Damian Sendler: Germany as in other European countries, the current outbreak of the avian influenza pandemic has not only severely disrupted daily life but has also had a considerable impact on medical treatment, notably in the fields of child mental care and university education. To some extent, rules developed and enforced in Germany are affected by its federal system and varying epidemiologies across its many federal states. As outpatient services have been utilized more sparingly and carefully over the previous several weeks, tele-child-psychiatry and psychotherapy have seen a rise in popularity. Doctors and nurses returning from retirement, as well as medical students who volunteer, will help to increase the number of medical staff members. Due to the shutdown of schools, the federal government has warned that educational disparities would rise. Children’s welfare is a major concern in the wake of these closures and a dearth of day-care facilities.
Damian Jacob Sendler: The first European reports of COVID-19 instances were made around the end of January 2020; the first case in Germany was made public on January 27. Denial: ‘It is a Chinese issue’, ‘It is an Italian problem, ‘The virus is not hazardous for young people’ was the first response of the general public in other nations. Teenagers and adolescents began throwing Corona parties as a result of the crisis’s early stages. It wasn’t long before people realized that this epidemic was affecting their own families and that their loved ones may be at risk, even if they were only a few years old at the time. Personal relationships suffered as a consequence. Adolescents and young adults seem to be more socially isolated from a developmental standpoint. Young people have unique challenges when it comes to interacting with their peers, according to a report from the German Federal Ministry of Family Affairs, Senior Citizens, Women and Youth.
Damian Sendler
The chancellor and the federal government offer overall directives, while state policies are established at the state level under the German federal system. The impact of COVID-19 in various German states must be taken into account. For example, in the North, notably in the Northeast, there is a significant epidemiological disparity between states with lower rates of infections and deaths. Baden-Württemberg and Bavaria share a boundary with the German city of Ulm. There are many cases in these two states, and both have strong laws in place, whereas Mecklenburg-Western Pomerania, the state least afflicted, has closed its borders and isolated itself.
On March 16th, the federal government declared a state of emergency. As a result, families were put under more strain as parents were obliged to work from home while still attempting to homeschool their children.
Dr. Sendler: There have been large shifts in medical care throughout the country and within federal states as a result of the lockdown. Many high-risk therapies, such as day-treatment facilities in child and adolescent psychiatry, have been shut down at the same time that schools have been shuttered. Some patients (such as those with autism, intellectual impairments, or comorbid diseases including cancer) have voiced anxiety regarding their prolonged treatment in the absence of elective surgeries, which are often postponed if feasible. As telepsychiatry and telepsychiatric care for children have grown tremendously in recent years, the health care system has acknowledged and responded to these new kinds of treatment. A large number of medical students and student nurses have volunteered to serve at “drive in”-corona-testing stations, where retired physicians and nurses have returned to the health care system. To guarantee that all patients get basic treatment, students volunteer on hospital wards or in specialised medical facilities (e.g. dialysis centers). Additionally, medical groups and chambers of commerce have recruited volunteers to operate hotlines and provide counseling services to medical professionals.
In terms of child and adolescent mental health, what’s the current situation? The ‘calm before the storm’ is what we’re seeing in March and April. However, on a European level and in Germany, there are considerable disparities between various states and within states (see ESCAP policy statement Fegert et al. 2020b). While in some specialized psychiatric hospitals, the new hygiene measures could be implemented with little disruption to normal service because they did not have to contribute as much to the hospital’s reorganization as in some university hospitals, where wards were closed in order to provide more intensive care beds. The majority of facilities continue to provide inpatient care even as certain aspects of outpatient therapy are shifted to rely on telephone or video connections. Quarantine conditions have been implemented at certain clinics/centers for new cases (e.g. after a suicide attempt). Face masks are now required for all patients in the wards, and visits to the unit have been severely restricted. Patients and their families, however, have shown amazing tolerance and cooperation in the face of these rigorous rules. Because of the higher infection risk, outpatient services are only utilized sparingly. In order to eliminate needless physical interaction in waiting rooms, most institutions have created a preclearance and screening process through telephone. It’s not uncommon for hospitals to hire more guards when a tiny percentage of patients and families object adversely and violently to the increased security measures.
Damian Jacob Sendler
During the lockdown, concerns have been raised about the safety of children. There are no schools, so families are left to fend for themselves at home. Amidst the present recession, this may already be difficult, but the strains of typical institutions and peer connections make it much more so. Daycare centers for students are likewise closed, although physical contact is maintained to a certain level. Youth welfare outpatient services have been essentially halted, with more usage of telephone or video conferencing in place of in-person visits..
Damian Jacob Markiewicz Sendler: Hospital and clinic medical staff have responded admirably to the extraordinary shifts, making daily adaptations to cope with the ever-changing clinical environment. Every week, politicians are compelled to make such adjustments, and health care has been obliged to adapt by reorganizing service delivery. It is now possible for general managers of hospitals and specific Corona taskforces to redeploy staff from our units into other parts of the facility. While everyone is focused on the COVID-19 cases, it is unclear how much money will be allocated to continue providing mental health treatments. While this is often done on an individual basis, it doesn’t make sense during and after the current economic crisis. The authors believe that Germany’s child and adolescent mental health care services should be funded using the budget for the previous two years prior to the economic crisis in order to allow them to return to regular levels of service provision.
It was not until the 1970s that the legal idea that equates mental disease with physical sickness was established in Germany. An expert panel constituted in August 1971 handed up a report on “Psychiatrie-Enquête” in September 1975 to the German Parliament expressing this requirement in writing. It wasn’t until 1988 that the legislation officially reflected this professional judgment by including a statutory paragraph that highlighted the unique requirements of patients with mental illness ( 27 SGB V. The German Bundestag’s committee on social matters kept a record of the discussion.
During the present epidemic, the urgent requirements of high-risk populations are evident. however they should not be overlooked or ignored. Doctoral defenses, grand rounds, and student supervision have all been postponed or shifted to videoconferences due to the government shutdown. Requests for e-learning programs from child psychiatrists, psychologists/psychotherapists, and social workers working in quarantine have surged. Health and social care workers signed up for these programs within two weeks of their release. We offered all of our online courses in child protection, trauma therapy, and transition psychiatry at no charge to our department, and more than 2000 medical professionals signed up for CME credit in the first few days after the program’s debut. Psychiatry, psychosomatics, and psychotherapy in Germany have endorsed this effort. Transfers of child and adolescent psychiatrists to other agencies should not be hindered in terms of their education after the crisis. It will also be necessary to make changes to the laws now in place for the training of future child and adolescent psychiatrists in order to avoid a long-term harmful influence on their careers.
The Future of Psychiatry (= Clinical Neuroscience) was written by Thomas Insel,1 director of the National Institute of Mental Health, in 2012.
Damien Sendler: Today’s issues are just as significant as the ones he discussed in the past. Our understanding of mental disease has been fundamentally altered by recent discoveries made possible by technological advancements in brain research. New research is changing the way we think about depression, moving it away from being just a monoaminergic disorder to one that involves circuits, neurotransmitters, synaptic plasticity, second messenger systems, and even epigenetic and genetic abnormalities. 3
Until recently, these developments seemed to be confined to the pages of our most prestigious scientific publications. There has been no paradigm change in the way most doctors care for patients or communicate about our specialty with each other and the general public. ” Why is this shift still a matter of the future, despite the fact that so much progress has already been made? What is stopping us from adopting a fresh identity in our profession today?
There is a widespread misconception that neuroscience has no place in patient treatment, and this may be the most significant roadblock. Many issues remain unresolved in the existing scientific frameworks. We are seeing the emergence of novel, hypothesis-driven treatment options, but most of this research has yet to be implemented in ordinary clinical practice.
The intricacy of research and the difficulty of keeping up with a quickly evolving discipline may also be a factor in the reluctance to embrace neuroscience. Let’s take a look at how far neurogenetics has come, for instance. For a doctor trained in the early part of the 20th century, most of today’s cutting-edge science may seem incomprehensible. The amount of time and effort required to keep up with the latest research is well above what can be accomplished by continuous education.
Psychiatry residency programs may be expected to lead the way if the field’s identity is to change. They represent the most concentrated location of psychiatry instruction and serve the specific purpose of educating psychiatrists. Neuroscience should be included into psychiatric training by most residency directors, which is a positive sign. 4 But the majority of programs do not teach neuroscience in a systematic or thorough way. What’s the problem?
Fundamentally, they do not have to. There is not a single mention of neurology in the Accreditation Council for Graduate Medical Education’s formal program criteria. In spite of this, the new psychiatric milestones5 only serve to raise attention to the subject. However, in practice, our regulating bodies have not yet regarded neuroscience to be of equivalent relevance to the regulated areas. The enormous amount of prerequisites means that even if schools wanted to include neuroscience in their curriculum, there would be little room for it.
There is still a long way to go for programs that are dedicated to teaching neuroscience. There is a lot of ground to cover. We need to know what and how much information is being taught, and we also need to know who is doing the teaching. Few programs have enough faculty competence to warrant their existence. It turns out that skill in topic does not always translate into expertise in instruction, as many people find out when they finally do this. To put it another way, what support is there for teachers who aren’t experts?
How will students react when a curriculum is put into place at the next level? There is nothing easy about neurology. Isolated from real clinical skills, it might be scary for new doctors. To add to the confusion, many courses are lecture-based. Lectures allow for the organization and presentation of enormous quantities of complicated content. Lectures, on the other hand, may be especially unsuitable for helping pupils learn because of this. It’s impossible to keep up with everything.
The last point is that no matter how well developed a classroom curriculum is, it will still only account for a tiny portion of training. For the reasons outlined above, most learning occurs in clinical settings under the guidance of academics who do not often use a neuroscience viewpoint.
