Stakeholders' perceptions of child and adolescent mental health services in a South African district: a qualitative study

Arvin Bhana,Gbotemi Bukola Babatunde,André Janse van Rensburg,Inge Petersen

doi:10.1186/s13033-020-00406-2

Abstract

BackgroundIn order to develop a district child and adolescent mental health (CAMH) plan, it is vital to engage with a range of stakeholders involved in providing CAMH services, given the complexities associated with delivering such services. Hence this study sought to explore multisectoral dynamics in providing CAMH care in one resource-constrained South African district as a case study, towards informing the development of a model for district mental health plan and generating lessons for mental health systems strengthening to support CAMH services using the Health Systems Dynamics (HSD) framework. HSD provides a suitable structure for analysing interactions between different elements within the health system and other sectors.MethodsPurposive sampling of 60 key informants was conducted to obtain an in-depth understanding of various stakeholders' experiences and perceptions of the available CAMH services in the district. The participants include stakeholders from the Departments of Health (DoH), Basic Education (DBE), community-based/non-governmental organizations and caregivers of children receiving CAMH care. The data was categorized according to the elements of the HSD framework.ResultsThe HSD framework helped in identifying the components of the health systems that are necessary for CAMH service delivery. At a district level, the shortage of human resources, un-coordinated CAMH management system, lack of intersectoral collaboration and the low priority given to the CAMH system negatively impacts on the service providers' experiences of providing CAMH services. Services users' experiences of access to available CAMH services was negatively impacted by financial restrictions, low mental health literacy and stigmatization. Nevertheless, the study participants perceived the available CAMH specialists to be competent and dedicated to delivering quality services but will benefit from systems strengthening initiatives that can expand the workforce and equip non-specialists with the required skills, resources and adequate coordination.ConclusionsThe need to develop the capacity of all the involved stakeholders in relation to CAMH services was imperative in the district. The need to create a mental health outreach team and equip teachers and caregivers with skills required to promote mental wellbeing, promptly identify CAMH conditions, refer appropriately and adhere to a management regimen was emphasized.

Highlights

In order to develop a district child and adolescent mental health (CAMH) plan, it is vital to engage with a range of stakeholders involved in providing CAMH services, given the complexities associated with delivering such services
The paucity of specific national CAMH policies and national implementation guidelines, poor intersectoral collaboration and the shortage of CAMH resources still hinder the provision of optimal child and adolescent mental health services in many countries [25]
Certain community factors such as low mental health literacy resulting in misconceptions and stigmatization, and the dysfunctional nature of the family system within the communities were highlighted as major CAMH risk factors within the district that impedes access to CAMH services

Summary

Introduction

In order to develop a district child and adolescent mental health (CAMH) plan, it is vital to engage with a range of stakeholders involved in providing CAMH services, given the complexities associated with delivering such services. There has been increased attention paid to improving child and adolescent mental health (CAMH) services in different countries around the globe [29, 47]. The paucity of specific national CAMH policies and national implementation guidelines, poor intersectoral collaboration and the shortage of CAMH resources still hinder the provision of optimal child and adolescent mental health services in many countries [25]. Barriers to CAMH service provision in LMICs will undoubtedly be aggravated by the COVID-19 pandemic, an event that will substantially test the resilience and responsiveness of district health systems. It has already been noted that the pandemic will add to the current CAMH burden, and a strong system of governance, service provision and financing will be vital to ensure the well-being of children and adolescents [19]

Methods

Results

Discussion

Conclusion