Mental disorders in young people, the post-covid surge
Lockdown has triggered outbreaks that have specialists on alert as to whether the increase will continue
BarcelonaIf the mental health of adolescents and young people could be analysed as if it were a patient, the most appropriate diagnosis would be "acute stress and anxiety". Astrid Morer, president of the Catalan Society of Child and Adolescent Psychiatry, of the Academy of Medical Sciences of Catalonia, points out that in times of "high social vulnerability and stress" society responds with an increase in relapses or the onset of new disorders, a fact that was already noted in the economic crisis a decade ago. Thirty percent of the population admits that their emotional stability has been affected in this crisis, and the thermometer of the Hospital Sant Joan de Déu indicates that the emergency department has attended 50% more young people and, despite the fact that the majority of those who have attended presented with anxiety, psychosis, depression and eating disorders, there has been a notable increase in self-harm and suicide attempts. With the diagnosis in hand, the prescription is to allocate more resources and be more attentive to the evolution of what has been called the new pandemic wave.
Will this mean that these young people will be sick adults? It is estimated that 30% of these kids will need lifelong support. There is a lack of perspective to have the real and stable picture but we must take into account that the peak of cases is also explained by the fact that for months the population avoided going to the doctor except in case of emergency. Visits to mental health clinics were reduced by 40% and disorders did not begin to appear until school attendance returned and the health network was loosened. Professionals note that during the first months the smallest, those under 10, were the ones who expressed more emotional discomfort. "The routine has been broken, the space for socialisation among peers has been closed to them and they have been affected by economic changes at home, deaths without mourning, environmental fear", factors to which must be added the fact that adolescence is already a complicated stage in itself, because character is being shaped, says Montse Dolz, director of the mental health unit at Sant Joan de Déu, who points out that often all this cocktail means that a pathology is " mistaken" for the non-conformity of age.
More serious cases
The delay in care and diagnosis in the pandemic has meant that patients arrive in an advanced situation, through hospital emergencies and without first going through primary care, stresses the director of the Pla Director de Salut Mental i Addiccions, Jordi Blanch, who says that for the Department of Health the strategy is based on a good policy of "prevention rather than treatment". In this line, the psychiatrist Dolz adds the importance of "devoting efforts to a good screening" at the school stage to "save future pathologies and pathologise mild cases", taking into account that half of mental disorders debut - in medical jargon - before the age of 18, according to a recent study by Idibaps and the Clínic.
The pandemic has aggravated it, but it is a fact that young people and adolescents find it difficult to go to primary consultations and it is often "the mothers who make the consultation" when they notice a sudden change in their children's behaviour. Carlota Albuin, member of the mental health group of the CAMFiC (Catalan Society of Family and Community Medicine), points out that the concentration of staff and efforts on covid and the fact of prioritising online consultations have made the care process more difficult, especially among young people and adolescents, because taking into account the characteristics of the stage they are in "they don't open up easily to explain what is happening to them". There is a lack of time to dedicate to the patient - the historical demand of doctors - but professionals must also be taught to have "training to guide" these very young patients and make them see the need "to refer them to the CSMIJ", the special mental health centres for this group, the family doctor points out. "We need this time in the consultation room so that the interview with the young person is therapeutic; with haste and stress, a correct interaction is not established", says Albuin.
If young people accept the referral, they run up against waiting lists, which are longer than a month, and that is why families often opt for the short cut of the hospital emergency room. In this case, too, there are no reliable data and the department hopes to compile them in the coming months with an automatic register of all available resources, says Jordi Blanch, who is confident that the number of cases will stabilise due to the calm brought by the holidays and once the network has absorbed "the outbreak" of the upsurge in cases. "The cases that had to come out have already come out," he says. However, Morer warns that the evolution will depend on whether families can regain their composure and reduce the high level of precariousness, since emotional and mental comfort is closely related to socio-economic well-being.
Blanch assures that mental health has been on the Catalan's government agenda for years and is one of its priorities, but also admits that the network has a historical deficit of psychologists and that budget allocations should also be increased. From the UCA, the adolescent crisis unit of the Benito Menni center in Sant Boi, clinical psychologist Anna Robert points out the lack of "transition centres" for patients "between 18 and 25" to avoid, as happens now, that when they become 18 they are referred to adult services. "Many are lost in this step and that is why we must provide the CSMIJ with resources to make an accompaniment within the community", he says.
In the midst of professionals and institutions, what do the patients say? "We must first do away with social stigma, because mental health is the last barrier standing", stresses Àngels Bardají, president of Obertament, the organisation that fights against stigmatisation and which demands "a tripling of mental health budgets" because the waiting time for a visit diverts patients to private centres, with prices that are unaffordable for many families.