Children with challenging behaviour should not only be given psychiatric care, but mental health professionals had to come up with an integrated care plan for each individual, the President said.
Marie-Louise Coleiro Preca recounted that when she was social solidarity minister she visited a 13-year-old girl who was locked in isolation at Mount Carmel Hospital’s young people’s unit.
“There, I discovered there was only a psychiatric care plan for the girl but not a psychosocial one. She ended up whiling away the time eating pasta and not exercising, just growing bigger and bigger.”
It emerged that the teen was keen on dancing and, through funds allocated by the Malta Community Chest Fund, she was sent to dance classes and was now also training to become a nail technician.
“There are a lot of qualified professionals in the mental health sector but we really need to learn to work together. We must not react to a case but we must work with the community,” Ms Coleiro Preca said. “We must look at early intervention. Challenging behaviour must not merely be treated with a psychiatric care plan but with an integrated care plan.
“Our approaches must be interdisciplinary not multidisciplinary.”
Addressing a seminar organised by Richmond Foundation titled ‘Children with challenging/meaningful behaviour’, the President stressed that the YPU was not the place for children with challenging behaviour.
She referred to another case she encountered, this time involving a 15-year-old who had been through every single home across the island.
No one could “put up” with the girl because of her challenging behaviour. She was transferred to an adult shelter for victims of domestic violence and finally ended up on the streets.
“She only had two choices: taking to the streets or ending up at the YPU. We have numerous services but we need to be able to link them together to create a value chain,” said the President.
We must not react to a case but we must work with the community
Consultant psychiatrist Nigel Camilleri spoke on making sense of challenging behaviour in young people. He stressed the importance of providing a personalised service and to involve young people, their family and carers as equal partners in decisions about mental health service design and delivery.
Crisis care and outreach teams should be able to carry out home treatment with a flexible approach, he said.
Dr Camilleri suggested having a capacity whereby service users would be empowered to safely self-manage their conditions by being trained in self-help psychological therapy or improving diet and exercise regimes.
He emphasised early intervention to prevent children being brought up in damaging environments, even starting during the antenatal period, as well as more preventative work through good public mental health.
Systematic family therapist Charlie Azzopardi explained that “to be cast as a deviant is to hasten the progress of becoming that very thing”.
Speaking about children’s meaningful behaviour during parental conflict, Dr Azzopardi said the strongest attachment children built along childhood, and possibly even adulthood, was with their parents.
Children often started fearing the collapse of the family as they sensed it much earlier than the parents themselves.
They were, obviously for survival reasons, much more sensitive to the signs of danger and relied on their sensitivity. It was their equipment, he explained. As a reaction to sensing danger, children moved to ensure their survival, physically and psychologically.
“It is ‘challenging’ because we don’t understand it, not because it doesn’t have a meaning. The more severe the marital conflict is, the greater the danger perceived by the child and the stronger the challenging behaviour.”