Improving access to care for children with mental disorders: a global perspective

Abstract

Developmental disabilities, emotional disorders, and disruptive behaviour disorders are the leading mental health related causes of the global burden of disease in children aged below ten years. This article aims to address the treatment gap for child mental disorders through synthesizing three bodies of evidence: the global evidence base on the treatment of these priority disorders; the barriers to implementation of this knowledge; and the innovative approaches taken to address these barriers and improve access to care. Our focus is on low resource settings, which are mostly found in low and middle income countries (LMIC). Despite the evidence base on the burden of child mental disorders and their long-term consequences, and the recent mhGAP guidelines which testify to the effectiveness of a range of pharmacological and psychosocial interventions for these disorders, the vast majority of children in LMIC do not have access to these interventions. We identify three major barriers to implementation of efficacious treatments: the lack of evidence on delivery of the treatments; the low levels of detection of child mental disorders; and the shortage of skilled child mental health professionals. The evidence base on implementation, although weak, supports the use of screening measures for detection of probable disorders, coupled with a second stage diagnostic assessment, and the use of non-specialist workers in community and school settings for the delivery of psychosocial interventions. The most viable strategy to address the treatment gap is through empowerment of existing human resources who are most intimately concerned with child care, including parents, through innovative technologies such as mobile health, with the necessary skills for the detection and treatment of child mental disorders.

Randomized controlled trial of an online mother-daughter body image and well-being intervention.

“…Despite an identified need, few body image interventions have been disseminated at scale (Stice, Becker, & Yokum, 2013). As with most mental health interventions, this is likely due to multiple factors including an overreliance on face-to-face interventions and delivery by expert providers, participant barriers (e.g., time, scheduling, cost, perceived stigma), and a lack of funding and infrastructure for dissemination (Atkinson & Wade, 2013;Patel, Kieling, Maulik, & Divan, 2013). Consequently, there is an on-going need to develop and evaluate effective, acceptable, and scalable body image interventions.…”

Paid staff or volunteers – does it make a difference? The impact of staffing on child outcomes for children attending community-based programmes in South Africa and Malawi

“…These represent the more severe end of child well-being and emotional need. Despite the immense burden of mental disorders in children in LMIC there is a marked lack of services [49,50]. This lack of services includes a lack of specialised personnel to address child mental disorders, as well as a dearth of formal training programmes to enable staff to address child mental health.…”

“…This lack of services includes a lack of specialised personnel to address child mental disorders, as well as a dearth of formal training programmes to enable staff to address child mental health. In answer to this lack of specialised skill, many LMIC have adopted task-sharing approaches to service delivery, including the use of non-specialist workers to deliver mental health services [50,51]. There is growing evidence that lay health workers, if specifically trained, can provide some services and care traditionally delivered by mental health professionals [52–56].…”

Development of national capabilities in low and middle income countries for research in child mental health

“…The complete picture, with national data from low and middle income countries (LMICs) included, would certainly depict a more vulnerable scenario. In fact, due to population growth and under-resourced health care systems, the burden of mental health and substance-use disorders is expected to further increase worldwide in the next decades, and the steepest rise is predicted to occur in LMICs [7].Considering the evolving adverse scenario of child mental health across the globe, international calls and initiatives have been proposed and implemented aiming to foster the development of preventive and treatment interventions, health-system strengthening, and policymaking [12,13]. Importantly, in LMICs, the development and consolidation of in-country research capabilities that are able to identify local specificities and connect to commonalities across countries, both in terms of etiology, biological substrate, clinical presentation, treatment response, long-term trajectories of disorders, and also health system organization, are…”