Exploring the challenges of meeting child mental health needs through community engagement in Kenya

Abstract

Background: Despite growing evidence on the extent of child mental health problems in low-middle-income countries, the gap between need and provision remains high. Previous research in high income countries has demonstrated that evidence-based interventions can be scaled-up through community consultation, particularly by engaging key stakeholders. Aims: This study aimed to explore community stakeholders' views on children's mental health needs and culturally acceptable interventions in Kenya, to ascertain how to integrate global service standards with culturally-specific expectations. Methods: Focus groups were conducted with community stakeholders (seven young people 14-17 years, seven parents, nine teachers and 11 other professionals). These participants were recruited from an urban community of internally displaced and disadvantaged families in Nakuru. Results: Results indicated that Kenya faced similar challenges in meeting mental health needs as in other countries, including economic constraints, limited knowledge, stigma and systemic issues, but that these were manifested in culturally specific ways that were linked to societal and professional's attitudes and local context. Conclusions: Stakeholders' views are important in informing the planning, delivery and evaluation of interventions. However, for such interventions to be sustained, a clear therapeutic framework, evidence-base and sociocultural adaptation are likely to be important factors. Key Practitioner Message• Stakeholders' views are important in informing the planning, delivery and evaluation of interventions. • Interventions and services can be scaled up through community consultation, particularly by engaging key community stakeholders.• Evidence-based interventions should reflect the local context, maximise available resources and be culturally acceptable.

Stakeholder Perspectives on Children's Mental Health Needs and Supports in Six Low‐ and Middle‐Income Countries

“…Although participants’ conceptualisation of mental health (or, rather, how this was perceived in their societies) was not substantially different from those in previous LMIC research (Amuyunzu‐Nyamongo, ), they adopted a holistic approach to their definition of mental health needs, and were aware of the complexity of these needs in vulnerable populations. They were also conscious of how addressing both mental health and vulnerability were compromised by negatives attitudes and stigma, including from the professionals themselves (Getanda and others, ). For this reason, joint awareness programmes could help bridge similar gaps between communities and services.…”

“…Semi‐structured interviewing is a popular and useful strategy for gaining important insights from participant perspectives (Roulston, ). Interview guides were developed based on the existing literature on child mental health concepts, needs and service provision in LMIC (Getanda and others, ). Aligning with the quality framework for a thematic design, recruitment continued until saturation was achieved (O'Reilly and Parker, ) as guided by the research agenda.…”

“…The influence of sociocultural factors on mental health is well‐documented (Tol and others, ), but there remains limited knowledge on how these can best inform appropriate interventions and supports (Abera and others, ; Amuyunzu‐Nyamongo, ; Betancourt and Khan, ). Additionally, there is variation in knowledge and understanding of child mental health concepts among agencies (Getanda and others, ); and discordance between children, parents and practitioners (O'Reilly and others, ). These challenges are more pronounced in LMIC, but also among vulnerable populations such as children in care and homeless young people (O'Reilly and others, 2009).…”

Practitioner Review: Mental health problems of refugee children and adolescents and their management

“…Although the theoretical principles of interventions are not substantially different, a number of factors need to be taken into consideration for refugee children in LMIC. The key differences lie in the conceptualisation of mental health and associated stigma, need for cultural adaptation of interventions, and limited or lack of specialist child mental health services (Getanda, O'Reilly, & Vostanis, ). Consequently, psychosocial responses often need to target the affected populations, and be integrated with economic and community rebuilding efforts (Betancourt & Williams, ).…”

Editorial: Global child mental health – emerging challenges and opportunities

“…Despite the emergence of evidence regarding the cultural adaptation and feasibility of interventions in LMIC settings, and to a lesser extent on their effectiveness, there is still a lack of guidelines on planning and delivering services in different contexts. These should take into consideration the existing infrastructure and level of resources; enhance interprofessional working; and incorporate natural social support systems by capturing stakeholders’ perspectives (Getanda, O'Reilly, & Vostanis, ). The development of targeted child mental health policy and its incorporation into existing child legislation would also provide a much needed framework for the establishment of standards and for the subsequent increase in resources.…”