PORTRAIT Expert

Simone Marchini

French-speaking Belgium has a solid foundation in child and adolescent mental health: recognized clinical expertise, committed teams, relatively favorable reimbursement arrangements, and real capacity for innovation. Few systems of this size can draw on such a base.

But this wealth remains unevenly accessible. Child psychiatry services are heavily concentrated in major urban centers, while more remote areas have far more limited resources. For many families, this means long journeys, delays, and sometimes forgoing care altogether. This territorial imbalance isn’t unique to Belgium, but it hits hardest for children and adolescents already made vulnerable by social or geographic isolation.

A less visible difficulty concerns continuity of care. The different levels of care exist, but the handoffs between them remain too often fragile, poorly coordinated, or hard for families to navigate. In a complex institutional system, where multiple levels of power, funding, and organization coexist, it’s not always easy to find the right entry point or ensure a smooth handoff between those involved.

Since the 2015 reform, meaningful progress has been made, particularly in prevention, network-based work, and the development of mobile teams. These developments are moving in the right direction. But they also reveal how far there is still to go: better connecting primary care with specialized services, strengthening collaboration with schools, families, and other local stakeholders, and making care pathways more coherent from the point of view of the people using them.

In this respect, other international experiences, such as Quebec’s, are instructive for the attention they pay to community anchoring, care coordination, and evaluating quality of care based on lived experience. This is likely the direction to take: making an already valuable offering more legible, more accessible, and more continuous.

In Belgium, improving the mental health of children and adolescents mainly means better connecting what already exists: reducing territorial inequalities, securing transitions between levels of care, and giving young people and families more of a voice.