Scoping child mental health service capacity in South Africa disadvantaged communities: community provider perspectives
| DOI | https://doi.org/10.1108/JCS-05-2022-0017 |
| Published date | 28 November 2022 |
| Date | 28 November 2022 |
| Pages | 281-297 |
| Subject Matter | Health & social care,Vulnerable groups,Children's services,Sociology,Sociology of the family,Children/youth,Parents,Education,Early childhood education,Home culture,Social/physical development |
| Author | Abyshey Nhedzi,Sadiyya Haffejee,Michelle O'Reilly,Panos Vostanis |
Scoping child mental health service
capacity in South Africa disadvantaged
communities: community provider
perspectives
Abyshey Nhedzi, Sadiyya Haffejee, Michelle O’Reilly and Panos Vostanis
Abstract
Purpose –This study aims to establish the perspectives of community providers on challenges and
enablersin developing child mental health capacityin disadvantaged communities in SouthAfrica.
Design/methodology/approach –The authors involved 29 community providers operating in a large
urban-deprived area in the Gauteng Province, east of Johannesburg. Community providers had
educational,social and health care backgrounds. Their perspectives were capturedthrough three focus
groups, two participatory workshops and reflective diaries. Data were integrated and subjected to
inductivethematic analysis.
Findings –Three interlinked themes were identified. Community mobilization was viewed as pre-
requisitethrough mental health awareness andstrategies to engage children, youthand parents. Service
provision should take into consideration contextual factors, predominantly inequalities, lack of basic
needs and gender-based issues (domestic violence, teenage pregnancy and single motherhood).
Participantsreferred to severe mental health needs, and relatedto physical health conditions, disabilities
and impairments, rather than to common mental health problems or wellbeing. They proposed that
capacity building should tap into existing resources and integrate with support systems through
collaborativeworking.
Practical implications –Child mental health policy and service design in Majority World Countries
(MWCs), should involveall informal and structural support systems and stakeholders.Contextual factors
require consideration,especially in disadvantaged communities and low-resource settings, and should
be addressedthrough joined up working.
Originality/value –Children’s mental health needs are largely unmet in MWC-disadvantaged
communities. Thesefindings capture the experiences and perspectives of various communityproviders
on how to enhancemental health provision by mobilizingcommunities and resources.
Keywords Child, Mental health, Services, Stakeholders, Capacity, Majority world countries
Paper type Research paper
Introduction
Meeting the mental health needs of children and youth under 18years is an increasing
global policy priority (World HealthOrganization, 2020). Despite recognition by international
bodies, mental health provision remains limited in Majority World Countries (MWC),
especially in disadvantaged communities (World Health Organization, 2018). There are
several established reasonsfor the high level of child mental health needs in MWC.
Children’s mental health needs in these contexts are complex and strongly associated with
socioeconomic and environmental adversity. Risk factors or vulnerabilities are inter-linked
and more pronounced in contexts of extreme disadvantage such as urban informal
Abyshey Nhedzi is based
at the University of
Johannesburg, Auckland
Park, South Africa.
Sadiyya Haffejee is based at
the Centre for Social
Development in Africa,
University of Johannesburg,
Auckland Park, South Africa.
Michelle O’Reilly is based
at the Department of Media,
Communication and
Sociology, University of
Leicester, Leicester, UK.
Panos Vostanis is based at
the Department of Media,
Communication and
Sociology, University of
Leicester, Leicester, UK and
Centre for Social
Development in Africa,
University of Johannesburg,
Auckland Park, South Africa.
Received 16 May 2022
Revised 9 August 2022
Accepted 3 November 2022
The authors are grateful to all
participants for their generous
contribution to this study. They
thank Kids Haven NGO,
especially Mr Sam Mokgopha
and Ms Susan Daly,for their
ongoing support. This study was
funded by an ESRC IAA Strategic.
Economic and social research
council (ESRC) impact
acceleration account (IAA)
strategic partnerships.
DOI 10.1108/JCS-05-2022-0017 VOL. 17 NO. 4 2022, pp. 281-297, ©Emerald Publishing Limited, ISSN 1746-6660 jJOURNAL OF CHILDREN’S SERVICES jPAGE 281
settlement communities (Bele et al., 2015). These factors transcend the child’s
socioecology and include social determinants like poverty, child marriage, labour, gender
inequity, maltreatment and domestic violence; health indicators like malnutrition,
developmental delays, communicable diseases and substance misuse; and environmental
determinants such as poor housing and sanitation, overcrowding and pollution (Azzopardi
et al.,2019
;Rose-Clarke et al.,2019). Challenges of parental ill mental health and impaired
childrearing capacity can be negatively influenced by issues like unemployment. Exposure
to gender-based and community violence are additionalvulnerabilities for maltreatment and
mental health. When older children have to contribute to family income and care
arrangements, they can be susceptible to exploitation and be deprived of protective factors
such as schooling and peer relationships(Reza and Bromfield, 2019).
Despite their higher levels of mental health need, children living in disadvantage have
significant lower access to mental health support than those living in affluent areas, both in
Minority and MWC. Inequalities are reflected in limited access to various services and
sources of support or protection, in terms of recognition, help-seeking, care pathways,
travel and competing economic pressures (Chisholm et al., 2006;Chisholm et al.,2017;
Harris and Wilson, 2018). For thosereasons, disadvantaged children are more likely to seek
support when in crisis, because of the lack of community-based services and preventive
approaches (Garcia-Alteset al.,2018).
In addition, there are substantive disparities between Minority and MWC in relation to
infrastructure, specialist resources and skilled staff (World Health Organization, 2018). For
example, in South Africa access to support is constrained by limited designated resources
for children with mental health problems,and ongoing unequal access to existing resources
(Tomlinson et al.,2022). Consequently, psychosocial support in MWC is variably provided
by a range of agencies such as schools, primary health, child and youth centres, non-
governmental organizations (NGOs) and community volunteers or paraprofessionals (Patel
et al., 2018;Docrat et al., 2019a). Psychosocial response is, thus, often combined with
functions like child protection, health promotion and life skills training (World Health
Organization, 2014).
Cultural and contextual factors can further compound children’s access to sources of
support. Stigma of mental health remainsprominent within certain societies, institutions and
even professionals, which may hinder early recognition of emerging difficulties and prevent
help-seeking (Khalil et al.,2020). Other factors include the conceptualization of mental
health, childhood and gender roles and the lack of culturally sensitive and acceptable
interventions (Getandaet al., 2017).
Understanding the nuances and complexities associated with such factors can help
maximize current resources, predominantly informal support networks of extended families,
schools and communities (Clark et al.,2018;Kohrt et al.,2018). Providers of community
support and services have unique knowledge and expertise of local needs, strengths and
priorities (Vostanis et al., 2018). Recognizing this epistemic value, therefore,means actively
involving these key stakeholdersin the co-production and planning of strategies to enhance
capacity within their community.This requirement informed the rationale for this study.
Methodology
The aim of this study was to establish the perspectives of various community providers on
challenges and enablers in developing child mental health capacity in disadvantaged
communities in South Africa. This aim was addressed through the following research
questions:
RQ1. How do community providersconceptualize child mental health needsand support
within their communities?
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