Mental health one of the hurdles today's youth are grappling with in SA
From early childhood 13-year-old Fatima had been suffering from anxiety.
As she became older her mental health worsened so much that she started having severe panic attacks that negatively affected her schooling and resulted in her being treated in a psychiatric hospital.
But the hospital experience did not make things easier for the teenager as she had to share a ward with adults, which she found “terrifying”.
“Why would the doctor send me to a hospital with adults ... where people are tied up? I hate it here.”
In another SA heath facility, 15-year-old Andile, who was diagnosed with attention deficit/hyperactivity disorder (ADHD), regularly needed to go to a community clinic for check-ups and medication. But the pursuit of heath services often meant he had to skip school and his mother had to take a day off work to take him to the clinic for every appointment.
Often he didn't get the help he needed and sometimes left the clinic without seeing a psychiatrist, forcing him to return to the clinic. At times his file would go missing or staff at the pharmacy would take too long and he was missing out on school.
These two teenagers are just some of the millions of adolescents across the country who live with mental health disorders and are experiencing treatment gaps within the country’s healthcare system.
According to the latest issue of the SA Child Gauge — an annual publication of the Children’s Institute at the University of Cape Town that monitors progress towards realising children’s rights — despite a significant number of adolescents living with mental health conditions in SA, the majority remain untreated and as a result their development lags behind.
In SA the treatment gap for children and adolescents is about 90% and only one in 10 children with a treatable mental health disorder is able to access care.
While there is no clear data as to how many children live with mental health conditions, a 2012 review found that almost 20% of children and adolescents in Africa scored above cut-off values for risk of mental disorders and 10% had been diagnosed with mental health disorders.
Authors and child health specialists Simphiwe Simelane, Stella Mokitimi, Rene Nassen and Petrus de Vries, argue that though SA has the most child and adolescent psychiatrists in Africa, there are now fewer than 60 and only 20 of these specialists are in the public sector.
Therefore, children and families only have access to multidisciplinary child and adolescent mental health service teams in a handful of hospitals, mostly in big cities such as Cape Town, Johannesburg, eThekwini and Tshwane. Child and adolescent psychiatrists practising in the private sector are also concentrated in these cities.
They argue that mental disorders in young people not only cause distress and impair their functional abilities in daily life, they often have long-term ramifications that last into adulthood.
“It is estimated that half of adult mental illness starts before age of 14, reinforcing the need for early detection and intervention to achieve the best possible outcomes. In addition, inadequately treated and undiagnosed children and adolescents with mental disorders may develop secondary or additional disorders, such as substance use or resort to self harm to cope with their symptoms.”
Not only are children subjected to treatment gaps with no dedicated psychiatric services for them, but they are also burdened with the mental health of their own parents, which predisposes them to poverty, family disruptions and social isolation.
The authors of the document say one in five children has a parent with a mental disorder.
“The impact of a persistent and disabling mental disorder on parents’ ability to sustain themselves and their children increases the likelihood that their children will grow up experiencing poverty, housing problems, family disruptions, reduction of social and leisure activities and social isolation.
“They are also more likely to be taken into care, have poor communication skills, drop out of school and develop mental health problems and substance abuse issues themselves.”
Frequently experiencing the trauma of their parents’ relapse into mental illness and admission to hospital resulted in children “taking excessive responsibility at home, blaming themselves for their parents' mental illness and living with the stigma of their parents' illness in silence”.
“Yet, children and their parents receive little co-ordinated support, information or exposure to safeguarding measures from healthcare professionals to address the challenges.”
The authors say extending therapeutic support to children and having a family-focused approach when treating parents would go a long way in safeguarding the lives of children.
“Mental healthcare practitioners have a duty to ensure that their circle of care extends beyond their adult patients to actively promote the mental health, care and wellbeing of their children. This includes prevention and early interventions, including therapeutic counselling and parenting programmes that are designed to improve family functioning and promote positive parenting.”
An ideal child and adolescent mental health service team should include specialists such as a child and adolescent psychiatrist, psychologist, speech and language therapist, occupational therapist, child and adolescent mental health nurse practitioner, social worker and dedicated link professionals from the departments of basic education and social development.
They said preventive services should be offered mainly at community level such as schools and religious organisations “with the aim of promoting resilience, positive coping skills and creating a supportive environment in which they can thrive”.
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