'I Waited for It until Forever': Community Barriers to Accessing Intellectual Disability Services for Children and Their Families in Cape Town, South Africa

Psychiatrists' experiences of involuntary care in South Africa: dilemmas for practice in challenging contexts

Providing for people with psychosocial conditions in crisis is a complex and controversial endeavour that has gained significant attention over the past decade. This increased focus is driven by global calls to reduce coercion, including by the United Nations Committee on the Rights of Persons with Disabilities, who interpret Article 12 of the United Nations Convention on the Rights of Persons with Disabilities in General Comment 1 to advocate for the replacement of substituted decision-making with supported decision-making. Psychiatrists occupy a central role in determining how to care for and respond to individuals with psychosocial conditions in crisis in the midst of these debates. They must protect the rights of people with psychosocial conditions in crisis and provide appropriate support within challenging and dynamic contexts. This responsibility includes promoting the autonomy of people with psychosocial condition while ensuring their long-term health, safety and well-being.In this study, we conducted a phenomenological analysis with a sample of nine psychiatrists in South Africa to explore their experiences with involuntary care and the complex dilemmas they face in delivering healthcare to individuals with mental health conditions. Our findings indicate that psychiatrists encounter significant challenges in preserving patient autonomy, particularly within the resource-limited context of South Africa. Pervasive stigma and insufficient support infrastructure complicate efforts to prioritise autonomy. At the same time, professionals must address the critical need to ensure the long-term safety and well-being of their patients. The absence of involuntary care can exacerbate a person's vulnerability to community stigma and inadequate community support, posing severe risks to their welfare. Balancing between protecting a person's autonomy and addressing the limitations of support structures creates a complex predicament for mental health professionals, often resulting in feelings of isolation and moral distress among psychiatrists.

Using Attachment and Biobehavioral Catch-up with young children with developmental delays: A multiple-baseline trial of attachment, sensitivity, and cortisol

The Attachment and Biobehavioral Catchup intervention potentially offsets psychosocial risks facing dyads in which children have intellectual disability or developmental delays. In this single-case multiple-baseline study the efficacy of this intervention was tested across three such South African families. Maternal sensitivity, attachment security, and child affect regulation were measured weekly during a baseline and intervention period, using the Ainsworth Maternal Sensitivity Scales, Attachment Q-sort and salivary cortisol, respectively. Furthermore, post-intervention interviews invited parents' and intervenors' evaluations of the intervention. Visual analysis broadly indicated improvement in maternal sensitivity and attachment security across subjects over time following the introduction of the intervention, although randomisation tests were not statistically significant. Effects on affect regulation were not clearly observed and may have been influenced by case-specific variables. Parent-participants and intervenors also identified particularly helpful contributions from the intervention. Findings underscore the importance of individual-level effects evaluation, especially when implementing interventions outside the original population.

Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-covid era: A systematic review

General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health-trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.

The Care Dependency Grant for children with disabilities in South Africa: perspectives from implementation officials

For people with disabilities, appropriate social protection interventions can contribute to breaking the cyclical relationship between poverty and disability and may improve social inclusion. In South Africa, a national social assistance programme provides 'social grants' to individuals on the basis of poverty, age, or disability. These grants have been extensively studied but there has been little investigation into the Care Dependency Grant, designed to support the care of children with disabilities. These children consistently have far poorer outcomes on key metrics for wellbeing, health, and education than their non-disabled peers. More attention ought to be focused on uplifting this profoundly marginalised population. We present initial findings from interviews with officials at the South African Social Security Agency, the country's grants implementation agency. These narratives add weight to the growing local and international consensus that complementary interventions and effective intersectoral collaboration may greatly enhance the impact of cash transfers.

'I bring her up with love:' Perspectives of caregivers of children with neurodevelopmental delays in western Kenya

OBJECTIVE

This study aims to understand the challenges and perspectives of caregivers with neurodevelopmental delays (NDD) in rural Kenya.

METHODS

Semi-structured interviews and the Affiliate Stigma Scale were administered to the primary caregivers of children with NDDs recruited from the communities near Eldoret, Kenya. Constant comparison and triangulation methods were used to inductively develop relevant themes and concepts.

RESULTS

Sixteen caregivers participated. Challenges, which included hardships related to safety and supervision, challenging emotions and financial difficulties, were compounded by a lack of social support and community stigma towards these children. However, caregivers still felt deep love for their children, desired acceptance from the community and found sources of strength from faith and religious institutions.

CONCLUSION

The study uncovered crucial insights into the perspectives of caregivers within this population and revealed a paucity of disability awareness and understanding within the community, possibly informing future programmes and intervention policies.

Effectiveness of abbreviated trauma-focused cognitive behavioural therapy for South African adolescents: a randomized controlled trial

Background: In low- and middle- income countries (LMICs) trauma exposure among youth is high, but mental health services are critically under-resourced. In such contexts, abbreviated trauma treatments are needed.Objective: To evaluate the efficacy of an abbreviated eight-session version of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for improving posttraumatic stress disorder (PTSD) and depression symptoms in a sample of South African adolescents.Method: 75 trauma-exposed adolescents (21 males, 54 females; mean age = 14.92, range = 11-19) with posttraumatic stress disorder (PTSD) symptoms were randomly assigned to eight sessions of TF-CBT or to usual services. At baseline, post-treatment and three-month follow-up, participants completed the Child PTSD Symptom Scale for DSM 5 (CPSS-5) and the Beck Depression Inventory II (BDI-II). The trial is registered on the Pan African Trial Registry (PACTR202011506380839).6.Results: 95% of TF-CBT participants completed treatment while only 47% of TAU participants accessed treatment. Intention-to-treat analyses found that the TF-CBT group had a significantly greater reduction in CPSS-5 PTSD symptom severity at post-treatment (Cohen's d = 0. 60, p < .01) and three-month follow-up (Cohen's d = 0.62, p < . 01), and a greater reduction in the proportion of participants meeting the CPSS-5 clinical cut-off for PTSD at both time points (p = .02 and p = .03, respectively). There was also a significantly greater reduction in depression symptom severity in the TF-CBT group at post-treatment (Cohen's d = 0.51, p = .03) and three-month follow-up (Cohen's d = 0.41, p = .05), and a greater reduction in the proportion of TF-CBT participants meeting the BDI clinical cut-off for depression at both time points (p = .02 and p = .03, respectively).Conclusion: The findings provide preliminary evidence of the efficacy of an abbreviated eight-session version of TF-CBT for reducing PTSD and depression symptoms in a LMIC sample of adolescents with multiple trauma exposure.

Putting cultural difference in its place: Barriers to access to health services for parents of children with intellectual disability in an urban African setting

BACKGROUND

Access to appropriate specialist level services for children with intellectual disability is challenging in Africa, with very few services available. Much literature on the utilisation of services by carers of children with intellectual disability in Africa emphasises the supposed incompatibility between indigenous and western beliefs, failing to identify more obvious, embodied barriers to access to care.

METHOD

As part of a study on children with intellectual disability in Cape Town, South Africa, we interviewed caregivers regarding the difficulties in accessing care, specifically the complex, expensive and time-consuming travelling routes from home to care.

RESULTS

Caregivers discussed the embodied difficulties accessing care. Everyday struggles with transport, and crowded, dangerous and hostile environments were identified as barriers to care.

CONCLUSION

These challenges are often overlooked in the literature, in favour of an emphasis on cultural difference. This dualistic view of the world may obscure more obvious reasons why people find it difficult to use services, even when they are available.

Challenges and support needs of parents of children with developmental disabilities (DD) in Accra, Ghana

BACKGROUND

Parents of children with developmental disabilities (DD) have diverse challenges and needs. If met, these parents are able to provide adequate care for their children. Unfulfilled needs like information about their child's diagnosis, counselling, and poor access to informal and formal supports increase parental stress and hinder their potential to provide optimal care for their children and themselves.

AIMS

This study explores the unique challenges and needs of parents caring for children with DD in the Accra metropolis. This is the first study exploring the needs of parents in a Lower-middle income (LMIC) country like Ghana.

METHODS AND PROCEDURES

A qualitative research design was adopted for this study. Data was collected using semi-structured interviews from 9 parents of children with DD.

RESULTS

Findings from thematic analysis revealed five themes including; Emotional needs; Informational needs; Financial needs; Informal Support, and Formalized Support. Parents indicated their great need for information on their children's condition, support from family, religious groups, and other formalized institutions and how to provide better care.

CONCLUSIONS AND IMPLICATIONS

Parents have several expectations and needs which must be addressed. Findings have the potential of influencing the design and development of appropriate interventions to meet the needs and improve the quality of life of parents of children with DD in the Ghanaian context.