The Health care Atlas for Mental Health care for Children and Adolescents examines the activities within primary and specialist health care services from 2019–2023. Building upon the foundational insights 2020 Healthcare Atlas for Mental Healthcare and Substance Abuse Treatment, this updated atlas offers comprehensive data on treatments for children and adolescents in Norway. COVID-19 pandemic has influenced patterns of morbidity and health care activities both during and in the aftermath of the pandemic. The atlas is structured into two main sections: (1) an overview of patients and health care activities at an aggregated level, and (2) an analysis of treatments within the principal diagnostic groups in mental health care services for children and adolescents. Both sections explore the treatment of mental disorders across various health care settings, including mental health care services, somatic care, interdisciplinary addiction treatment, and private specialists under public funding contracts.
Main findings
- Overall, there are small regional differences in the number of patients receiving outpatient treatment, with significant disparities for some mental disorders.
- Significant disparities are observed in the duration of treatment and waiting times among different hospital referral areas.
- Treatment rates for autism and ADHD have substantially increased. Although there are moderate variations in activity between referral areas, a significantly higher proportion of boys than girls receive treatment for these conditions.
- Considerable geographical variation is observed for patients receiving treatment for depression.
Patients in Mental Health care Services for Children and Adolescents
Mental health challenges are common among children and adolescents. Such challenges as depression or anxiety, encompass a spectrum of severity from mild to severe. In contrast, mental disorders are distinguished by a pronounced burden of symptoms and are frequently associated with significant functional impairments (Norwegian Institute of Public Health).
Children and adolescents with mental health issues or disorders seek help in both primary and specialist health care services. While the treatment of mental disorders typically occurs within specialist health care services, general practitioners (GPs) play a critical role in the early identification and management of mental health issues and milder mental disorders. GPs often collaborate with child welfare services and health stations to provide follow-up care. Data on general practitioner activity offers valuable insights into the proportion of children and adolescents engaging with primary healthcare services due to mental health concerns.
Mental comorbidity, defined as the co-occurrence of multiple mental disorders, is prevalent among children and adolescents. Common combinations include depression with anxiety and attention-deficit/hyperactivity disorder (ADHD) with specific developmental disorders. Data from the period 2019–2023 indicates that 30% of children and adolescents receiving outpatient treatment for depression were also treated for anxiety disorders, while 39% of those treated for ADHD were concurrently receiving treatment for specific developmental disorders.
The presence of comorbidity adds significant complexity to treatment, often challenging care processes and rendering treatment outcomes less predictable (Roth and Fonagy, 2005). The high prevalence of comorbidity among this population underscores its substantial influence on variations in patient needs and clinical practices, highlighting its critical importance in the planning and provision of mental healthcare services.
Outpatient treatment
Referral and Follow-up with General Practitioners
Intensity of care
During and following the COVID-19 pandemic, there was a significant increase in the number of patients referred to specialist health care services. This surge in referrals exceeded the capacity of existing services, leading to prolonged waiting periods for treatment
The intensity of treatment (care) is clinically relevent for certain mental health diagnoses, particularly anxiety disorders, depression, and eating disorders. The following analysis focuses on patients receiving outpatient care for these conditions, with at least one documented contact during their treatment pathway. The analysis encompasses the duration of the treatment course, measured within the same year as the referral. Given that the referral date often constitutes a component of the treatment course for most patients, the year 2022 is the latest year for which comparable data is available.
The table presents key metrics related to treatment timelines and intensity. Column 1 displays the median number of days from the date of referral to the initial contact. Subsequent columns show the median number of days between the second, third, fourth, and fifth contact dates and the referral date. Additional columns illustrate the median intervals for the 6th to 11th and 11th to 15th contact dates. The difference between the average intervals for the 3rd to 15th contact dates and the 0th to 15th contact dates provides insight into the relative intensity of care from the 3rd contact onwards, compared to the overall intensity across the entire treatment course up to the 15th contact.
The median is employed as the primary measure for analyzing waiting times and treatment intervals, as it offers a more representative measure of the typical treatment intensity and frequency of care experienced by patients across different referral areas. By sorting all referral periods in ascending order, the median provides a robust metric that mitigates the influence of outliers, ensuring a more accurate reflection of patient experiences.
A significant disparity in waiting times was observed across different referral areas during the study period. The longest waiting time were recorded in St. Olavs, Nordland, and Finnmark, while patients in Vestfold experienced waiting times that were less than half the duration of those in the St. Olavs referral area. The data presented in the right-hand columns of the analysis reveal that Førde, Fonna, and Finnmark had longer intervals between each care contact compared to other referral areas. Additionally, UNN, Nord-Trøndelag, Finnmark, and St. Olavs exhibited slightly higher values for the time to the second contact, indicating delays in early-stage treatment progression.
The discrepancy between the two measures of treatment pathway intensity—initial waiting times and intervals between subsequent contacts—underscores the variation across referral areas in terms of patient progression along the treatment course. A substantial difference between these measures suggests delays in patients' access to timely health care, whereas a small difference indicates more consistent planning and treatment scheduling throughout the course of care. Referral areas such as UNN, Bergen, Sørlandet, and Vestfold exhibited lower variances, demonstrating a parallel trend in both waiting times and treatment intensity. Notably, UNN deviates from this pattern, with a higher median waiting time for the third patient contact, despite maintaining a comparatively brief overall duration of care. In contrast, Førde demonstrated relatively low treatment intensity, with shorter waiting times compensating for the reduced intensity over time.
St. Olavs is characterized by prolonged waiting times, extended intervals to the second patient visit, and a failure to reduce time gaps throughout the subsequent treatment course up to the 15th visit. Finnmark and Nord-Trøndelag exhibit similar patterns. Conversely, OUS, despite long waiting times, maintains the highest treatment intensity of all referral areas at the outset of the treatment course.
Inpatient Treatment
ADHD
Anxiety
Autism
Depression
Eating Disorder
Substance Use Disorders
Specific Developmental Disorder
Adjustment Disorder
About the Atlas
Do You Have Questions?
For inquiries or comments, please contact the Health Atlas Service at Helse Førde HF via helseatlas@helse-forde.no.