KL study shows: Training amendment for the further treatment of patients over 18 is favoured, but there is a lack of resources

Mentally ill adolescents need stable care structures in the transition to adulthood. The traditionally prescribed change of treatment from child and adolescent psychiatric care to adult psychiatric care at the age of 18 does not meet this need. An amendment to the medical training regulations came into force on 15 May 2024, which now officially allows child and adolescent psychiatrists (KJPs) in Austria to continue treating their patients beyond the age of majority. A study conducted at the Karl Landsteiner University has now analysed the assessments of child and adolescent psychiatrists regarding the regulation for the first time and recorded the initial practical effects on care. The results show: In terms of content, the amendment is favoured, but once again it becomes clear how overburdened the psychiatric care system in Austria is. Only with adequate resources can it be effective in the long term - both in terms of prevention and treatment.

Austria's transition system shows clear deficits. This fact becomes clear once again with the entry into force of a new amendment for child and adolescent psychiatrists. According to the child and adolescent psychiatrists surveyed, the regulation is very welcome in principle, but does not solve the root of the care problem in child and adolescent psychiatry, summarises study author Matthias Neumann MSc MA, research associate (PreDoc) at the Transition Psychiatry Research Centre at the Karl Landsteiner University of Health Sciences in Krems. The need for care for mental health problems and the legal definition have highlighted a gap here. Following the introduction of the amendment, it has not yet been ascertained what changes it has led to or how it is dealt with in (clinical) practice." As part of a study, 16 child and adolescent psychiatrists were therefore asked about the situation in qualitative interviews. 

Five key findings
First and foremost, there was great dissatisfaction with the introduction and implementation, says Neumann: "It came very quickly, unexpectedly and without much information, and many child and adolescent psychiatrists had not been able to prepare well for it. The interviewees said that they had received calls from patients who insisted on appointments after all, but the doctors had no capacity, which in turn led to frustrating cancellations." In terms of content, however, the second result was that the amendment was extremely positive. "Many have already continued to care for their patients through legal grey areas. The exact procedures have so far varied from state to state, and in some states there have already been verbal agreements with some health insurance companies. Nevertheless, it is clear that the adult setting is not suitable for many patients who have just come of age, as they are still very attached to their parents and it would make sense to continue their care in a child and adolescent psychiatric setting." The third and fourth result relates to the private practice sector: "Despite the approval of the content, little has changed, the lack of resources is still blatant, the waiting lists are long and many patients sometimes wait months for treatment despite great suffering." 

The second aspect concerns cooperation with health insurance companies. "The doctors had hoped that the official prescription would mean that billing with the insurance companies would now also work well. Unfortunately, there are still numerous individual case reviews and in many cases letters of authorisation or similar are required, which entails additional bureaucratic work." Last but not least, the fifth empirical value shows a very similar problem in the inpatient sector, according to the study author: "The wards are almost always overloaded and it is currently unthinkable in most cases to treat patients beyond the age of majority in an inpatient child and adolescent psychiatric setting. The frustration here is naturally great on all sides."

Child and adolescent psychiatric services must be expanded
To summarise, it can be said that The lack of resources in the Austrian child and adolescent psychiatric care landscape currently makes it almost impossible to realise the potential contained in the amendment. This applies to both the inpatient and non-inpatient sectors, as any form of further treatment must always be weighed against the opportunity costs of other urgently needed treatment places for younger patients. The sustainable realisation of the amendment's potential therefore requires a comprehensive investment in personnel and infrastructural capacities. "Otherwise, it is to be expected that the improvement in psychiatric care for transition-age patients originally intended by the amendment will not materialise in practice," concludes Matthias Neumann.

Neumann, M., Dörfler, S., Holzinger, A. & Steiner-Hofbauer V. The amendment to Austria’s medical training regulation permitting continued care by child and adolescent psychiatrists after reaching legal adulthood: a qualitative study on professional attitudes and clinical practice. Neuropsychiatr (2025). https://doi.org/10.1007/s40211-025-00527-5
https://link.springer.com/article/10.1007/s40211-025-00527-5