The Czech Republic is facing what doctors describe as a critical shortage of child psychiatrists. Although the government is taking steps to address the problem, children in need of care now spend months waiting for an appointment.
Martin Hollý, photo: Alžběta Švarcová
Ten percent of Czech children suffer from hyperactivity (known in medical terms as ADHD syndrome), anxiety and even depression. With prompt medical attention these problems can be successfully dealt with but very often they are left undetected or unaddressed. The Czech Medical Chamber now registers 70 child psychiatrists for the entire Czech Republic, which means there are 300,000 children per specialist. Dr. Martin Holy, head of the child psychiatry ward at Bohnice hospital, says that overlooking or underestimating behavioral problems in children may have serious consequences.
“Two problem areas that I would mention are ADHD which many children have and also cases of mild autism which can both go undetected for quite long unless the child is seen by a psychiatrist. In both cases the symptoms are often ascribed to a lack of discipline and attempts to treat it as such create a vicious circle. These are neurological problems and when they fail to get proper treatment they become worse and can severely damage the children’s development, their behavior becomes increasingly problematic, they lack friends and appear anti-social. So by addressing the problem at an early age we can prevent many future problems.”
Photo: S. Braswell / Stock.XCHNG
Apart from long waiting periods for appointments and lateness in addressing the problems the shortage has another serious consequence that has been criticized by the Ombudsman - children in need of care are hospitalized for longer than would be necessary if they could get good outpatient care in their place of residence. In addition to the most common problem among young children, ADHD, more and more teenage girls are suffering from anorexia and bulimia. Besides the country’s three psychiatric clinics for children, ten of the country’s hospitals have psychiatric wards. However the network of 70 psychiatrists providing outpatient care around the country is woefully inadequate. A third of those specialists are close to retirement age and replacements are hard to find. The problem is that child psychiatry has not been a separate line of study at Czech universities for some years, students have had to graduate in psychiatry and then specialize in child psychiatry which takes an additional eight years on average and most give up on the idea soon after starting work. The government has now moved to change that and child psychiatry will be reinstated as a separate line of study. However it will take several more years to see the result of this change in practice and Dr. Holy says that unlike in other areas it is not easy to fill the vacancies with foreign doctors.
“Since in psychiatry the basic diagnostic method is communication with the patient it is very difficult to fill vacancies with foreign specialists. They need to a have a very good working knowledge not just of the language but the culture and way of life and there are not many candidates who meet those criteria. So the idea of just filling the vacancies with foreign doctors does not work well –either in child psychiatry of psychiatry for adults.”