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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00841

Child and Adolescent Mental Health Services in South Africa – Senior stakeholder perceptions of strengths, weaknesses, opportunities and threats in the Western Cape Province

 Stella Mokitimi1, 2*, Kim Jonas3, 4, Marguerite Schneider5 and  Petrus J. De Vries2, 3
  • 1Red Cross War Memorial Children's Hospital, South Africa
  • 2Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa
  • 3Adolescent Health Research Unit, University of Cape Town, South Africa
  • 4South African Medical Research Council, South Africa
  • 5Alan J Flisher Centre for Public Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa

Background
There is general consensus that child and adolescent mental health services in low- and middle-income countries have an urgent need to be strengthened. However, this require not only a universal understanding of services and service needs, but also indepth local knowledge to inform relevant service strengthening. This study sought to explore the perspectives of senior child and adolescent mental health service providers and policy-makers in one South African province to identify strengths, weaknesses, opportunities and threats to child and adolescent mental health services.
Methods
A qualitative study was conducted with thirteen purposively-sampled senior child and adolescent mental health service providers, senior managers, and policy-makers from the Western Cape Province, using a half-day multi-stakeholder workshop format. Verbal and written data were recorded and coded for analysis. Two independent raters performed thematic analysis.
Results
The comprehensive bio-psycho-social approach and strong specialist child and adolescent mental health service units were identified as strengths. Limited capacity, workload demands, inadequate and inequitable resource allocation, poor implementation of early detection and preventative policies, and overall neglect of child and adolescent mental health services, were identified as weaknesses. Collaborative working between child and adolescent mental health and paediatric services, and increased provincial government (Department of Health) involvement, were identified as potential opportunities to develop and strengthen child and adolescent mental health services. Silo working of agencies, societal stressors, inadequate infrastructure and other resources, and lack of dedicated funding for child and adolescent mental health, were identified as threats to the development of services.
Conclusions
This analysis of strengths, weaknesses, opportunities and threats reinforced the widespread neglect of child and adolescent mental health services in South Africa and highlighted areas for further research and advocacy. There is a clear need to explore the perspectives and experiences of service users and providers to generate comprehensive multi-stakeholder evidence that may identify positive ‘tipping points’ for improvements and strengthening of child and adolescent mental health service delivery, training and research.

Keywords: Child, Adolescent, Mental Health Services, Health Systems, tipping point, South Africa, Africa, Low- and middle- income countries

Received: 08 Apr 2019; Accepted: 23 Oct 2019.

Copyright: © 2019 Mokitimi, Jonas, Schneider and De Vries. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mrs. Stella Mokitimi, Red Cross War Memorial Children's Hospital, Cape Town, South Africa, mktste003@myuct.ac.za