Psychiatric Times Welcomes New Section Editor

Since the US Surgeon General released his report on issues facing children and adolescents, there has been a growing interest in supporting the unique needs of our youth. In honor of our 40th anniversary, Psychiatric Times invited Stephen Mateka, DO, to join the board as a dedicated child and adolescent psychiatry section editor to best support clinicians and their patients.

Mateka, who is double board certified in general and child & adolescent psychiatry, is the medical director of psychiatry for Inspira Health and serves as cochair of psychiatry, where he provides direct clinical care for child and adolescent inpatient services and oversees 2 child and adolescent partial hospitalization programs on behalf of the Center for Family Guidance. He is the president of the New Jersey Psychiatric Association (NJPA) and serves on the Inpatient/Partial Hospitalization/Residential Committee and Public Resources Committee for the American Academy of Child and Adolescent Psychiatry (AACAP). Mateka is also psychiatrist adviser for PerformCare, where he works closely with the New Jersey Department of Children and Families and Children’s System of Care.

Psychiatric Times: When did you realize your interest in child and adolescent psychiatry?

Stephen Mateka, DO: My high school psychology teacher, Dr Mahoney, was quite eccentric and would conduct his class differently than any other teacher I ever had. He piqued my interest in asking, “Why do people do what they do?”

I pursued a psychology major in college, but as a sophomore I realized how much mental illness was treated with medication. I was not content with the idea that I could recognize a patient would benefit from a medication intervention but then would have to send them to someone else. As a result, I shifted my focus to the premed curriculum to be a psychiatrist.

Due to my change of plans in the middle of college, I was not prepared to take the MCATs upon graduation, so I pursued a job as a mental health counselor at a psychiatric hospital. I thoroughly enjoyed my work. Once I had the opportunity to work with the child and adolescent population, it no longer felt like work. It was then I made the decision to pursue child and adolescent psychiatry once I got to medical school.

PT: What do you like most about psychiatry/child and adolescent psychiatry? What do you like least?

Mateka: I love that being a kid at heart offers therapeutic value to build rapport with the child and adolescent psychiatric population. One of the primary reasons I pursued child and adolescent psychiatry was that I get to maintain hope that my efforts will yield a great impact and have the potential to change a youth’s life trajectory for the better.

The daily struggle is dealing with my own helplessness because I cannot make anyone do anything. So many of my patients have had unfair or undeserving life events, yet tend to attempt to get their needs met in ways that keep circumstances unfair or make it more unfair for them. I think most people are frustrated by not being able to change their living environment that contributes to patient distress. I, however, see it as a great opportunity to promote self-efficacy and an internal locus of control.

PT: In your view, what are the most pressing challenges in clinical care for children and adolescents today?

Mateka: The limitation of resources and overwhelmed caregivers are the biggest challenges. The delay in accessing resources is the unintended consequence of our society now appreciating the importance of mental health and pursuing treatment.

PT: Much has been said about the crisis in children’s mental health. Based on your experiences, are things much worse than they
have been?

Mateka: Yes. We are seeing higher acuity patients more frequently. There has been an increase in frequency and intensity of violent behaviors. Caregivers appear more consistently overwhelmed to care for and meet the needs of child and adolescent psychiatric patients. This has led to “stuck” kids in multiple settings, including emergency departments, acute inpatient units, and residential treatment settings because caregivers are not always willing to have the child back in the home.

PT: You have sought roles in the AACCAP as well as the NJ chapter of the American Psychiatric Association in addition to your clinical work. What got you interested in doing so?

Mateka: My professional aspirations are driven by my desire to make a positive impact in psychiatry beyond the patients I deliver direct care to on a daily basis, which led to my pursuits within AACAP and NJPA. Once I got involved, I was surprised by how much you can separate yourself in a positive way just by showing initiative and following through on tasks. Professional medicine organizations are eager to have dedicated individuals, because it is all volunteer based work. It may sound basic, but simply reaching out to your professional organizations and expressing your interest will be enough to get involved.

PT: What advice can you share about burnout, and how do you maintain a work/life balance?

Mateka: Consistent self-reflection makes it so much easier to identify if you are suffering signs of burnout and are no longer showing up the way you most desire. You cannot address burnout if you do not first recognize it.

The field is shifting away from the term work/life balance, because it promotes untenable expectations of balance. The new term is work/life integration, which is a much more realistic conceptualization of the daily life of a physician.

I focus on my effort and energy being equitably—and not equally—dispersed. There are times when my professional endeavors will require more bandwidth and others when my personal life needs the priority. None of it would be possible without the unconditional and unwavering support of my wife and family. Social supports are vital for me to maintain the standards I have set for myself.

PT: Looking forward, what are you most excited about in psychiatry and child and adolescent psychiatry, in particular?

Mateka: I am easily most excited by the fact that mental health is coming to be recognized and appreciated in a widespread manner by society. Fighting the stigma of mental health has been a long road. In my opinion, it is one of the few good things that have come from the COVID-19 pandemic. It made us all appreciate the importance of mental health. With the dissipating stigma and increased focus, I expect it will continue to lead to increased investment in resources to meet the mental and behavioral health needs of the communities we serve.

PT: As you take on this role of section editor, what do you want your colleagues to know?

Mateka: I want my colleagues to know that, when treating those with mental health issues, I consider rule No. 1 to be “know your audience.” The best chance we have for a patient and family to follow our guidance is when they feel validated, seen, heard, and understood.

I want readers to know the goal of information disseminated to them is to empower an internal locus of control and self-efficacy so that whether it’s a mental health professional or layperson, they have guidance to effectively address the mental health needs in front of them. We all have a limited amount of time, energy, and effort. There is a tendency to focus on what we wish we can control but can’t instead of what is within our power. This frequently leads to lack of or limited progress for patients and families.

PT: Thank you!

Dr Mateka is the medical director of psychiatry for Inspira Health and serves as cochair of psychiatry. He is the president of the New Jersey Psychiatric Association (NJPA) and serves on the Inpatient/Partial Hospitalization/Residential Committee and Public Resources Committee for the American Academy of Child and Adolescent Psychiatry (AACAP). Mateka is also psychiatrist adviser for PerformCare, where he works closely with the New Jersey Department of Children and Families and Children’s System of Care.