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de Vries PJ. Editorial perspective: Transforming child and adolescent mental health services and systems (CAMHSS) around the globe - the importance of diversity, inclusion and equity in CAMHSS research. Child Adolesc Ment Health 2024; 29:194-196. [PMID: 38634297 DOI: 10.1111/camh.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
Children and adolescents around the globe have mental health and neurodevelopmental needs. However, no country or region of the world has found good solutions to meet these needs, which are often long-term and complex. Most child and adolescent mental health research comes from high-income, mostly English-speaking, contexts even though 95% of the world's children and adolescents live in low- and middle-income countries (LMIC), where there is vast cultural, linguistic, and socio-economic diversity, with limited services and systems for child and adolescent mental health (CAMH). There is therefore both a 'knowledge gap' (more than 90% of all research represents less than 10% of the global population) and an 'identification and treatment gap' (fewer than 1 in 10 children in LMIC ever receive a diagnosis or any kind of treatment). The purpose of this editorial perspective was to consider the challenges of diversity, inclusion and equity in CAMH research around the globe, and to present some practical things we can all do to close these gaps and transform the global CAMH research agenda.
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Affiliation(s)
- Petrus J de Vries
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Hannon E, Anselimus SM, Bardikoff N, Bulc B, Germann S, Gonsalves PP, Melendez-Torres GJ, Ospina-Pinillos L, Sinha M, Wanjiru M. Why cities matter for adolescent mental health and wellbeing. Lancet 2024; 403:708-710. [PMID: 37827186 DOI: 10.1016/s0140-6736(23)02238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Affiliation(s)
| | - Sweetbert M Anselimus
- Tanzania's Psychosocial Welfare Organization, and University of Dar es Salaam, Iringa, Tanzania
| | - Nicole Bardikoff
- Global Mental Health at Grand Challenges Canada, Toronto, ON, Canada
| | - Barbara Bulc
- Global Development and SDG CoLab, Geneva, Switzerland
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Mutahi J, Kangwana B, Khasowa D, Muthoni I, Charo O, Muli A, Kumar M. Integrating Mental Health Management into Empowerment Group Sessions for Out-of-School Adolescents in Kenyan Informal Settlements: A Process Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:223. [PMID: 38397712 PMCID: PMC10888709 DOI: 10.3390/ijerph21020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/25/2024]
Abstract
This article presents processes for developing contextualized training procedures to better appreciate partnership, capacity-building experiences, and specific implementation challenges and opportunities for mental and public health teams. The program enrolled 469 out-of-school adolescents to participate in the integration of youth mental health into health and life-skill safe spaces. The teams utilized various methods to achieve process outcomes of restructuring and adapting curricula, training youth mentors, and assessing their self-efficacy before integrating the intervention for 18 months. The Coronavirus (COVID-19) pandemic became an additional unique concern in the preliminary and the 18-month implementation period of the program. This necessitated innovation around hybrid training and asynchronous modalities as program teams navigated the two study locations for prompt training, supervision, evaluation, and feedback. In conclusion, out-of-school adolescents face a myriad of challenges, and a safe space program led by youth mentors can help promote mental health. Our study demonstrated how best this can be achieved. We point to lessons such as the importance of adapting the intervention and working cohesively in teams, building strong and trusting partnerships, learning how to carry out multidisciplinary dialogues, and continuous supervision and capacity building. This article aimed to document the processes around the design and implementation of this innovative intervention and present a summary of lessons learned.
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Affiliation(s)
- Joan Mutahi
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
| | - Beth Kangwana
- Population Council–Kenya-Avenue 5, 3rd Floor Rose Ave, Nairobi P.O. Box 17643-00500, Kenya; (B.K.); (A.M.)
| | - Dorcas Khasowa
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
| | - Irene Muthoni
- Integrated Education for Community Empowerment, Nairobi P.O. Box 7631-00300, Kenya;
| | - Oliver Charo
- Rapid Effective Participatory Action in Community Theatre Education and Development, Nakuru P.O. Box 15614-20100, Kenya;
| | - Alfred Muli
- Population Council–Kenya-Avenue 5, 3rd Floor Rose Ave, Nairobi P.O. Box 17643-00500, Kenya; (B.K.); (A.M.)
| | - Manasi Kumar
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, US-550 First Avenue New York, New York, NY 10016, USA
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Abdalhai KA, Mokitimi S, de Vries PJ. Child and adolescent mental health services in Khartoum State, Sudan: a desktop situational analysis. Child Adolesc Psychiatry Ment Health 2024; 18:21. [PMID: 38310302 PMCID: PMC10838434 DOI: 10.1186/s13034-024-00707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/11/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Sudan is a Northeast African country, with 61.7% of its population under 24 years. With a large youth population and significant cultural and linguistic diversity, Sudan, like most low-income countries, has contributed minimal data to global child and adolescent mental health (CAMH) research. This study aimed to perform the first ever situational analysis of CAMH services and systems in Khartoum State, Sudan. METHODS The study focused on Khartoum state and covered the calendar years 2019 and 2020. Using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) version 2.2 adapted for CAMH, the study focused on the publically available data sources. Findings were described and presented in tables and figures using the WHO-AIMS template. RESULTS The situational analysis found no CAMH-specific policies, no separate budget for CAMH, and no supervising body for CAMH services in Khartoum. Three tertiary mental health hospitals provided CAMH services, all combined with adult mental health services. Essential medicines were available in all facilities, except methylphenidate available only in 3 central pharmacies. There was no free access to essential psychotropic drugs for children and adolescents except in emergency settings. Data about training to primary healthcare providers and the process of referral to specialized services were limited. A school mental health programme existed which provided early identification and management of CAMH problems in schools. The workforce was small and variable across all levels of care. No formal public health awareness campaigns and little evidence of formal intersectoral collaboration on CAMH were identified. A health information system existed, but no CAMH-specific items were reported. Among a handful of publications on CAMH, no national studies on CAMH were identified. CONCLUSIONS This situational analysis represented the first systematic collation of data and information about CAMH in Sudan. Findings highlighted some areas of strength, but also many gaps in CAMH services and systems. We acknowledge the need to complement the desktop analysis with in-depth data collection with stakeholders across multiple levels, but hope that this will serve as a first step towards strengthening CAMH services in Sudan and other low-income countries.
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Affiliation(s)
- Khalid A Abdalhai
- Department of Psychiatry, Faculty of Medicine, International University of Africa, Khartoum, Sudan.
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Stella Mokitimi
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Petrus J de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Schlebusch L, Chambers N, Rosenstein D, Erasmus P, de Vries PJ. Supporting caregivers of children with developmental disabilities: Findings from a brief caregiver well-being programme in South Africa. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:199-214. [PMID: 36352758 DOI: 10.1177/13623613221133182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
LAY ABSTRACT Young children with developmental disabilities and delays who live in low- and middle-income countries are at significant risk of not reaching their full potential. We know that daily interactions with their caregivers (parents or other people taking care of them) play an important role in promoting their development. However, having a child with developmental disabilities can have a negative impact on carers' mental health and well-being, which in turn can influence their capacity to care for their children. To date, very little attention has been given to the caregivers' capacity to care. The World Health Organization developed a Caregiver Skills Training programme which includes a brief, three-session module that focuses on improving caregivers' well-being and mental health. This well-being programme is based on acceptance and commitment therapy. Acceptance and commitment therapy shows increasing evidence of helping people respond to their stressors, thoughts, feelings and experiences a little differently and commit to small changes that are in line with their personal values. Acceptance and commitment therapy has shown promise in improving feelings of well-being in caregivers of children with developmental disabilities. We adapted the World Health Organization Caregiver Skills Training Caregiver well-being module to suit the South African context. The resultant 'Well Beans for Caregivers' was then delivered to caregivers from a rural, low-resource setting in South Africa. We found the intervention easy to implement, highly acceptable to caregivers and showed promising impacts on caregivers' well-being and mental health. This intervention has the potential to be implemented widely and sustainably to build caregivers' capacity to care for their children.
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Atilola O, Ayinde O, Obialo FK, Adeyemo SO, Adegbaju D, Anthony R. Towards school-based mental health programs in Nigeria: the immediate impact of a depression-literacy program among school-going adolescents and their teachers. Child Adolesc Psychiatry Ment Health 2022; 16:70. [PMID: 35999596 PMCID: PMC9400212 DOI: 10.1186/s13034-022-00503-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Depression-literacy, which is the foundational requirement for symptom recognition, positive attitude and help-seeking, is poor among adolescents in Nigeria. This study, therefore, aims to determine the impact of a school-based training program on depression-literacy among a cohort of high-school students and their teachers in South-West Nigeria. METHODS An adapted version of the Break Free from Depression, a 4-module depression awareness curriculum for staff and students, was implemented among students and their teachers. Paired-sample T-test was used to assess the domain-specific (knowledge, attitude, and confidence) impact of the training by comparing the baseline and immediate (within the week of the training) post-scores. RESULTS A total of 3098 students and 294 teachers from 21 schools across three states in South-West Nigeria successfully completed the training. There was a significant positive difference (p < 0.05), at post-test, in the knowledge, attitude, and confidence among the students. The same was observed among teachers except for attitude where positive change did not reach significant level (p = 0.06). When statistically significant, the calculated effect size (eta squared) was highest for knowledge (students: 0.07, p = 0.001; teachers: 0.08, p < 0.000) and least for attitude (students: 0.003, p = 0.002 teachers: 0.085, p = 0.06). Multiple regression analyses result showed that the level of pre-scores predicted the magnitude of change in all domains of depression-literacy (p < 0.05) after controlling for age, gender, and type of school among the students, but not for teachers. CONCLUSIONS School-based depression-literacy programs can lead to significant positive change in knowledge, attitude, and confidence of students and teachers.
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Affiliation(s)
- Olayinka Atilola
- Department of Behavioral Medicine, Lagos State University College of Medicine Ikeja, Lagos, Nigeria.
| | - Olatunde Ayinde
- grid.9582.60000 0004 1794 5983Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Felix-Kingsley Obialo
- grid.9582.60000 0004 1794 5983Center for Creativity and Entrepreneurial Studies, Dominican University Ibadan, Ibadan, Nigeria
| | - Sunday Oladotun Adeyemo
- grid.412320.60000 0001 2291 4792Department of Psychology, Olabisi Onabanjo University Ago-Iwoye, Ago-Iwoye, Nigeria
| | - Dapo Adegbaju
- grid.490120.e0000 0004 9338 1163Federal Neuro-Psychiatric Hospital Yaba, Lagos, Nigeria
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Ramaswamy S, Sagar JV, Seshadri S. A transdisciplinary public health model for child and adolescent mental healthcare in low- and middle-income countries. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 3:100024. [PMID: 37384265 PMCID: PMC10305986 DOI: 10.1016/j.lansea.2022.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Despite the high burden of child and adolescent mental health problems in LMICs, attributable to poverty and childhood adversity, access to quality mental healthcare services is poor. LMICs, due to paucity of resources, also contend with shortage of trained mental health workers and paucity of standardized intervention modules and materials. In the wake of these challenges, and given that child development and mental health concerns cut across a plethora of disciplines, sectors and services, public health models need to incorporate integrated approaches to responding to the mental health and psychosocial care needs of vulnerable children. This article presents a working model for convergence, and the practice of transdisciplinary Public Health, in order to address the gaps and challenges in child and adolescent mental healthcare in LMICs. Located in a state tertiary mental healthcare institution, this national level model reaches (child care) service providers and stakeholders, duty-bearers, and citizens (namely parents, teachers, protection functionaries, health workers and other interested parties) through capacity building initiatives and tele-mentoring services, public discourse series, developed for a South Asian context and delivered in diverse languages. Role of Funding Source The Ministry of Women and Child Development, Government of India, provides financial support to the SAMVAD initiative.
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Affiliation(s)
- Sheila Ramaswamy
- SAMVAD, Department of Child & Adolescent Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - John Vijay Sagar
- Department of Child & Adolescent Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Shekhar Seshadri
- Department of Child & Adolescent Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
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Mokitimi S, Jonas K, Schneider M, de Vries PJ. Child and adolescent mental health services in the Western Cape Province of South Africa: the perspectives of service providers. Child Adolesc Psychiatry Ment Health 2022; 16:57. [PMID: 35836277 PMCID: PMC9284743 DOI: 10.1186/s13034-022-00491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current work in the field point to the need to strengthen child and adolescent mental health services (CAMHS) globally, and especially in low- and middle-income countries (LMICs). Policy development, planning and service provision must be relevant to the needs of stakeholders at grassroots level, and should include their perspectives. This study set out to explore the perspectives and lived experiences of service providers, including their recommendations to strengthen CAMHS in South Africa. METHODS Using focus group discussions (FGDs) and semi-structured individual interviews (SSIIs), qualitative data were collected from 46 purposefully selected multidisciplinary health service providers across the Western Cape, one of the nine provinces of South Africa. Audio-recorded data were entered into NVivo 11 (QSR), and thematic analysis was performed by two independent raters. RESULTS Results highlighted a significant lack of CAMH resources, poor intersectoral collaboration, limited access to training, absence of consistency and uniformity in service delivery, weak support for staff, and high rates of negative attitudes of staff. External factors contributing to poor CAMHS identified by service providers included poor socioeconomic circumstances, high rates of HIV/AIDS, substance use and stigma. The eight recommendations to strengthen CAMHS included a need to (1) increase CAMH staffing, (2) provide dedicated CAMHS at secondary care and child-friendly infrastructure at primary care, (3) review current service focus on number of patients seen versus quality of care provided to children, (4) formalise intersectoral collaborations, (5) increase learning opportunities for trainees, (6) employ a lead professional for CAMHS in the province, (7) increase support for staff, and (8) acknowledge staff initiatives. CONCLUSIONS Findings underlined the need for quality improvement, standardisation and scale-up of mental health services for children and adolescents in South Africa. Whilst we used the Western Cape as a 'case study', we propose that our findings may also be relevant to other LMICs. We recommend that the perspectives of service users, including children and adolescents, be sought to inform service transformation.
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Affiliation(s)
- Stella Mokitimi
- grid.7836.a0000 0004 1937 1151Division of Child and Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Kim Jonas
- grid.415021.30000 0000 9155 0024South African Medical Research Council, Cape Town, South Africa
| | - Marguerite Schneider
- grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Petrus J. de Vries
- grid.7836.a0000 0004 1937 1151Division of Child and Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
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Mokitimi S, Schneider M, de Vries PJ. A situational analysis of child and adolescent mental health services and systems in the Western Cape Province of South Africa. Child Adolesc Psychiatry Ment Health 2022; 16:6. [PMID: 35078503 PMCID: PMC8787885 DOI: 10.1186/s13034-022-00440-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though child and adolescent mental health is a global health priority, services are very limited, particularly in low- and middle-income countries (LMIC), and therefore need comprehensive strengthening. This requires knowledge of the hardware elements of the system (human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems). This study sought to examine these elements of child and adolescent mental health (CAMH) services and systems in the Western Cape Province of South Africa. METHODS The World Health Organization Assessment Instrument of Mental Health Systems (WHO-AIMS) version 2.2 of 2005 was adapted to identify key variables of interest in CAMH. Data were collected for the calendar year 2016 and focused on the public health sector. We outlined findings based on best available data across the six domains of the WHO-AIMS. RESULTS In domain 1, we found no provincial CAMH policy or implementation plans to support the national CAMH policy and were unable to identify a CAMH-specific budget. In domain 2, there was no dedicated provincial leadership structure for CAMH, and no dedicated or 'child- and adolescent-friendly' mental health services at primary or secondary care levels. At tertiary level, there were only three specialist CAMH teams. The majority of CAMH resources were based in the City of Cape Town, with limited resources in the rural districts. Essential medicines were available in all facilities, and the majority of children and adolescents had access to free services. In domain 3, data were limited about the extent of training offered to primary healthcare staff, and little or no psychosocial interventions were available in primary care. Domain 4 identified a small and variable CAMH workforce across all levels of care. In domain 5, few public health campaigns focused on CAMH, and little evidence of formal intersectoral collaboration on CAMH was identified. Domain 6 identified significant limitations in health information systems for CAMH, including lack of child- and adolescent-specific and disaggregated data to establish baselines for policy development, monitoring, evaluation and CAMH research. CONCLUSIONS This study identified significant structural weaknesses in CAMH and presents a clear call for action to strengthen services and systems in the province and in South Africa. it would be important to expand research also to include provider and user perspectives for service strengthening.
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Affiliation(s)
- Stella Mokitimi
- grid.7836.a0000 0004 1937 1151Division of Child and Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 South Africa ,grid.415742.10000 0001 2296 3850Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch, 7700 South Africa
| | - Marguerite Schneider
- grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, South Africa
| | - Petrus J. de Vries
- grid.7836.a0000 0004 1937 1151Division of Child and Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 South Africa
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