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

Abstract

Background 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. 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. Methods Purposive 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. Results The 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. Conclusions The 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.

Child and adolescent mental health services in the Western Cape Province of South Africa: the perspectives of service providers

“…Our findings also concur with broader South African and international literature. For instance, a qualitative study that explored multistakeholders' perceptions of CAMHSS in another South African province (KwaZulu-Natal) found that there was a shortage of CAMH resources (human and infrastructure) resulting in service providers being overwhelmed with their workload, inadequate CAMH training for non-specialists, lack of a coordinated system of CAMH, and stigmatisation of mental illness in children and adolescents [19]. In an international systematic review that explored primary care practitioners' perceptions of the barriers to the effective management of CAMH problems, the authors found lack of staff training, lack of prioritisation of mental health problems, lack of resources, and family issues as key barriers [20].…”

Where is Batho Pele? The perspective of child and adolescent mental health service users in the Western Cape Province of South Africa

“…While we were not able to include voices of service users from rural districts in the Western Cape, the themes that emerged for the urban area of Cape Town, showed many similarities with ndings in the Amajuba rural district of KwaZulu-Natal (KZN), where Babatunde and colleagues recently conducted a situational analysis (31) and collected stakeholder perspectives. In their investigation of health, education, non-pro t organisations and service users, emerging themes included lack of services, poor coordination, lack of intersectoral work and low prioritisation of CAMH work.…”

“…In their investigation of health, education, non-pro t organisations and service users, emerging themes included lack of services, poor coordination, lack of intersectoral work and low prioritisation of CAMH work. The stakeholder study combined ndings for providers and service users, so it was not possible to do a direct comparison between the two studies, but illustrative quotes from the KZN study included comments about the need for information and parent education, and some positive examples of good care and support to families (31). One very interesting theme that emerged from the KZN study was the important role of schools and the Department of Education as partner in the early identi cation and treatment of child and adolescent mental health problems.…”

The plight of social workers working with children and adolescents suffering mental health disorders in South Africa

“…However, the implementation pace of these policies at the grassroots level is concerning, with no evidence thereof in any of the country's nine provinces [17]. Furthermore, mental health programmes for children and adolescents are also concerning in South Africa, where there is no evidence of procedures and protocols for CAMH disorders [19]. The implication is that intervention strategies that are currently designed and implemented may not have scienti c basis.…”

“…It is clear from the narratives that CAMH disorders and their social workers face many obstacles when accessing mental health services from hospitals. South-African studies [19,12] attested to this by pointing to CAMH disorder services that are underprovided and ineffective. A South African analysis of CAMH disorder services found a limited number of psychiatrists dedicated to CAMH disorders [39].…”