During the wave of refugees in 2015, Volker Mall examined the mental health of Syrian children. Now the medical director of the kbo children’s center and holder of the chair for social pediatrics at the TU wants to help Ukrainian children with an interdisciplinary trauma consultation with a team led by psychologist Andrea Hahnefeld.
SZ: Mr. Mall, in your study from 2015/16 you came to the conclusion that around 30 percent of the children needed psychological, psychotherapeutic treatment. Do you think this figure is realistic for Ukrainian children too?
Volker Mall: At first, this number did not surprise us at all, because these children and families had a long ordeal behind them. They have experienced long periods of exposure to war and long escape routes. All in all, this results in a very high risk of developing such disorders as a result of trauma. The situation of the children from the Ukraine is perhaps a little more favorable – in the sense that they have not been exposed to these events for so long. The concern here is more for the children and families who are still trapped in the cities – and this is certainly particularly great now, given the shortage of food, the shortage of medical care, and the constant danger to life from bombing raids. I think you have to be very concerned that there will be similarly high numbers.
On the other hand, many more children have come from Ukraine now than from Syria.
Mall: That is the special situation at the moment, that we mainly have mothers with children who have fled. Who were torn out of a stable social environment and end up here in a social void for the time being. I believe it is our moral duty to do everything we can to ensure that this arrival here is as successful as possible.
Knows what can help traumatized children: Volker Mall, Chair of Social Paediatrics at the Technical University of Munich and Medical Director of the kbo Children’s Center.
(Photo: Stephan Handel)
What diagnoses did you come to with the Syrian children back then?
Mall: We have often seen trauma disorders, but of course also somatic problems. It starts with a completely incomplete vaccination status and continues with dental problems. We have increasingly seen chronic diseases of all kinds, such as the lungs and kidneys, but also diseases of other organ systems.
When we talk about post-traumatic stress disorder, how does that affect children? What symptoms can be observed?
Mall: Some of the symptoms are similar to those of adults. But then there are typical signs in preschool children who cause problems with integration. If you know them, then you can treat them well.
And if you don’t treat them, what is there to fear in the long run?
Mall: That is certainly a big barrier for integration, for inclusion, for kindergarten, school. Overcoming this is possible. In principle, these symptoms respond well to therapy, but this has to be done early and consistently, and then the path to the facilities is paved much better.
Ms. Hahnefeld, the children’s trauma consultation hour has existed since 2016. It is now to be made accessible to Ukrainian refugees as well. How do you intend to reach the families?
Andrea Hahnefeld: The first families have already reached us, they came via volunteers who were already familiar with the kbo children’s center in Munich. They contacted us directly. Apart from that, we work a lot with other specialists and institutions of all kinds who specifically address us. As part of a cooperation project financed by the Bavarian Ministry of the Interior with the psychosomatic department of the Rechts der Isar Clinic, we have been offering consultation hours for refugee families since 2016. We can currently access this offer from the chair very unbureaucratically, since the “Interdisciplinary Child Trauma Consultation for Children and Families with a Refugee Background” as an EU-funded project via the Chair of Social Paediatrics enables low-threshold access for families.
The city of Munich, among others, complains that there is a shortage of Ukrainian interpreters. Don’t you have any problems there?
Hahnefeld: We regularly work with interpreters who are specially trained in healthcare. We easily got a Ukrainian interpreter for the interdisciplinary children’s trauma consultation this week.
“Good therapy doesn’t just take place in the clinic”: Diploma psychologist Andrea Hahnefeld.
(Photo: Stephan Handel)
Are the children only diagnosed during this consultation or are they then treated further?
Hahnefeld: First of all, we do a clearing in the interdisciplinary children’s trauma consultation, i.e.: What is pending? Why is the child assigned to us? Why is the family looking for help? And with the children who were there now, that was just very clear. They had already had pre-treatment in the Ukraine and came to us with a specific request. If this is a child with a trauma-related disorder, then the first step is extensive interdisciplinary diagnostics, in which we also include the child’s environment. Then we can initiate treatment, which can initially also take place in our office hours.
Mr. Mall already hinted at this: is it the case here, as with many other mental illnesses, that the earlier one intervenes, the greater the chances of recovery?
Hahnefeld: Absolutely, it is also shown in the studies and in the literature that the social support in the environment is actually a protective factor for these children with a refugee background. And especially with children, who are very strongly integrated into the whole system, it is important to start at several levels. We also do this by working closely with childcare facilities and other professionals so that the children can also be cared for, supported and encouraged outside of the family. Good therapy does not only take place in the clinic, but also starts with the parents and the structures in the environment.
Mr. Mall, you also hold the chair for social pediatrics at the TU. Will you also accompany this supply scientifically? And what insights do you hope to gain from this?
Mall: We have always done this by scientifically accompanying the treatment and care of children with refugee backgrounds. This is how we will do it in this case as well, so that the information we gain can flow into the care in the best possible way. We are trainees and would like to continuously improve the care and treatment. In the first step we would like to do this on a case basis, in the next step also in systematic studies. We also work with our colleagues Peter Henningsen, Director of the Clinic for Psychosomatic Medicine and Psychotherapy at the Technical University, and with Sigrid Aberl, Head Physician at the Munich Clinic Schwabing. At the moment we are already running studies in which we are examining children with a refugee background. We can build on this for the further evaluation of our approach.