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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0218

Increasing clinical severity in child and youth mental health: service gaps or a sociodigital paradigm shift?

RISING ACUITY IN CHILD AND YOUTH MENTAL HEALTH: SERVICE GAPS OR SOCIO-DIGITAL PARADIGM SHIFT?

In the post-COVID period, referral numbers and acceptance rates have not returned to pre-pandemic levels, while the clinical severity of presentations has increased and the clinical profile has shifted toward educational difficulties, hyperactivity, and attention problems.

The study aimed to track changes in the clinical severity of referrals to a child and youth mental health service in New Zealand between 2017 and 2025, and to discuss whether the increase was related to service gaps or to post-pandemic deterioration and increased exposure to algorithm-driven digital environments. Data were divided into pre-pandemic (2017 to 2019), COVID (2020 to 2022), and post-COVID (2023 to 2025) periods and examined in terms of new referral numbers, acceptance and rejection decisions, the proportions scoring 2 or above on HoNOSCA items, clinical severity at the three-month review, and discharges. Before the pandemic, referrals resulted in 3,567 acceptances and 2,089 rejections, with an acceptance rate of 63%; during COVID, there were 3,069 acceptances and 2,501 rejections, with an acceptance rate of 55%; and after COVID, there were 3,095 acceptances and 2,644 rejections, with an acceptance rate of 54%. New referrals decreased by 18% during COVID and recovered by only 8%; the decline in the acceptance rate during COVID persisted after COVID, with a total reduction of 41% reported. The clinical profile changed during COVID with an increase in self-harm (the HoNOSCA self-harm item was elevated in 25.6% before the pandemic, 31.8% during COVID, and 25% after COVID), while post-COVID referrals were characterised by educational or learning difficulties (the school and language item increased from 43.9% to 53%), hyperactivity and attention problems (from 69.6% to 72.6%), and reduced self-care and independence (from 17.8% to 27.6%); difficulties in family relationships decreased (from 52.6% to 40.3%), while emotional symptoms remained predominant across all periods (79.5%, 76.8%, and 72.1%). After COVID, cases receiving assessment only carried a higher clinical burden than before the pandemic, with a 21% increase in clinically significant items; at the three-month review, post-COVID clinical severity was higher than during COVID, and discharge rates remained below pre-pandemic levels. The author notes that, because staffing levels remained unchanged throughout the period, the service had to adapt within existing resources through coping mechanisms such as referral prioritisation, group interventions, partnerships with non-governmental organisations, workforce training, psychiatrist-led triage, reduced use of psychometric assessments, and clinical coordination.

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