Child and adolescent mental health services in the Western Cape Province of South Africa: the perspectives of service providers

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.

Integrating a mental health intervention into PrEP services for South African young women: a human‐centred implementation research approach to intervention development

“…Our "Discover" phase also highlighted potential implementation approaches to overcome barriers to mental health service integration within PrEP delivery for South African AGYW. Recent qualitative work with South African primary providers reported a similar set of potential implementation strategies to promote mental health services in primary care, including community outreach, staff supervision, flexible service delivery models, and screening and referral mechanisms [51,52]. Studies to adapt the Friendship Bench in Botswana, Vietnam and Malawi have all reported challenges with training and supervising younger lay counsellors, intervention fidelity, loss to follow-up and community stigma, underscoring the importance and relevance of the implementation approaches identified in our research [35,[53][54][55][56].…”

Where is Batho Pele? The perspective of child and adolescent mental health service users in the Western Cape Province of South Africa

“…The experiences of responsive and person-centred care were recognised and appreciated by the users. In an earlier publication, service providers shared some of their innovations to provide acceptable CAMHS in facilities despite the challenges mentioned (11). Here, the success of service innovations was re ected in the voices of the users.…”

“…Over the last few years, we have been evaluating the CAMH landscape of services and needs in the Western Cape, one of the nine South African provinces. Findings to date have identi ed a lack of policy and implementation at the level of the policy landscape, high resource limitations (9) and signi cant challenges as perceived by senior stakeholders (10) and grassroots service providers (11). One of the key 'landscapes' not previously examined in the South African context is the perspective of service users.…”