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A common basis is the culture of human rights: child and adolescent psychiatry in Europe is inspired by the deep respect of children's rights. By valuing these approaches and building on their strengths, while sharing a strong commitment to a shared value system, it has proved possible to develop a versatile model of child psychiatry, able to provide the means to prevent and cope with psychological and psychiatric difficulties by offering interactive and holistic interventions at community, family and individual levels.

The European tradition also involves the social and public field, aiming at creating networks of many agencies which all contribute to the support of young people on the basis of their needs, irrespective of age, gender, social or cultural background. In Europe, child psychiatrists respect individual differences, not. Child and adolescent psychiatry is strongly linked to other neighboring disciplines such as pediatrics, neurology, psychiatry and psychology and to many other activities targeted at the child's physical and mental health, such as pedagogy, rehabilitation, speech therapy and physiotherapy.

This interdisciplinary work is fundamental for prevention, treatment and research in the field of developmental age. The 3rd Millennium Europe wants to be more and more open to new and different cultures. Migration from neighboring as well as from more distant countries requires our systems to be more flexible in order to respond to new cultures and habits. The aim of European child psychiatry is to integrate harmoniously these populations and to enrich their cultures.

Europe is facing massive challenges in child and adolescent mental health. However, one adolescent out of five has cognitive, emotional and behavioral difficulties and one adolescent out of eight suffers from a diagnosable mental disorder, and the prevalence is increasing decade by decade.

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Suicide associated with depression, substance abuse, eating disorders, conduct disorders, attention deficit hyperactivity disorders ADHD and post traumatic stress disorder PTSD in children are all deserving concerted action. Developmental psychiatric disorders rarely have a spontaneous remission and may cause difficult social adaptation or mental disorder in adult life if not early diagnosed and treated.

Child mental health is important in its own right, but it has also to be considered in the context of a lifespan approach: most adult mental disorders find their origin in childhood and adolescence and require early intervention and treatment. Mental disorders prevented in childhood are mental disorders prevented for life.

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Provision of services and the number of child psychiatrists varies very widely across European countries, ranging from one per 5, people under the age of 20 to one per 51, for the same population group. Countries of the European Union markedly differ in the organization of children and adolescents mental health services and in the content and organization of child psychiatry training. Little information is available about health and social investment into child and adolescent mental well being, but all indicators strongly suggest that child and adolescent mental health in most European countries is receiving a relatively small proportion of funding within mental health, which in turn receives a low investment from general health investment, on average only 5.

Investing in the mental health of children and adolescents is the most cost-effective intervention, aiming at preventing the burden of mental health problems in all age groups, and lowering the personal suffering and loss of productivity at individual, family and population level throughout the lifespan. Recognizing the needs of children, adolescents, families and communities of Europe, and backed up by the evidence developed by European experts, the signatories of this declaration believe that European countries, regions and municipalities, supported and advised by intergovernmental agencies such as the.

The core of our commitment is a reduction of the institutional approaches of care, which engender social exclusion. On the contrary it is essential to improve the quality of life of people with mental ill health or disability through social inclusion and the protection of their rights and dignity.


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Pediatrics , 2 , ee Prevention of childhood depression: Recent findings and future prospects. Biological Psychiatry , 49, Gladstone, T. Treatment, intervention and prevention with children of depressed parents: A developmental perspective. Gotlib Eds. The prevention of depression in at-risk adolescents: Current and future directions. Journal of Cognitive Psychotherapy , 14, Sustained change in parents receiving preventive interventions for families with depression.

American Journal of Psychiatry , , Mental health promotion to build better citizens in Colombia. While the current initiative has not met with the expected success, community leaders and academicians are convinced that an intervention could prevent violence. A decision has been made to develop two things: 1 a program beginning to work on child growth and development when children are younger and 2 a healthy schools initiative. The intervention will apply the social ecology concept developed by Earls and colleagues 23 , coupled with the life course health development concept utilized for many years by WHO.

With adequate political will the vision for child mental health services, training, and research in the LAC countries can be expanded, drawing on the experiences in other regions of the world that have faced or are now facing similar challenges.

The next three paragraphs describe three specific actions that we believe are both feasible and in the best interests of developing a long-term strategy for child and adolescent mental health in the LAC nations. One step would be to initiate a yearly research training seminar that would help to develop a cadre of young LAC researchers and establish key mentoring relationships.

Another possible action would be to establish an LAC child and adolescent mental health training committee. This could be done under the auspices of one of the LAC child and adolescent mental health professional organizations, or it could be established ad hoc by PAHO. Such a group could carry out a systematic study of existing training programs, coordinate them, and identify extrabudgetary resources for additional training programs.

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One model for establishing more uniform standards is the European Union of Medical Specialists, which provides training guidelines and accreditation for specialists. Another measure that we recommend would be to establish an LAC mechanism for the dissemination of model programs. The LAC countries have no lack of interesting, innovative, and meaningful programs, but there is no consistent mechanism for program dissemination. With the downturn in the LAC economies, using professional meetings is no longer an effective mechanism for broad dissemination. These meetings also often fail to involve important stakeholders from the education, health, and political spheres.

One possibility would be to establish an LAC journal on child and adolescent mental health. This might be done in collaboration with the Journal of the American Academy of Child and Adolescent Psychiatry or as a collaborative effort by LAC academic institutions. The LAC countries have long been concerned about child and adolescent health, including mental health. LAC professionals are active in professional organizations and scientific inquiry around the world.

Coupled with vigorous political will based on the framework of the UNCRC, this concern and professional expertise could usher in a new era of progressive development in child and adolescent mental health in the LAC nations. Systems of care in South America. Facilitating pathways: care, treatment and prevention in child and adolescent mental health. Heidelberg: Springer Verlag; Jolly R, Cornia, GA, eds. The impact of world recession on children.

New York: Pergamon; Selle MS. Rev Neuropsiquiatr Infanc Adolesc. Children in the streets of Brazil: drug use, crime, violence and HIV risks. Subst Use Misuse. The impact of living on the streets on latency children's friendships. Rev Saude Publica. Belfort E. Psiquiatr Salud Integral.

School dropout and conduct disorder in Brazilian elementary school students. Can J Psychiatry.

Tracy R.G. Gladstone, Ph.D.

United Nations Children's Fund. The progress of nations. The association of educational achievement and school dropout with risk of alcoholism: a twenty-five-year prospective study of inner-city children.

J Stud Alcohol. Manlove J. The influence of high school dropout and school disengagement on the risk of school-age pregnancy. J Res Adolesc. Child mental health in Latin America: present and future epidemiological research. Int J Psychiatry Med. ADHD in a school sample of Brazilian adolescents: a study of prevalence, comorbid conditions and impairments. Rohde LA.

Tracy R.G. Gladstone, Ph.D. - Other Publications Wellesley Centers for Women

Fleitlich BW, Goodman R. Rev Bras Psiquiatr. Fleitlich-Bilyk B, Goodman R. Prevalence of child and adolescent psychiatric disorders in southeast Brazil. World Health Organization. Atlas: child and adolescent mental health resources: global concern: implications for the future. Geneva: WHO; Richmond JB, Kotelchuck M. Political influences: rethinking national health policy. In: McGuire CH, ed. The handbook of health professions education. San Francisco: Josey-Bass; Fostering child wellbeing. Integrating mental health and health with a children's rights perspective.

Facilitating Pathways to Mental Health Treatment for Those in Crisis

Revista Harv Rev Lat Am. Pediatr Py. Antiepileptic drugs in child neuropsychiatry: a Latin American view.