Child Psychiatric Services in the Private Sector: Some Insights

Abstract

This paper looks at child psychiatric services in the private sector and all that can be done with child psychiatric services in the private sector. The need for public-private partnerships, the role of child psychiatrists in private practice providing integrated services, and the need for school mental health services by private psychiatrists is emphasized. The paper ends by emphasizing the need to focus on adolescent mental health and eradicating the stigma that surrounds child and adolescent mental health.

We have always had individuals who ran child and adolescent psychiatric services in the private sector. Now in the last decade, there has been a mushrooming of child and adolescent comprehensive mental health centers where various professionals like a psychiatrist, psychologists, occupational therapists, special educators, and speech therapist work in sync to manage a child or adolescent with mental health issues. The advantage is that it becomes cost-effective and parents get all services for their child in a financially affordable model under one roof. Postgraduate training in psychiatry has also blossomed where specialized fellowships in child and adolescent psychiatry and a specialized D.M. qualification in child and adolescent psychiatry are now available. There is a need for a tremendous amount of work to be done in the private sector in liaison with the public, municipal, and government sector facilities. This paper provides some perspective on the same and all that can be done by facilities in the private sector.

Some of the work that can be done in the private sector (possible and hypothesized) are as follows:

School Mental Health: Psychiatrists working in child and adolescent psychiatry must visit schools on a regular basis. There is a need for us to break the shackles of being a psychiatrist that just sits in the clinic and we must access the community so that schools, students, and parents lose the fear of psychiatry and psychiatrists. Faith in the psychiatrist will also increase if endorsed by the school and if consultations happen within the school setting where the fee structure is affordable and viable to all. Every school must have a counselor/psychologist and they must team up with a local psychiatrist to provide efficient coordinated care to the students that need help. Child and adolescent psychiatric services are always incomplete without school-based services and there is a need for a greater push in this area. ¹

Workshops for students/parents: While psychoeducation would happen at an individual level in the clinic, it is vital that child and adolescent psychiatrists in the private sector visit various schools and organizations and conduct workshops for students and parents alike. Sometimes one may get paid for these workshops and sometimes one may have to do it pro bono, but it exposes people in the community to existing services available and those that attend the work and thus exhorts them to seek help when needed. There is a need for parent training as Indian parenting has to change with the modern era and there is a need for parent retraining in many aspects as the child becomes an adolescent. ²

Special school settings: There is a lot of work that can be done by private practitioners in special schools as that is another neglected area where help is needed. Helping special schools and special educators work with special children and handle specific issues that may arise in various developmental disabilities must be handled. Workshops on sexual issues in developmental disabilities, specific issues in autism spectrum disorders, and handling children with epilepsy and cerebral palsy also play an important role in the management of these children. Parents of special children may need support in handling these children and their mental health issues may need to be addressed in groups as well as at an individual level. Promoting and starting support groups for parents of children with special needs while also catering to the stress management and mental health of special educators is a must for the private sector child psychiatrist. The private sector can work in unison with municipal and government centers and help these children get assessed and certified as per the government norms and also guide parents about the same. The procurement of the UDID needed for special children from a disability perspective may also be facilitated by this unison. ³

Various Facets of School Counseling in Private Setups

The school counselor has multiple roles to play in the school setting. The counselor very often maintains the balance between the principal, teachers, and students. The counselor also handles parents and is often the spokesperson for the school and the public relations expert in times of distress. The counselor plays a role not only in child and adolescent development but also plays a role in the training and retraining of parents in parenting skills, training the teachers in behavior modification, and classroom management of behavioral problems. The principal, teachers, and parents all have different priorities when set to manage a school. The principal aims to protect the name of the school, the teacher is aimed at course and syllabus completion and the parents want a sound education and good results for their wards. The school counselor plays a role in developing a working partnership between the teachers, parents, and students while also satisfying the needs of the school. They have to use the biopsychosocial model of psychological problems and help parents and teachers understand the child from a holistic perspective. They also have to empower the teaching and non-teaching staff in handling any issues that arise within the school. They often lay down standard operating procedures (SOPs) to manage bullying, episodes of child sexual abuse, and any psychological untoward incidents that may happen in school.^4,5

Special Focus on Adolescent Mental Health

It is important that teenagers in a school are handled in a proper manner. Often many schools are large and adolescents may not be understood. The school psychiatrist must be sensitive to the developmental needs of adolescents as well must exhort school authorities to realize the same. Adolescents often develop a detachment from their parents in their search for independence. There is a need for school counselors to invent and curate special programs to manage the issues faced by adolescents. There is a need for effective classroom sessions on sexuality and gender education, bullying and anti-bullying strategies, and the need for also conducting courses in personality development, resilience building, and emotional intelligence. ⁶ There is a need for talks on handling love and relationships, handling break ups, and handling rejections in love and by peers. There is also a need to help build body image and overcome peer pressure and also have orientations about substance abuse and using foul language in schools. There is a need for effective group therapy interventions for teenagers with similar problems and this could be used to help them realize that they are not the only ones that have a problem and would help them gain psychosocial support and recover well.^7,8 There are many new age problems that also need attention in teenagers. Nowadays we are seeing many adolescents in schools that have all the signs and symp- toms of gender dysphoria and borderline personality disorder but cannot be given a diagnosis as the age is below 18 years.^9–10

Removing the Stigma

The school psychiatrist model is one that is aimed at removing stigma. The fact that the psychiatrist visits the school is important as it means that the child and parent are not referred and do not have to go outside to meet a psychiatrist. The charges within the school are far more affordable than in a private clinic. The fact that medication and therapy may be prescribed within the school setting makes it less ambiguous and more accepting. The model also makes it holistic so that the psychiatrist, psychologist, teacher, and principal along with the parents can often have a joint meeting and work towards the improvement of the child. This also helps in a team effort in the management of the problem which is often clinically rewarding.

Need for Private Practice Clinicians to Take Up School Psychiatry

There is a need for expert clinicians and experts from various fields to come out of their glass houses and move into schools if we have to achieve the objective of positive school mental health for all. These clinicians have to realize that moving into schools does not degrade or undermine them but rather enhances their own skills and makes them accessible to a wider audience. The psychiatrist also gains exposure which is often immediate and he gets known in a particular area. Treating children and adolescents and their problems may also result in many adults and parents seeking help for their problems. School psychiatry is the need of the hour as that is where the future generations lie and treating a child or adolescent may help us nip in the bud, an adult psychiatric problem. Thus we are practicing school psychiatry, child psychiatry, and preventive adult psychiatry all in one.