Child and adolescent mental health services and systems in low and middle-income countries: from mapping to strengthening

Abstract

Purpose of review Most of the world's children and adolescents live in low and middle-income countries (LMICs) where mental health services are very limited. Here, we reviewed literature over the last 18 months describing the current landscape of child and adolescent mental health services and systems (CAMHSS) in LMICs, and present findings from systems strengthening research. Recent findings The challenges in CAMHSS are well described with little change over the last two decades. Fortunately, research has started to move from ‘mapping’ towards systems ‘strengthening’. Using the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS) framework, we reviewed recent CAMHSS innovations. Clinical care and human resource innovations focused on primary care with validation of screening tools, training and task-sharing for capacity-building. Intersectoral collaboration emerged as a priority domain for strengthening, alongside a theme around the importance of participatory research to inform policy reforms. The potential role of digital technology to strengthen CAMHSS was identified as an emerging theme. Summary There is an urgent need to increase the priority of CAMHSS in LMICs. This will require innovations at multiple levels aimed at all CAMHSS domains, with active participation of all relevant local stakeholders to ensure the translation of research into policy and practice.

A situational analysis of child and adolescent mental health services and systems in the Western Cape Province of South Africa

“…Overall data suggested clinical care provision to fewer than 10% of the expected population of children and adolescents in need of mental healthcare. Our findings raise significant concerns about CAMH in the Western Cape, and by implication, about CAMH services and systems elsewhere in the country and in other low/middle-income countries [ 2 , 10 , 13 , 15 , 65 , 66 , 69 – 71 ]. Even though it will be important to expand our research also to explore software elements of the health system (e.g.…”

“…Adequate provision of resources in a health system requires adequate financing to ensure that a good enough service is delivered [ 4 ]. Child and adolescent mental health disorders have a ‘triple burden’ in terms of its economic impact—first in terms of the child (costs associated with the treatment of the child, loss of future earnings as a result of disability and reduced work capacity for the individual), second in terms of the caregivers and family (reduced family income as a result of caregiving and loss of productivity), and third in terms of wider societal costs (costs to the healthcare, social care, criminal justice and educational system) [ 68 , 69 ].…”

“…They used the WHO-AIMS framework to group these studies. Overall, only a handful of mapping studies were identified over the last few years, mainly in South Africa and India [ 69 ]. Across the WHO-AIMS domains some innovations were identified to strengthen specific aspects.…”

“…Apart from the WHO-AIMS domains, digital technology was identified as a potentially exciting vehicle to strengthen many health system domains. However, the authors argued that any system strengthening should be articulated with a ‘whole-systems’ perspective, mindful of the cultural, socio-economic and linguistic diversity of LMIC communities [ 69 ].…”

Child and Adolescent Mental Health Services in the Western Cape Province of South Africa: the Perspectives of Service Providers

“…Participants were selected from the health sector in the Western Cape. The Western Cape is divided into a number of urban (metropolitan) and rural districts (for further detail about the health districts in the Western Cape, please see [7,11]. We aimed to include a wide range of service providers from all the urban health districts (Southern/Western substructure, Mitchell's Plain/Klipfontein substructure, Tygerberg/Northern substructure, Khayelitsha/Eastern substructure), and rural districts (Cape Winelands, West Coast, Overberg, Eden and Central Karoo), and from all levels of care (primary, secondary and tertiary).…”