Andrew Dawes

Politics and Mental Health: The Position of Clinical Psychology in South Africa:

Clinical psychology in South Africa, with few exceptions, has been unresponsive to its socio-political context. Attempts by certain authors to make their work relevant to the South African context are examined. Their adherence to a non-critical, conservative ideology is suggested as a reason for the lack of a more powerful critical focus. It is argued that Apartheid (or the policy of racial segregation) adversely affects the mental well-being of most South Africans through its generation of stress situations unique to this society. It is further argued that clinical psychology cannot claim scientific or moral respectability as long as it continues to take an uncritical position. South African clinical psychologists can begin to remedy this situation through the development of appropriate research and training, as well as public pronouncement through their professional associations.

The Effects of Political Violence on Children a Consideration of South African and Related Studies

Abstract This paper considers two propositions which have recently been advanced in debates in South Africa and elsewhere. The first is that children exposed to political violence will necessarily be emotionally damaged by the experience. The sccond is that exposed children will be socialised to endorse violence as a dominant mode of conflict resolution. Both these propositions are contested by referring to research conducted in South Africa and abroad. It is argued that attempts to understand the psychological sequellac of exposure to political violence need to take into account a number of interlinked factors. These include the type of political violence experienced, the childs developmental level and the availability of supports in the family and community. The evidence suggests that there is no simple relationship between exposure to violence and psychological disturbance or endorsement of violent conduct by children.

PROSOCIAL AND ANTISOCIAL TENDENCIES IN CHILDREN EXPOSED TO COMMUNITY VIOLENCE

ABSTRACT The objective of the study was to explore the relationship between exposure to community violence and antisocial and prosocial behaviours. Data was collected from a sample comprising 78 Grade 7 children (mean age 12.8 years) living in a high violence community in Cape Town. The children completed a shortened version of the Survey of Exposure to Community Violence (Richters & Saltzman, 1990). They were rated by their teachers on four sub-scales of the South African Child Assessment Scales (Barbarin, 1998): opposition/defiance, aggression, self-regulation, and affability (prosocial behaviour). The results indicate a moderate correlation between direct exposure to violence and levels of aggression, opposition/defiance and deficits in self-regulation. Additionally, direct exposure was found to be less predictive of aggression than gender. The sample was most likely to be exposed to violent incidents in the vicinity of the home or in the wider community, rather than in school or in the home. This finding has implications for safety and violence prevention initiatives.

Scaling up child and adolescent mental health services in South Africa: human resource requirements and costs.

BACKGROUND Children and adolescents with mental health problems have poor service cover in low- and middle-income countries. Little is known about the resources that would be required to provide child and adolescent mental health services (CAMHS) in these countries. The purpose of this study was to calculate the human resources and associated costs required to scale up CAMHS in South Africa. METHODS A spreadsheet model was developed to calculate mental health service resources, based on an estimation of the need for services in a given population. The model can be adapted to specific settings by adjusting population size, age distribution, prevalence, comorbidity, levels of coverage, service utilisation rates, workloads, length of consultations and staff profile. Steps in the modelling include population identification; estimates of prevalence, service utilisation and staffing; and costing. RESULTS Using a nominal total population of 100,000 (of which 43,170 would be children and adolescents under 20 years of age), the following full-time equivalent staff are required at minimum coverage level: 5.8 in PHC facilities, .6 in general hospital outpatient departments (OPDs), .1 in general hospital inpatient facilities, 1.1 in specialist CAMHS OPDs, .6 in specialist CAMHS inpatient facilities, .5 in specialist CAMHS day services, and .8 in regional CAMHS teams. This translates into roughly

Violence, violence prevention, and safety: A research agenda for South Africa

21.50 and

Child and adolescent mental health in South Africa.

5.99 per child or adolescent per annum nationally for the full coverage and minimum coverage scenarios respectively. When comparing the results of this model with current realities in South Africa, there remains a substantial shortfall in existing levels of CAMHS provision. CONCLUSIONS The model can be used as an advocacy tool to engage with planners and policy makers on a rational basis. It can also be adapted for use in other countries, and is intended to support wider calls for a global scaling up of mental health services.

What's Changed? The Racial Orientations of South African Adolescents During Rapid Political Change

Violence is a serious problem in South Africa with many effects on health services; it presents complex research problems and requires interdisciplinary collaboration. Two key meta-questions emerge: (i) violence must be understood better to develop effective interventions; and (ii) intervention research (evaluating interventions, assessing efficacy and effectiveness, how best to scale up interventions in resource-poor settings) is necessary. A research agenda to address violence is proposed.

Women coping with AIDS in Africa: contributions of a contextually grounded research methodology

Mental health problems in childhood and adolescence pose a major threat to public health. Epidemiological studies in high, middle and low income countries indicate that approximately one in five children and adolescents suffer from a mental disorder. In many instances these persist into adulthood. In South Africa, HIV infection, substance use, and exposure to violence increase vulnerability to mental disorders. Child and adolescent mental health services play a key role in reducing the burden of mental disorders in childhood and later in adulthood. This paper focuses on service needs for children and adolescents in South Africa. It commences with a discussion of the prevalence of child and adolescent psychiatric disorders after which the legal and policy context of child and adolescent psychiatric services is described. A framework for child and adolescent mental health service provision is presented, following which steps for reducing the extent of unmet service need are considered. The paper concludes with a call to scale up child and adolescent mental health services in South Africa, based on the stark realities of unmet need and the constitutional rights of children and adolescents to appropriate mental health care.

Child Care, Developmental Delay and Institutional Practice

The authors outline cross-sectional studies (across time and age) of the effects of the political changes in South Africa on the intergroup orientations of adolescents, as well as their orientations to the new democracy. The study was undertaken between 1992 (before the end of apartheid) and 1996 (after apartheid), with 14-year-old and 17-year-old high school students from formerly designated Black, Coloured, White and Indian population groups. Participants completed Duckitts Subtle Racism Anti-Black Scale, a Repertory Grid following Kelly and measures of adjustment to political change. The results indicate that levels of anti-Black African racism, particularly among Whites previously advantaged under apartheid, were high in both years, and have increased with the emergence of the new state. The study found in addition, that orientations towards the new political dispensation were related to levels of racism. Some evidence of outgroup preference for Whites was evident among Black participants, while a degree of outgroup rejection of other Black groups was also evident among these groups in 1996.

Tolerance and Solidarity

Abstract The primary objective of this report is to describe a contextually grounded approach to the investigation of coping and psychological functioning in AIDS-sick mothers. Five AIDS-sick women on antiretroviral therapy who had at least one child under 6 years of age living in their households were interviewed. Among the issues that emerged was the complexity of the womens psychological functioning, the fact that they made strategic decisions about disclosure aimed at protecting important social support networks, and that their well-being was dynamically influenced by factors in the home and community. The study provides evidence for the value of a contextual approach when investigating the psychological functioning of HIV positive mothers living in poor high-HIV prevalence communities in developing countries.