Putting child and adolescent mental health at the centre: building an ecosystem of support

Aim This paper synthesises the latest evidence on child and adolescent mental health in South Africa, arguing that early investments therein are essential for breaking the inter-generational cycle of violence, poverty, discrimination, and mental ill-health, and identifying opportunities for intervention and systems-strengthening both within and outside the healthcare system. Method The paper draws on a range of evidence to explore the epidemiology of child and adolescent mental disorder and its social determinants. It emphasises the need to support children and families across the continuum from prevention and early intervention through to specialised mental health services, and examines how to enhance the use of schools and health facilities to support children and families. Findings Fifty per cent of mental disorders have their onset before the age of 14, so it is vital to intervene early in the life-course to promote optimal mental health. An estimated 17% of South Africa’s children have a diagnosable and treatable mental disorder, yet only one in 10 are able to access care, with specialist child and adolescent mental health services being concentrated in a handful of urban centres. Therefore, innovative approaches, such as the Western Cape’s child and adolescent mental health service-strengthening project, are required to bring services and support closer to home. Conclusion Outreach, training and task-shifting have the potential to build the capacity of frontline workers at primary care level and should be rendered with a child- and family-centred approach, including adult services, to focus attention on the vulnerability and care needs of children of parents with mental disorders. It is also essential to strengthen support for children and families through improving access to social assistance, parenting programmes and health-promoting schools.