A situational analysis of child and adolescent mental health services and systems in the Western Cape Province of South Africa

Abstract

\n Background:\n\nChild and Adolescent mental health services (CAMHS) and systems need strengthening globally. 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 CAMHS in the Western Cape Province of South Africa\nMethods:\n\nThe 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 CAMHS. 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.\nResults:\n\nIn domain 1, we found no provincial CAMHS policy or implementation plans to support the national CAMHS policy, and were unable to identify a CAMHS-specific budget. In domain 2, there was no dedicated provincial leadership structure for CAMHS, 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 CAMHS 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 CAMHS workforce across all levels of care. In domain 5 few public health campaigns focused on CAMH, and little evidence of formal intersectorial collaboration on CAMHS was identified. Domain 6 identified significant limitations in health information systems for CAMHS, including lack of child- and adolescent-specific and disaggregated data to establish baselines for policy development, monitoring, evaluation and CAMHS research.\nConclusions:\n\nThis study identified significant structural weaknesses in CAMHS and present 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.