The Absence of ‘Social’ In The Bio-Psycho-Social Approach in Child and Adolescent Psychiatry in Denmark

Abstract

A growing number of children and adolescents are experiencing mental health problems worldwide (Katznelson et al. 2022; WHO 2024). A recent study estimates that around 15 % of children and adolescents in Denmark will have a diagnosis before they turn 18 (Jeppesen et al. 2020). Research points to the importance of applying the bio-psycho-social model (Engel 1977) in diagnosing and treatment (see Rothenberger et.al. 2015), and officially the model is used in Danish child and adolescent psychiatric treatment. This study focuses on the role of social work in a professional field dominated by health care workers. The main task of social workers in psychiatric facilities is to ensure coherent cross sectorial cooperation with local municipalities responsible for the outpatient care. However, the study indicates that social factors such as parents’ employment, housing, school, and general societal structures are not deemed relevant in diagnosing and treatment. Why is the bio-psycho-social model being reduced to a focus on symptoms? Social workers are mainly included in patient care when there is a conflict or a suspicion of a problematic use of substance in the family. How does this become relevant and not issues of loneliness or stigmatization? The system tends to focus on the individual and the solutions at reach within the system – even though important aspects of recovery lie within the social realm. The study is based on interviews and participant observation among social workers, psychologists, psychiatrists, and nurses at nine units in and around the city of Copenhagen, Denmark.