South Africa has about 30 specialists, child and adolescent psychiatrists, the majority of whom work in private practice where access is limited owing to financial constraints.
State-funded specialist child and adolescent mental health facilities are only available in Gauteng (which has four service units), the Western Cape (with two units) and KwaZulu-Natal (with one).
As a result, it is estimated that only 10% of children and adolescents in need of mental health treatment have access to it. This only emphasises how fragile and unequally distributed the South African healthcare system is.
According to the South African Society of Psychiatrists (SASOP), about one in seven children have a treatable mental health condition but most will carry the burden through to adulthood due to South Africa’s chronic lack of specialists and facilities to support their unique needs.
Dr Alicia Porter, a psychiatrist and member of the SASOP’s board of directors, believes that South Africa must go beyond policies and invest in training, staffing and facilities that make appropriate treatment available to the most vulnerable members of our society.
The Covid-19 pandemic has exacerbated South Africa's already fragile health-care system.
Porter calls attention to how mental health conditions are the leading cause of illness and disability in children and teens, while 50 to 80% of adult mental health disorders originate in childhood, impacting on physical and mental health, increasing the risk of substance abuse, and limiting opportunities for education and employment..
“In South Africa we are completely unable to meet the mental health needs of children and adolescents, and we as psychiatrists have been calling for urgent action for a long time. We need to act now to protect the next generation and prevent the socio-economic consequences of poor mental health,” Porter said.
“Child and adolescent mental health is not prioritised, which is reflected by a lack of dedicated funding, human resources and facilities, as well as the frequent unavailability of psychotropic medication.
“This is amplified by a lack of knowledge and understanding of what child and adolescent mental health entails and what services are needed,” she said.
Porter added that a lack of understanding and acceptance of mental health led to the stigmatisation of families who sought help within their extended families, communities, and health-care system, with psychiatric problems being viewed as the child “just being naughty” or “just going through a phase”, and the result of poor parenting.
The key priorities highlighted by psychiatrists to be addressed if South Africa is to improve child and adolescent mental healthcare are:
Primary care nurses should receive mental health training specifically focused on how these conditions present in children and adolescents in order to help with mental health promotion and awareness, as well as screening and early detection.
Similarly, teachers should be trained in recognising mental health conditions, mental health promotion, and basic counselling, and mental health skills training should be included in the school curriculum to help children and teenagers develop coping skills and resilience.