-long plea of my colleague Maggie De Block. To work on a re-alignment of the nomenclature giving priority to the revaluation of the intellectual act. That call, by the way, will benefit not only the child psychiatrists, but all specialists who have little technical performance.

Mr. Speaker, Mr. Prime Minister, dear colleagues, in February last year, I, together with other colleagues, submitted the proposal for a resolution which is submitted to you today and which is intended not only to relay the concerns of the field which I know ⁇ well but also to address the deficiencies found in the field of psychiatric care in the hospital of small and young patients.

Pedopsychiatry, this specialty is a health care area still unfortunately very confidential. The young people concerned and their surroundings struggle to admit, to recognize these mental pathologies that, for some, can be heavy, confusing, sometimes resulting from a disability, dependence or even a crime.

True, the mental illness of a child or adolescent is not obvious to anyone. This taboo may explain the gaps found in the care of these young patients. Too often yet, they do not receive adequate care, due to the lack of K beds, as has already been mentioned, due to the lack of pediatric psychiatrists, yet due to the lack of adequately adapted pediatric services in psychological care and psychosocial care. These deficiencies are hardly acceptable because they can sometimes seriously impair the future of these young children. It is therefore urgent to consider with realism and pragmatism the extent of this problem, especially since the demand for the matter continues to grow. According to various scientific instances, this trend will not diminish.

Today, according to the fourth health survey conducted in our country, ⁇ one in three young people between the ages of 15 and 24 are in psychological distress. Of course, any problem in this area does not require residential care. This care can be done at the level of outreaching, hospitalization, emergency services or even private consultations with a pediatric psychiatrist. The outgoing government has rightly emphasized the prevention and detection of mental problems as well as the quality and availability of home care that should be prioritized, especially when it comes to a child.

However, the hospital offer in pediatric psychiatry does not meet the needs of patients. Professionals in the industry would like to be able to remedy this. For example, the province of Liège has only 20 K beds for the approximately 23,000 children and adolescents living there.

With this text, we ask the government to evaluate the fragmentation and distribution of hospital care in pediatric psychiatry so that the supply in the matter coincides with the needs of the infanto-juvenile population. We also demand that this offer evolve and make it much more flexible. My intention is, therefore, to guarantee every child and every adolescent a varied psychiatric care, adapted to their situation and health status, and above all a quality care.

I am pleased that this draft resolution was welcomed favorably by all my colleagues in the Public Health Committee. I thank them very much.

Colleagues, the resolution proposal presented today represents a step forward in the care of children in need of psychiatric assistance. Belgium has long struggled with a shortage of child psychiatrists. Several child psychiatrists sounded the emergency bell. According to them, there are about 300 psychiatrists in our country. As a result, there is an enormous capacity shortage, which makes children unable or too late to go to the psychiatrist.

One of the reasons for the shortage of child psychiatrists is the lack of education. With an average of 12 per year, we really do not save it, ⁇ not if a part in the Netherlands is working. An estimated 25 to 30 Belgian child psychiatrists work in the Netherlands. According to them, the work is similar, but you would not only earn more in the Netherlands, but also – this is more important – the multidisciplinary teams are larger. Working in such a team ensures that one is stronger in order to do the necessary shipment in the notifications for crisis response. The references for recording can therefore be restricted.

Despite the recruitment movement that Belgium has made in recent years, the supply of care in child psychiatry can hardly meet the demand. Children’s psychiatrists in Belgium therefore often have too long days. Because of the undercrew, they also work under extremely heavy pressure. In the hospitals, unlike in the Netherlands, they have to do a large part of the shipments themselves. Due to the minimal administrative support, they sometimes make the first telephone contact themselves.

Despite previous policy choices aimed, among other things, at reducing the number of hospitalizations – I think of easing the path for health networks – there are still long waiting lists for consultations due to these problems.

I will give a few examples, which demonstrate how terrible the situation is. For a treatment reception, the waiting time can be up to more than 6 months. Urgent cases can sometimes be seen only after 2 or 3 weeks. Crisis intervention units capture a lot, but they only work for a short period. Many patients do not receive adequate follow-up care.

A consequence of the waiting lists is that some children in Belgium do not see a psychiatrist during their entire course of illness or come to a doctor when it is already too late. Sometimes children really need to be in a crisis before somewhere on the agenda can be released. It is important to emphasize that this is really not just about children with sleep disorders or educational problems. It is also important to mention that children with psychiatric problems who reach a doctor, due to a lack of K-beds, too often end up in beds of type A, for acute adult psychiatry. I hope for most of us that this will not happen to their own child, because I can imagine that as a child it is not easy to reach out to adults, let alone for those who need mental health care.

Given the importance of good mental health care, the lack of capacity is actually a blame for our Belgian healthcare system. It is therefore important that there is a change in perception about psychiatry in general and child psychiatry in particular. By today approving the draft resolution, we demonstrate that the political world dares to break the taboo that too often prevails around these disorders. This gradually creates a political view of child psychiatry as well.

The resolution should be the precursor to the development of a good long-term policy plan. By daring to invest in those young patients, one can save the parents and ⁇ the child a lot of suffering.

Mr. Speaker, the N-VA was very pleased with the initiative to put child psychiatry on the agenda of this Parliament. I am therefore largely in agreement with what the previous speakers have already said, but we still have a different point of view than most others.

The current social context plays an important role in this. There are a lot of newly assembled families and there are more and more families living in poverty and therefore also children in poverty.

This new social situation is accompanied by more unstable situations and this is also reflected in the increasing need for child psychiatry. It is also important not only to help children through acute or chronic child psychiatry, but to help them function within the framework in which they live, namely school and family.

At the same time, it is important to mention that this also concerns powers that affect not only the federal government, but ⁇ also the Communities.

Early reception of signals and accompanying early intervention are therefore fundamental in the problemology. Many organizations can be involved. Think of the child and the family and the doctor. They are ideally placed to assess the situation of the family.

The N-VA group also found it important to add an amendment in which we ask to finally work on the recognition of clinical psychologists. Children and young people in psychiatry are better off if the problem is addressed multidisciplinary. Psychosocial care should be strengthened.

This amendment was unanimously approved in the committee, for which I thank all my colleagues in the committee for public health. The future government is urged to work on the recognition of clinical psychologists.

Of course, the patient care in child psychiatry is urgently needed to be improved. No one can deny it and no one can object to it, even at a time when there is a need to save everywhere. At the federal level, this does not work well, but it will be done. There will also be savings in healthcare. Therefore, one should not surpass his powers here.

Our group is convinced that the improvement of patient care in pediatric psychiatry can only be achieved if better coordination between all actors and services involved in pediatric psychiatry for both the preventive and curative aspects as well as the follow-up and follow-up. This is only possible through a thorough homogenisation of mental health care at Community level.

We are not alone with this idea. Even in the institutional agreement for a sixth state reform for a more efficient federal state, the homogenisation of preventive health care and mental health care respectively is pushed forward by a transfer of powers to the Communities.

Communities face specific problems. One of the major problems in the field of mental health care for children and young people, especially in the border region between Flanders and the Netherlands, is the significant shortage of child psychiatrists. The reason is simple. A child psychiatrist who goes to work a few kilometers further north, in the Netherlands, often in much more pleasant conditions than in Belgium, is welcomed with open arms and can earn a lot more. Not much can be changed at the Flemish level today. Even with the sixth state reform, which is now being proposed, one could not change much on that, because, admit, that state reform is not a Copernican revolution at all, on the contrary.

The resolution that is being voted on today has no eye for this. Compared to the proposals for delegation of powers, which are currently in the process, this resolution is rather overdue.

Our group, the Flemish Interest Group, can, of course, not allow the proposal for the sixth state reform, which already has very little to do with the body, to extend even more by supporting this outdated resolution, no matter how meritorious the concerns of the applicants may be.

My colleagues and my party will ⁇ and firmly support this resolution. I find it only regrettable for the applicants that the resolution is almost identical to the 2009 resolution and that we must therefore repeat it. I regret that she is not present here, but I have understood from the minister, from various parliamentary questions, that there would be a plan “youth and children” for next year.

We ⁇ support the content of the resolution, namely that, as we do for adults in mental health care, within the framework of Article 107, we should also look more and more at the functioning of care circuits for children. This includes not only hospitals, but also local health centers, child psychiatrists and child psychologists. All levels must be included in the care circuit.

We will support the resolution today, but I really hope that this is the last time we have to support such a resolution. I also hope that soon there will be a Minister of Health who has a bill and a concrete plan for children and young people in mental health care.

Madame Detiège, I give you the word but do not resume the debate; it has already taken place.

Mrs. Muylle, the problem you cite is the poor functioning of the government or the previous government. I thought CD&V was still there. I do not understand these comments well.

Try to continue on the subject!

I would also like to emphasize that in this legislature there were still resolutions adopted that are a copy. I think of the resolution on medicines in rest homes. Only a few figures have changed. There is more happening, including from other parties.