Abstract
BackgroundEven though child and adolescent mental health is a global health priority, services are very limited, particularly in low- and middle-income countries (LMIC), and therefore need comprehensive strengthening. This requires knowledge of the hardware elements of the system (human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems). This study sought to examine these elements of child and adolescent mental health (CAMH) services and systems in the Western Cape Province of South Africa.MethodsThe World Health Organization Assessment Instrument of Mental Health Systems (WHO-AIMS) version 2.2 of 2005 was adapted to identify key variables of interest in CAMH. Data were collected for the calendar year 2016 and focused on the public health sector. We outlined findings based on best available data across the six domains of the WHO-AIMS.ResultsIn domain 1, we found no provincial CAMH policy or implementation plans to support the national CAMH policy and were unable to identify a CAMH-specific budget. In domain 2, there was no dedicated provincial leadership structure for CAMH, and no dedicated or ‘child- and adolescent-friendly’ mental health services at primary or secondary care levels. At tertiary level, there were only three specialist CAMH teams. The majority of CAMH resources were based in the City of Cape Town, with limited resources in the rural districts. Essential medicines were available in all facilities, and the majority of children and adolescents had access to free services. In domain 3, data were limited about the extent of training offered to primary healthcare staff, and little or no psychosocial interventions were available in primary care. Domain 4 identified a small and variable CAMH workforce across all levels of care. In domain 5, few public health campaigns focused on CAMH, and little evidence of formal intersectoral collaboration on CAMH was identified. Domain 6 identified significant limitations in health information systems for CAMH, including lack of child- and adolescent-specific and disaggregated data to establish baselines for policy development, monitoring, evaluation and CAMH research.ConclusionsThis study identified significant structural weaknesses in CAMH and presents a clear call for action to strengthen services and systems in the province and in South Africa. it would be important to expand research also to include provider and user perspectives for service strengthening.
Highlights
Even though child and adolescent mental health is a global health priority, services are very limited, in low- and middle-income countries (LMIC), and need comprehensive strengthening
Child and adolescent mental health is a global health priority, yet it is generally known that services are limited, in low- and middle-income countries (LMIC) [1, 2]
Hardware typically refers to human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems, while the software typically refers to ideas and interests, relationships and power, values and norms, and the interactions between all factors and actors [3, 4]
Summary
Even though child and adolescent mental health is a global health priority, services are very limited, in low- and middle-income countries (LMIC), and need comprehensive strengthening This requires knowledge of the hardware elements of the system (human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems). Qualitative data from semi-structured interviews with key stakeholders in the Kleintjes study [2] proposed three main themes as the reasons for the very low resources for CAMH: first, the impact of stigma associated with mental health disorders; second, the low priority of all aspects of mental health in LMIC; and third, the lack of attention to the link between poverty and poor mental health [2] While these proposed reasons are understandable when comparing mental health with physical health services, Kleintjes and colleagues did not attempt an explanation for the under-representation of child and adolescent versus adult mental health services
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