Abstract
Children and young people are vulnerable to developing mental health problems. In South Africa, this vulnerability is compounded by contextual risk factors such as community violence and poverty. However, mental health services are scarce and costly, which precludes access for many. Universal school-based mental health programmes can prevent the onset of mental health problems in children and young people and have been implemented to good effect in high-income settings. We sought to understand stakeholder perspectives on what such a programme should focus on and how it could be implemented in practice within the South African context. We interviewed children and young people (n = 22), parents (n = 21), teachers (n = 17), and school mental health counsellors (n = 6) recruited from two schools in the Western Cape, South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. We generated three overarching themes: ‘the value of a mental health and well-being programme’, ‘content and delivery’, and ‘practicalities and logistics’. Participants were optimistic about the potential value of such a programme. Developing content that was appropriate for group delivery, flexible and timed to fit within the school schedule was important. Finding ways to make activities meaningful for large classes was important logistically, as was determining to what extent leaners would feel comfortable participating alongside their peers. Participants felt that outsiders, as opposed to school staff, should deliver the programme and that parents should be involved where possible. Developing a mental health programme for children and young people in the South African context requires careful understanding of who the key role players in such an intervention will be and how exactly they want to be involved and, how the challenges associated with practicalities and logistics can be overcome.
Highlights
The rates of depression and anxiety amongst children and young people (CYP) are high and without intervention, often persist into adulthood (Costello et al, 2006; Woodward & Fergusson, 2001)
Depression and anxiety are highly comorbid and estimates suggest that comorbidity ranges from 10 to 50% (Garber & Weersing, 2010)
In low- and middle-income countries (LMICs) CYP are at an even higher risk for developing these disorders due to the many risk factors associated with living in poverty and conditions of precarity (Kieling et al, 2011; Lund et al, 2011; Patel et al, 2010; Skeen et al, 2019)
Summary
The rates of depression and anxiety amongst children and young people (CYP) are high and without intervention, often persist into adulthood (Costello et al, 2006; Woodward & Fergusson, 2001). The prevalence of mental health problems in CYP ranges between 10 and 20%, and at least 20% of CYP will have experienced a mental health issue by age 18 (Costello et al, 2003; Essau et al, 2012). Depression and anxiety are highly comorbid and estimates suggest that comorbidity ranges from 10 to 50% (Garber & Weersing, 2010). In South Africa, for example, available data is limited but suggests that rates are higher. A 2001 study suggests that the prevalence of anxiety among children 7–13 years ranges between 22% and 25.6% (Perold, 2001). South Africa is characterised by high rates of violence, trauma and poverty and high
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