Bru-Stars: Brussels' new mental healthcare network for young people

As part of the expansion of community mental healthcare provision – redirecting funding from institutional psychiatric care – a series of multidisciplinary outreach teams for adults, providing short- and long-term care, has been established across the country in the past five years. In 2015, similar networks were launched, this time for children and adolescents, with one network operating in each Belgian province.

Bru-Stars is Brussels’ network for child and adolescent mental healthcare, working in close collaboration with the capital region’s mental healthcare platform. Launched in September 2015, Bru-Stars unites francophone, Dutch-speaking and bi-community institutions in the capital, with a mobile psychiatric service set up in March 2016. It follows two successful projects for adults in Brussels; a third service, specialising in senior mental healthcare, is due in the coming years.

Bru-Stars will eventually number more than 30 health professionals, treating children and young people who are referred to the service. The Bulletin met some of the team to discuss how it operates.

What was your motivation for joining Bru-Stars?

Dr Karim Odr, chief of child psychiatry at Clinique Saint-Jean: I wanted to get to know our patients in the context of their life, as well as to participate in the creation of a project that offers a new form of care.

Dr Laurent Servais, a psychiatrist with a private practice in Brussels who previously headed a project for delinquents and adolescents: For me, it represents a challenge: how to coordinate systems in mental healthcare. The mobile team is at the intersection – offering an aspect that’s more systemic, therefore wider and representing many interests.

Dr Anne François, a child psychiatrist at Saint- Pierre University Hospital, and former head of child psychiatry at Queen Fabiola Children’s Hospital: This new policy encourages the possibility of organising new forms of therapeutic aids in addition to classical methods and networks of traditional care.

What kind of mental problems do you encounter in your work?

AF: Our patients are mainly youngsters who have dropped out of society. They may have already had a difficult and chaotic life, experiencing separation, abandonment and discontinuity. It can start at an early age. We treat patients from birth up to 23 years old. Their problems vary from dropping out of school, behavioural problems and suicide attempts to fear of going to school and teenagers who shut themselves away in their bedrooms and who are not able to access regular aid systems. Mental disorders are more likely to be found among youngsters who can’t leave the house for a diverse number of reasons. These can be biological problems such as schizophrenia, major depression, or relational problems linked to the family and their environment.

How do you work with a patient’s family?

LS: The two, patient and family, are inseparable. For some, psychiatry does not exist, and so in visiting the family, we respect the fundamental idea of helping young people who are suffering.

AF: We always have at least two professionals visiting the home: one who will be more attentive to the needs of the child while the other will look at the family system and see if there’s any way of improving everyone’s competences. This includes finding help on a long-term basis. The new mobile unit includes a crisis service.

How does this work?

AF: In a crisis situation, we need to react quickly, within 24 to 72 hours. In the last crisis cases our team was involved in, I was called to a hospital emergency service. One was for a suicide attempt. A young girl had been in a psychiatric hospital for children in Brussels for a long time. Her mother had requested a discharge, against the girl’s wishes and the doctors’ advice. A couple of days after the girl returned home, she made a serious attempt on her life. They hospital did not want to place her under observation as they felt there were underlying causes. We were asked to act as an intermediary between mother and daughter. The question was whether she should be hospitalised, return to the original institution, or if there was another possibility. This could take the form of a contract based on what was acceptable for her, verbalising the suicide attempt to try and understand why it happened, and to prevent it recurring.

Do confidentiality issues arise between children and parents?

LS: Yes, for example when a teenager needs the morning-after contraceptive pill; if a child is 12 or 13, their parents aren’t informed. It’s difficult for practitioners and is a question of ethics when deciding whether the child should benefit from confidentiality. This may not necessarily be the opinion of the parent, so it’s a complex question. In relation to the courts and the expert reports we provde, it’s quite clear, there is absolute confidentiality. In one of my cases, a youngster from Syria was able to see the information about them and modify or delete it. In the majority of cases there’s collaboration, setting boundaries, and this is frequently a case of negotiation.

AF: When we see a child on their own, there will be things that we pass on to the parents, but in this case, we will tell the child.

What are the challenges of integration in Brussels ?

KO: We have to function not only with care structures but also with youth social services such as Aide de la Jeunesse/Integrale Jeugdhulp. Rules and laws can be very different between the French-speaking and Dutch-speaking communities. We need to make the link between the services so that the patient is not lost between the two. Working with a population that is deprived and has so many languages is a challenge; I also speak Dutch and Arabic. We have to develop strategies to reach out to these communities.

LS: When we recruit people for the service, we take into account their linguistic abilities. And this might surprise you, but I think one of the exiled populations in Brussels that we never talk about is the European Commission, a breeding ground of exiles. It’s scandalous that the commission doesn’t have its own specific programme or framework. The number of people that I’ve treated at the commission and the training sessions I’ve given have shown me what an important question it is. It’s a real problem that concerns not just the EU institutions but everyone from a higher socio-economical background: in general, social workers don’t visit them. I really think the commission should collectively manage this: it’s one of the principal criteria for the psychological suffering of people who work at the commission, and their children.

Why is early intervention so important?

AF: With experience, we see that as soon as a child drops out, in general they drop out of sight of traditional systems. I’m currently working with an 11-year-old who dropped out of school two years ago. What is his future? You can’t wait too long with a case like this. He stays at home; he doesn’t pose a problem to society. When we take on a young adolescent we realise that the difficulties have been there since they were very young. When they get to 13 or 14 they’re in adolescence – that’s already a difficult time, but when the foundations aren’t solid, it’s even harder. There are still many possibilities open, but the earlier we can intervene, the better.

When should parents worry about their child’s behaviour?

LS: I would say it’s better to make sure there is a pleasant atmosphere at home. If I had to make one recommendation to parents, it’s to first take care in a way that is easiest and least taxing for themselves, and afterwards look to the child’s wellbeing.

What is the satisfaction of working with children and youngsters?

AF: It’s that the possibilities are almost infinite. When they are older, the possibilities may still exist, but they’re limited. When you see a young person reconstruct their life, recreating a social network and improving relations with their family, that is an enormous satisfaction.

Reach out

Clinical psychologist Kathleen Coppens is one of Bru-Stars’ coordinators, and previously worked for her doctorate in Uganda, studying the psycho-social rehabilitation of child soldiers. She tells us how Bru-Stars is involved in initiatives to raise awareness of mental health in the community.

There is a new vibe around mental health, and the Belgian government encourages the involvement of patients. We are working on the visibility of mental health, because it’s still so difficult in our society to admit that you have a mental health problem. Over the past few years there have been some artists in Belgium who have started talking about it, but we need people of all ages and backgrounds so we can reach a wider audience.

Publicity about issues such as burnout have seen more people sharing their experiences, helping it become less stigmatised. People are starting to realise that having a problem at one point in your lifetime doesn’t mean your whole life will be influenced by it.

Our platform, PFCSM, is celebrating its 25th anniversary, so we’ve been doing events to mark this. Every year we organise an art trail of mental health institutions in collaboration with schools in Brussels, based on a central theme. This has a positive impact but is largely limited to patients and their families, so it’s important to involve a wider audience.

Next May we will organise an event in Cinquantenaire park during the Brussels 20km, as mental health and wellbeing are closely related. There will be a village on mental health with fun activities for children and more serious ones on mental health that are accessible to everyone. We did something similar for Belgium’s National Day this summer.

As well as exhibitions, videos and other activities, we asked people passing by to make a postcard with their name and address and the following day patients from a day centre wrote them a personal message. We also had a large totem pole on which people could write ideas and messages about mental wellbeing.

Community involvement is important. Mental health problems are everywhere, and they also change over time. You may be fragile in one way but you can have so many other strengths. You can always contribute something to society.”

Photo: Natalie Hill

This article first appeared in The Bulletin Newcomer, autumn 2016