International Child Mental Health Awareness Week falls in May this year and brings into sharp focus the importance of the mental well-being of children and adolescents. The South African government has proposed a holistic approach which aims to address the physical, emotional and socio-economic risk and protective factors that have been identified.
A broad definition of child and adolescent mental health would be the capacity to achieve and maintain optimal psychological functioning and well-being from birth to 18 years. The acquisition of age-appropriate biopsychosocial developmental milestones falls within the definition. Other important mental health issues in children and adolescents include the development of a sense of identity and self-worth, and the formation of healthy interpersonal skills and relationships.
The policy guidelines issued by the Department of Health link risk factors with an increased likelihood of mental health problems and protective factors with mediating the effects of risk exposure. A relationship between causal factors and the developmental age of the child and adolescent has also been identified and age specific and inter-sectoral interventions in child and adolescent mental health services have been advocated, with a view to reducing the impact of risk factors and enhancing the effects of protective factors.
There are general intervention strategies which have been proposed as the foundation for ensuring the optimal development of children and adolescents. These fall in line with the constitutional rights of all South African citizens and those delineated at the international Convention for the Rights of the Child. The South African guidelines envisage these strategies as being implemented in the home, schools, churches and health facilities and the general focus of these strategic interventions include:
- The right to a safe and supportive external environment (including access to water, sanitation and electricity, access to transport, nurturing family units, a violence-free environment, adequate nutrition, access to sports and recreational facilities)
- The right to education and the opportunity to build social, life, cognitive and academic skills
- The right to access to quality health and mental health care services
Some of specific child and adolescent mental health issues that may need special attention going forward are:
- Optimal development as a foundation for the mental health of child
- The inter-relationship between the various areas of development and competency
- The critical periods of opportunity and risk across the lifespan and the extent to which a developmental stage is negotiated as being partially dependent on the successful acquisition of skills associated with previous developmental stages
- The socio-cultural and spiritual factors which influence the development of cognition, affect and behaviour and overall mental health status of children and teens
- The identification of certain groups of children and adolescents as being more vulnerable to mental to mental health problems than others (for example, children living below the breadline, homeless children, adolescent sex workers, those who are HIV positive or who have congenital abnormalities, political or economic refugees, those who are victims of violent crime, institutionalised children and orphans)
- The need for gender considerations in terms of vulnerability to discrimination
- The need for in-patient and out-patient treatment protocols for child and adolescent using drugs and alcohol
The policy guidelines focus on the implementation of mental health promoting strategies in the home, family and community settings. The central focus is on improving relationships and communication between parents, caregivers and children, through psycho-education, guidance and parenting skills training. Interventions should be ideally be focused on:
- Educating parents and caregivers on family health, including the specific requirements for children with special needs
- Empowering the community to provide support and programmes on effective parenting
- Providing access to mental health services at a community level for children and adults
Schools have also been identified as key sites in the provision of mental health interventions for children and adolescents. The World Health Organisation (WHO) has created a set of requirements for ‘child friendly schools’ which may need to be adopted by local schools – these include:
- The promotion of tolerance between different ethnic, religious, social and gender groups, as well as the adoption of no tolerance policy of bullying
- The creation of a learning environment which is supportive and which encourages active involvement in the learning process
- The creation of a nurturing environment with an absence of corporal punishment
- Fostering an environment which values and supports the development of creativity and other natural talents in addition to scholastic and sporting achievements
- The promotion of self-esteem and self-confidence
While health services are seen as being an integral part of the strategy for child and adolescent mental well-being, limited access to facilities and a lack of staff and resources at the grass roots level have hampered the provision of psychological services to many disadvantaged communities. Some of the interventions that have been suggested to ameliorate this lack of services are to re-train community health care workers in terms of privacy, confidentiality and the need for interpersonal skills, increased cooperation between community based NGO’s and public health facilities and specialised training in child and adolescent psychiatry for psychiatrists, nurses, psychologists and social workers.