Abstract
There is a widening mental health treatment gap for children and adolescents in sub-Saharan Africa. The region has few economic or human resources dedicated to the mental health of children and young people. The World Health Organization's Mental Health Gap Action Plan and the push for mental health to be included in the Millennium Development Goals have raised the profile of child mental health but comparatively few studies have estimated prevalence rates or assessed needs or tested interventions in African countries. In most countries there is no clear pathway to access treatment, especially in-patient facilities. This article considers these issues from clinical, educational and research perspectives.
Highlights
When compulsory treatment is deemed necessary, this is subject to judicial oversight and there are multiple opportunities for appeal
One important difficulty relates to language: in many African countries the local population will speak several languages, with varying degrees of proficiency; many minority mother tongues are not taught in schools; and many people are not familiar with written forms of the language
Another issue is that questionnaires devised in high-income countries are difficult to adapt to low-resource settings
Summary
New Zealand has a history of mental health legislation dating back to its beginnings as a modern state. The current legislation allows compulsory assessment and treatment for people with mental disorders in hospital or the community in limited circumstances if there is a significant risk to the individual of harm or poor self-care, or a significant risk of harm to others. The core principle underlying the doctor–patient relationship is respect of the autonomy of the patient to make informed decisions and to consent to any treatment, and this is strongly supported by legislation, with oversight from a number of institutions. When compulsory treatment is deemed necessary, this is subject to judicial oversight and there are multiple opportunities for appeal. Patients who are subject to compulsory treatment continue to have their rights protected. There is an expectation that treatment will be delivered in the least restrictive environment, the extensive use of community orders, and that collaboration and consent to treatment are encouraged
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