Doctor Caroline Culen: Austria - our children in crisis

Mental illness is one of the biggest public health challenges in the WHO regions and afflicts almost a quarter of the population as a whole. It also has a significant impact on children and young people.

Adolescence

Adolescence is a particularly vulnerable period, associated as it is with many physical,  psychodevelopmental and social changes and challenges.  It is therefore not surprising that around 50 per cent of all mental illness becomes apparent for the first time before the age of 14. Up to 75 per cent of all mental illness arises by early adulthood, at around 25 years.

There is a long established international body of knowledge about the frequency of mental illness in children and young people. The literature indicates that 15-20 per cent of young people between early childhood and the age of 20 suffer from a mental illness. Of those, 8-14 per cent present with symptoms which require diagnosis and treatment with as little delay as possible. 

Applied to Austria, these results from international studies indicate that of the approximately 1.73 million young people under the age of 19 (Statista 2021), around 250,000 have mental health problems which would require diagnosis and treatment.  

COVID-19 – a global stress factor

2020, 2021 and also 2022, the years of the coronavirus crisis, had consequences for the psyche and the quality of life of everyone. Depending on their situation and age, children and young people were particularly badly affected. Fundamental developmental stages such as leaving the parental home, extending their personal range of activity, establishing their own identity within a self-selected social peer group, exploring romance and sexuality and experiencing skill acquisition and self-efficacy were made much more difficult and frequently impossible. Instead, loneliness, hopelessness and anxiety were widespread.

Studies on the coronavirus and the psyche

Numerous Austrian studies have investigated the effects of the COVID-19 pandemic on the mental health of children and young people in detail.  Fifty-five per cent of the young people over the age of 14 questioned as part of a study by the Danube University Krems in cooperation with the Medical University of Vienna exhibited symptoms of depression. Almost half of them reported anxiety; 16 per cent had suicidal thoughts either daily or on more than half the days (Pieh et al 2021). Two-thirds of the six to 18-year-olds surveyed in a Salzburg study said that life was worse for them since the COVID-19 crisis than it had been before (Schabus et al. 2021). An investigation into the situation of apprentices, who make up a third of 15 year olds in Austria, found extreme stress with elevated levels of depression symptoms, anxiety and insomnia plus symptoms of eating disorders (Dale et al 2021).

Gender-specific differences

Girls and young women have suffered more. A study of children and Covid-19 by clinics in Tyrol indicated gender-specific differences.  As early as 2020 girls seemed to be more strongly affected than boys (Wenter et al. 2022). In surveys conducted by Salzburg University and Danube University Krems girls and young women indicated that they felt more stressed than male participants (who also felt very stressed). The symptoms specified in particular were low mood, anxiety and insomnia.  (Schabus und Eigl 2021, Dale et al. 2021).

Suicidality

A project for the Austrian Federal Ministry for Social Affairs, Health, Care and Consumer Protection to monitor psychosocial health noted from the beginning of 2021 clear indications of an increase in suicidal thoughts and suicide attempts, primarily in girls and young women. This is consistent with the findings from national and international studies (Kaltschik et al. 2022; Pieh et al. 2021; Schuler et al. 2022; Sevecke et al. 2022). However, a general increase in the rate of suicide was not seen by the end of 2021. The figures for 2022 are currently being analysed and, given the continuing high levels of mental stress elevated again by the war in Europe, the energy and the climate crises and the increased cost of living,  developments in 2023 are being closely monitored.

Obstacles to providing psychosocial care of children and young people

Obstacle one: A lack of affordable care and long waiting times

It has been known for many years that psychosocial health provision for children and young people in Austria needs many more resources beyond those funded by public authorities. In the Mental Health in Austrian Students (MHAT) study, for example, young people reported that they would like to receive advice and treatment but they either did not know where or how to access it or that they would have to pay for the care available to them.  As a result of the coronavirus pandemic, the media began to report on the long waiting times for therapy, on overbooked children and young people’s psychiatry and on the non-availability of outpatient appointments making the public increasingly aware of the problems in psychosocial care.

Obstacle two: Differences in socioeconomic background

Social inequality is reflected in the incidence of mental illness. In families with low levels of socioeconomic resources i.e. families with less money, children are 2.5 times more likely to suffer mental health problems than children in families with more socialeconomic reserves. There are many reasons for this, ranging from higher levels of stress to crises left untreated due to a lack of funding.

In Austria, there is a major imbalance in access to diagnosis and therapies. This applies to  availability which is very uneven throughout the Austrian regions (less availability outside of the major population centres, for example) and to the widely varying amount of funding offered by different health insurances. This affects both psychotherapy and clinical psychological diagnosis.  Psychological treatment is not covered by the health insurance “e-card” so far.

Obstacle three: Fear of social stigma is an obstacle to early treatment

Along with presenting many disadvantages, the coronavirus pandemic encouraged some positive developments. The social taboo surrounding mental health crises has lessened. It is now easier to speak about anxiety or depression than it was some years ago. There is less of a stigma associated with psychological/psychotherapeutic treatment.

Politicians recognise that there is a crisis

Politicians have recognised that many people are undergoing a mental health crisis and have made an effort to initiate projects which offer support, particularly to young people. There are more telephone advice services, mental health services and social services in schools. There has been support for the digital provision of advice; the GadK (Gesund aus der Krise – “Emerging in Good Health from the Crisis”) project has been set up. Under this project, the Austrian Federal Ministry for Social Affairs, Health, Care and Consumer Protection will finance psychotherapeutic or psychological help for young people throughout Austria until the beginning of 2024.  TOPSY, the psychosocial toolbox, is another project. Using background knowledge of mental health and practical exercises it is intended to support people without specific psychosocial training, such as youth workers who work with children and young people e.g. in the scouts, in youth groups, recreational facilities etc.

Nevertheless, much more is needed. It is important that Austria now sets a course that will help all children and young people in mental health crises quickly, without complication, professionally and free of charge.