South Africa’s Child and Adolescent Mental Health (CAMH) services are in crisis with only one in 10 children with diagnosable mental disorders able to access treatment.
This is one of the many concerning findings shared in the South African Child Gauge 2021/2022.
Launched on Wednesday 15 June during an event held in the New Lecture Theatre at the University of Cape Town (UCT), the 16th annual review of the situation of the country’s children this year focusses on child and adolescent mental health.
The report is published by the Children’s Institute (CI), UCT, in partnership with UNICEF South Africa, the DSI-NRF Centre for Excellence in Human Development, University of Witwatersrand, the Standard Bank Tutuwa Community Foundation and the LEGO foundation.
Sharing some of the report’s key findings at last week’s event, Prof Mark Tomlinson, Co-director, Institute for Life Course Health Research at the University of Stellenbosch, said that the government, communities, schools and early learning programmes, civil society and families all have a role to play in building an ecosystem of support for children and adolescents.
“Every single child in South Africa needs support so that they can develop the strength and resources to meet life’s challenges. And the ordinary support of parents, teachers and communities can help build resilience and set children on a positive trajectory” said Tomlinson.
Predictably, the report finds that environment matters in mental health.
In South Africa, two-thirds (63%) of children live in poverty, frequently in environments where the stress of material insecurity is made worse by inadequate services, discrimination and children. Thirty-nine percent of children live beneath the food poverty line, where food insecurity further intensifies the pressures and conflict within the home. Nearly one in two children (42%) have experienced violence, including physical violence (35%) and sexual abuse (35%).
Government intervention
Prof Shanaaz Mathews, Director of CI, said these children and adolescents were at particular risk of poorer mental health. She said, given the scale and intergenerational nature of violence against children, the response to trauma needed to extend beyond dedicated psychological and psychiatric services.
“Other services such as education, health, social services and the criminal justice system need to recognise and respond to the physical, social and emotional impact of trauma on children, and on the professionals and caregivers who are there the help them heal,” said Mathews.
But there is a huge gap between what is needed and what is available.
According to the report, 10 to 20% of children will develop a mental disorder or a neurodevelopmental disability. Yet, according to Petrus de Vries, Sue Struengmann Professor of Child and Adolescent Psychiatry at UCT, child and adolescent pshychiatrists and other mental health professionals are available in only a handful of urban centre, “while limited services and human resources compromise care at district level”.
Dr Simphiwe Simelane, from the Centre for Autism Research at UCT, said increasing capacity at primary and secondary levels in communities was a priority.
“Primary health care clinics and district hospitals should be able to identify and care for children close to home, while being supervised by child and adolescent mental health specialists caring for children with more complex conditions at secondary and tertiary hospitals,” Simelane said.
Mental health in the home
Another interesting finding is that the first 1 000 days of a child’s life are an essential foundation and set the course for adolescent and adult mental health.
The report states that families play a pivotal role in protecting children from harm and helping them cope. When poverty and hardship, however, undermines caregivers’ capacity to provide and care for their children, this “foundation” can begin to crumble. Families require resources and support, the report advises.
The Child Gauge identifies the Child Support Grant as one such effective support mechanism “which has strong positive effects on the mental health of caregivers and their children by helping to improve food security, reduce stress, and increase feelings of independence and control over resources and the future”.
“Parental mental illness is an important risk factor, and support services need to adopt a family-centred approach to help parents with mental illness cope with the challenges of parenting and to help their children who may be struggling with feelings of shame, isolation and self-blame,” the report suggests.
Normalising mental health care
Considering that 50% of adult mental health disorders are established by age 14, schools can also help identify and refer children in need of additional support to the health sector.
These programmes, the report advises, should also support educators who also experience high levels of stress which may undermine their ability to build positive educator-child relationships.
Schools are also ideally placed to normalise health care.
Christine Muhigana, country representative at UNICEF South Africa, said the UNICEF South Africa’s U-Report found that 65% of young people with mental health issues did not seek help.
To summarise, the report advocates a “whole-of-society” response.
Prof Linda Richter, Director of the DSI-NRF Centre of Excellence in Human Development at the University of the Witwatersrand, together with the other 90 authors who contributed to the development of the book, calls for the government and society to create a more supportive and enabling environment that nurtures child and adolescent mental health.
