Estonian population minister says psychiatric care must also be provided for minors

TALLINN – Estonian Minister of Population Riina Solman sent to the Ministry of Social Affairs her position on the draft Mental Health Act currently being coordinated, according to which psychiatric care must also be provided to minors in need.

According to Solman, it is important that families living in understanding relationships are not disregarded with the bill, but at the same time, it would be possible to quickly help children who do not receive the necessary help and care from their parents or legal representative. "I consider it necessary to supplement the content of this very important bill and to take better account of the different needs of children and families," Solman was quoted by Interior Ministry spokespeople as saying.

According to the minister of population, the bill must take into account that if, for example, a 16-year-old can vote, they may also be able to assess the need for psychiatric care. "The young person must be able to get help quickly, regardless of their parents' consent. Therefore, in the case of a minor seeking help, the psychiatrist should first assess their need for help, but also their maturity and discretion. When a young person is ready to take responsibility for themselves, receiving help should not depend on parental consent," she said.

According to Solman, the situation must also be resolved for those children who are not yet able to take responsibility for themselves. "In addition to adolescents, younger children who need the full support of an adult also need help. If this support is not provided by the parents themselves, it should be possible for them to turn to a psychiatrist by referral from an official, such as a family doctor, child protection specialist or school psychologist. If possible, an adult trustworthy to and suitable for the child should be involved in the treatment process," the minister said.

In her reply, the minister also pointed out that the bill, as it stands, would lead to disproportionately large and irrelevant additional work for psychiatrists if doctors are required to examine the criminal record of a parent or legal representative from the criminal records database and investigative bodies before providing assistance.

"I do not agree with the principle of the bill that a healthcare provider should be obliged to investigate the offenses committed by a parent or legal representative against the young person seeking psychiatric care. The provision of psychiatric as well as other medical care must be based primarily on the patient's need for assistance, and the investigation of offenses should remain a matter for the legal system. Assistance must often be provided quickly and the system must therefore ensure that minors do not lose too much time due to administrative issues," Solman said.

She added that if a parent has committed a crime against the child that has been proven, the child will receive assistance under the Victim Support Act and the necessary information will therefore be known when coming in for the psychiatrist appointment. "If the offense has not yet been identified, but the psychiatrist develops a suspicion when talking to the child, the doctor will inform the necessary authorities, but the child should be able to receive treatment despite the fact that there is no court decision and the investigation is still ongoing," Solman said.

According to Solman, one more technical nuance has also been overlooked during the formulation of the bill, that in addition to children and adolescents, people with mental disorders also belong to the circle of persons with limited active legal capacity. "As the bill specifically refers to minors, I consider it necessary to specify the circle of persons with reduced legal capacity to whom the amendments apply," the minister said.

Children's mental health problems are a major concern in Estonia. According to the National Institute for Health Development, 9,122 young people under the age of 15 were attending psychiatrist's appointments due to mental and behavioral disorders already before COVID-19 in 2019. Among them, 2,988 new cases of 0-14-year-olds had been registered during the year, and 1,695 new cases of 15-19-year-olds. Thus, the number of children and young people in need of psychiatric care is well over 10,000 per year. At the same time, it is difficult to estimate how large this number would be if all those in need were able to see a psychiatrist regardless of parental consent.