Gbotemi Bukola Babatunde recently completed her doctor of philosophy (Medicine) degree and has been awarded a postdoctoral fellowship in the College of Health Sciences. Her Ph.D. study focused on exploring access to child and adolescent mental health care services in a low resource district in South Africa.
Mental health is a fundamental component of health at every stage of life, from childhood to adulthood, and it is acknowledged as a crucial public health issue. Child and adolescent mental health (CAMH) problems have been categorised as a public health challenge affecting up to 20% of children worldwide. Despite the severe consequences of under-prioritising CAMH problems, mental health services for this population remain scarce in low resource settings. The study, therefore, sought to explore the state of the available CAMH services in a case study district to identify the challenges of CAMH services, possible strategies to address the challenges, inform the development of a district mental health care plan, and strengthen the CAMH system in the district.
Using a mixed-methods approach, the study provides insight into the challenges associated with CAMH services, which are typical of many low resource settings – particularly in low- and middle-income countries. Six major cross-cutting bottlenecks emerged from assessing the system using the World Health Organization (WHO) Health Systems and the Health System Dynamics (HSD) Frameworks’ building blocks. Under the leadership and governance block, a weak management structure (lack of intersectoral collaboration/liaison forum) was highlighted. Under the service delivery block, poor identification, screening, and assessment procedure, inappropriate referral pathways, limited task sharing/specialist vertical services, limited community-based CAMH interventions, and limited CAMH promotion and awareness were revealed. Stakeholders identified context-specific causal factors and possible strategies to address the bottlenecks in a participatory workshop.
All the factors identified in the workshop, when consolidated, yielded five key multilevel interventions required to strengthen the existing CAMH system in the district, particularly the leadership and governance, service delivery, and health workforce building blocks. They included the need to;
i) design routine awareness programs and user-friendly CAMH screening tools to facilitate early identification in the community;
ii) design of a functional district CAMH referral system;
iii) design of youth-friendly CAMH care packages;
iv) adopt a task-sharing approach with specialist supervision and mentoring of non-specialists;
v) develop an intersectoral working group to facilitate intersectoral collaboration. Additionally, a Theory of Change (ToC) model was developed to improve CAMH services based on the workshop’s data.
Her postdoctoral research will build on the Ph.D. study findings, focusing on extending the Community Mental Health Education and Detection (CMED) tool developed by the Southern African Research Consortium for Mental health INTegration (S-MhINT) to include CAMH conditions. The proposed psychoeducation intervention will educate children and adolescents, parents/caregivers, and the community to improve mental health literacy and facilitate early identification and effective management of CAMH conditions.