Abstract
Background: There is general consensus that child and adolescent mental health services in low- and middle-income countries have an urgent need to be strengthened. However, this require not only a universal understanding of services and service needs, but also in-depth local knowledge to inform relevant service strengthening. This study sought to explore the perspectives of senior child and adolescent mental health service providers and policy-makers in one South African province to identify strengths, weaknesses, opportunities, and threats to child and adolescent mental health services. Methods: A qualitative study was conducted with 13 purposively sampled senior child and adolescent mental health service providers, senior managers, and policy-makers from the Western Cape Province, using a half-day multi-stakeholder workshop format. Verbal and written data were recorded and coded for analysis. Two independent raters performed thematic analysis. Results: The comprehensive bio-psycho-social approach and strong specialist child and adolescent mental health service units were identified as strengths. Limited capacity, workload demands, inadequate and inequitable resource allocation, poor implementation of early detection and preventative policies, and overall neglect of child and adolescent mental health services, were identified as weaknesses. Collaborative working between child and adolescent mental health and pediatric services, and increased provincial government (Department of Health) involvement, were identified as potential opportunities to develop and strengthen child and adolescent mental health services. Silo working of agencies, societal stressors, inadequate infrastructure and other resources, and lack of dedicated funding for child and adolescent mental health, were identified as threats to the development of services. Conclusions: This analysis of strengths, weaknesses, opportunities, and threats reinforced the widespread neglect of child and adolescent mental health services in South Africa and highlighted areas for further research and advocacy. There is a clear need to explore the perspectives and experiences of service users and providers to generate comprehensive multi-stakeholder evidence that may identify positive "tipping points" for improvements and strengthening of child and adolescent mental health service delivery, training, and research.
Highlights
Mental health disorders are the number one leading burden of disease in children and adolescents [1] affecting 10–20% of children and adolescents around the world
In spite the fact that 90% of the world's children and adolescents live in low- and middle-income countries (LMICs), the evidence-base for the burden of child and adolescent mental disorders in low- and middleincome countries (LMIC) is very limited [8,9,10,11] and suggests a clear lack of policy development and policy implementation, very limited research, and very limited resources for Child and adolescent mental health (CAMH) services [11, 12]
The following threats for CAMH services in the province were identified: Silo working of agencies, societal stressors, inadequate infrastructure and other resources, and lack of dedicated funding for CAMH services
Summary
Mental health disorders are the number one leading burden of disease in children and adolescents [1] affecting 10–20% of children and adolescents around the world. In spite the fact that 90% of the world's children and adolescents live in low- and middle-income countries (LMICs), the evidence-base for the burden of child and adolescent mental disorders in LMICs is very limited [8,9,10,11] and suggests a clear lack of policy development and policy implementation, very limited research, and very limited resources for CAMH services [11, 12]. There is general consensus that child and adolescent mental health services in low- and middle-income countries have an urgent need to be strengthened. This require a universal understanding of services and service needs, and in-depth local knowledge to inform relevant service strengthening. This study sought to explore the perspectives of senior child and adolescent mental health service providers and policy-makers in one South African province to identify strengths, weaknesses, opportunities, and threats to child and adolescent mental health services
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