Do children have the right to health in psychiatric hospitals?

In 2018 Ombudsman of the Republic of Latvia monitored all six hospitals in Latvia, where in-patient psychiatric treatment of children is provided. During these monitoring visits Ombudsman examined treatment and other conditions of children in these hospitals.

Monitoring visits were performed by a team of experts – representatives from Prevention Unit and Children Rights Division of the Ombudsman’s Office, as well as certified children psychiatrist and certified psychiatrist who gave their opinions on the quality of health-care services to the Ombudsman.

After monitoring of these hospitals, Ombudsman has observed several systemic deficiencies in children psychiatric treatment, including:

  1. Lack or unavailability of out-patient services – due to insufficient funding there are long ques, in addition several services are available only in hospitals. Children have very limited access to services close to their place of residence.
  2.  Insufficient rehabilitation services – at this point psychosocial rehabilitation and non-drug therapies in hospitals are not being paid for or paid for incompletely;
  3. Lack of children psychiatrists – in some of the hospitals there were no children psychiatrists, or their service was limited. In these hospitals the most significant violations toward children’s health were established.
  4. Lack of unified clinical guidelines and standards – there is no unified understanding of what treatment would best suit the needs of each child and that increases risks of children rights violations, for example, children might be prescribed inappropriate or excessive doses of medications. Doctors give contradictory conclusions on treatment methods of children with different mental, behavioural or development health disorders.
  5. Informing children about treatment and informed consent from the age of 14 is a systemic problem as the children are not being involved in the treatment process, they do not receive information about their stay in the hospital.
  6. Education – children staying in hospitals for a longer time are not being fully provided with their right to education, especially secondary or vocational education, as it is not foreseen in the legislation.
  7. Possibility to stay in the hospital together with a parent or other care taker – in case of hospitalization the child, also in pre-school age, is being separated from the family. This can cause unnecessary anxiety, thus worsening or delaying recovery process.
  8. Lack of preventive, multidisciplinary and evidence-based programmes – Ombudsman is worried about frequent hospitalization of children from out-family care institutions, that is often substantiated based on social indications (behavioural disorders of the child or conflicts in the institution) and not due to child’s state of health.

Discussion on the above mentioned issued took place during Ombudsman’s Annual Conference on 13 December 2018. In addition, Ombudsman has sent information to the Prosecutor General about possible criminal offences. Information on possible violations in medical treatment was sent to responsible health-care institutions, including ministry. Several responsible officials and employees have lost their positions after the findings of the monitoring.