Background
The Western Cape Province of South Africa
2016 Community Survey | ||||||
---|---|---|---|---|---|---|
General population | Children, adolescents and young adults | |||||
0–14 years | 15–34 years* | |||||
District/municipality | N | % | N | % | N | % |
West Coast | 436,403 | 6.9 | 113,113 | 25.9 | 153,472 | 35.2 |
Cape Winelands | 866,001 | 13.8 | 230,708 | 26.6 | 316,210 | 36.5 |
Overberg | 286,786 | 4.6 | 74,764 | 26.1 | 94,453 | 32.9 |
Eden | 611,278 | 9.7 | 155,008 | 25.4 | 207,010 | 33.9 |
Central Karoo | 74,247 | 1.2 | 18,862 | 25.4 | 27,936 | 37.6 |
City of Cape Town | 4,005,016 | 63.8 | 1,042,259 | 26.0 | 1,331,960 | 33.3 |
Total | 6,279,730 | 100.0 | 1,521,601 | 24.23 | 1,977,569 | 39.49 |
Situational analysis and the World Health Organization Assessment Instrument for Mental Health Systems
Methods
Study design
Data collection
WHO-AIMS Domains | Western Cape provincial data collected |
---|---|
1. Policy and legislative framework | 1.1 CAMH policies, plans, and legislations (B1, B3, B4) 1.2 Human rights legislation relevant to children and adolescents (B5) 1.3 Financing: Expenditure on CAMH by the provincial DoH (B6) |
2. Clinical services for children and adolescents with mental health disorders | 2.1 Existence and functions of a regional CAMH authority (B9) 2.2 Organisation of CAMH services in terms of catchment areas (B10) 2.3 Outpatient services: Availability of CAMH outpatient facilities, and number/proportion of children and adolescents treated for mental health problems through outpatient facilities at primary, secondary and tertiary levels of care (B11, B12, B13) 2.4 Inpatient services: Availability of CAMH inpatient facilities, and number/proportion of children and adolescents treated (B15, B16, B17) 2.5 Availability of CAMH day patient facilities, community residential facilities, forensic facilities, or CAMH hospitals (B14, B18, B19, B25) 2.6 Interventions (medications): Psychotropic medicines appropriate for children and adolescents included on the essential medicines list; free access to essential psychotropic medicines, and availability of medicines in outpatient and inpatient settings at secondary and tertiary levels of care (B2, B8, B28, B29) 2.7 Interventions (psychosocial): Access to psychosocial interventions in outpatient and inpatient settings at secondary and tertiary levels of care (B26, B27) |
3. CAMH in primary healthcare | 3.1 Refresher training in CAMH provided to PHC doctors, nurses or other staff and interaction of PHC with specialist CAMHS (B31–B35) 3.2 Availability of medicines and psychosocial interventions in PHC facilities (B27, B33) |
4. Human resources | 4.1 Human resources in CAMHS (B38–B41) |
5. Public education and links with other sectors | 5.1 Public education and awareness campaigns about CAMH (B47) |
6. Monitoring and research | 6.1 Monitoring CAMH (B52, B53) 6.2 Research in CAMH (B54) |
Data capturing and analysis
Data Source Number (DSN) | Data source | Website link | References |
---|---|---|---|
DSN01 | Policy guidelines. Child and Adolescent Mental Health, 2003 | [16] | |
DSN02 | Healthcare 2030. The Road to Wellness, Western Cape Department of Health | [17] | |
DSN03 | Mental Health Act no.17 of 2002. National Department of Justice | [18] | |
DSN04 | Child Care Act 74 of 1983, National Department of Social Development | [19] | |
DSN05 | Western Cape Provincial Deputy Director for Mental Health and Substance Abuse | Interview on 9 February 2017 (data available from the author) | [20] |
DSN06 | Provincial Mental Health Directory, Department of Health, 2015 | [21] | |
DSN07 | Budget 2016 Summary, Western Cape Department of Health | [22] | |
DSN08 | Budget Overview of Provincial Revenue and Expenditure 2016, Treasury of the Western Cape Government | [23] | |
DSN09 | Budget Estimates of Provincial Revenue and Expenditure 2016, Treasury of the Western Cape Government | [24] | |
DSN10 | Mental Health Services in the Western Cape, Western Cape Department of Health | [25] | |
DSN11 | Division of Child and Adolescent Psychiatry (DCAP), Western Cape Department of Health | [26] | |
DSN12 | Mental Health Hospital Services, Western Cape Department of Health | [27] | |
DSN13 | Catchment Areas for Tertiary Child and Adolescent Psychiatry Units in the Western Cape | Data provided by the Head of Clinical Unit, Division of Child and Adolescent Psychiatry (12 March 2020) (data available from the author) | [28] |
DSN14 | Western Cape Mental Health Data and Facilities List 2016, Western Cape Department of Health | Mental Health provincial information system. The information is not publicly available but was provided by the Provincial Data Management Office for the purposes of this study (data available from the author) | [29] |
DSN15 | Tygerberg Hospital Annual Report 2016, Western Cape Department of Health | [30] | |
DSN16 | Court Diversion in the Western Cape Province | [31] | |
DSN17 | Standard treatment guidelines and essential medicines list for South Africa. Hospital level paediatrics, 2017 edition | [32] | |
DSN18 | First 1,000 Days Campaign, Western Cape Government | [34] | |
DSN19 | 2016 Annual Report, Salesian Life Choices | [35] | |
DSN20 | How to handle bullying, Western Cape Education Department | [36] | |
DSN21 | 16 Days of Activism for no violence against women and children, Western Cape Department of Social Development | [37] | |
DSN22 | Web of Science (version 5.34) data search, April 2020 | (articles added in the reference list) |
Results
WHO-AIMS Domain 1: policy and legislative framework
Policies, plans and legislations
Human rights legislation relevant to children and adolescents
Expenditure on child and adolescent mental health services by the Provincial Department of Health
Total health budget in South African Rand | Primary and secondary level | Tertiary level | ||
---|---|---|---|---|
District Health Services | Provincial Hospital Services | Central Hospital Services | ||
R19.983 billion (US$1.307 billion) | R7.826 billion (US $511.140 million) (39.2%) | R3.199 billion (US$ 208.849 million) (16%) | R5.697 billion (US$371.82 million) (28.5%) | |
Non-mental health services | Mental health hospitals | |||
R2.610 billion (US $170.427 million) (13.1%) | R589 million (US$38.505million) (2.9%) |
WHO-AIMS Domain 2: child and adolescent mental health resources
Existence and functions of a regional child and adolescent mental health authority
Organisation of child and adolescent mental health services in terms of catchment areas
Specialist CAMH unit | Metropolitan (urban) | Rural | ||
---|---|---|---|---|
Metro catchment area | District hospitals | Rural catchment area | Regional hospital | |
Division of Child and Adolescent Psychiatry (DCAP) | Southern Western Portion of Klipfontein | New Somerset Hospital Victoria Hospital False Bay Hospital Groote Schuur Hospital Red Cross District Service | Eden | George Hospital |
Tygerberg Child and Adolescent Psychiatry team | Northern Tygerberg Portion of Eastern | Karl Bremer Hospital Eerste River Hospital Tygerberg Hospital district service | Portion of Cape Winelands West Coast | Paarl Hospital |
Lentegeur Child and Family Unit (CFU) | Khayelitsha Mitchell’s Plain Portion of Eastern Portion of Klipfontein | Khayelitsha Hospital Mitchell’s Plain Hospital Helderberg Hospital | Overberg Central Karoo Portion of Cape Winelands | Worcester Hospital |
Availability of child and adolescent mental health outpatient facilities, and number/proportion of children and adolescents treated for mental health problems through outpatient facilities at primary, secondary and tertiary levels of care
Geographic service areas | Age distribution | Total (% children) | |
---|---|---|---|
> 18 years | < 18 years | ||
City of Cape Town | 131,836 | 6330 | 138,166 (4.58%) |
Cape Winelands District | 16,986 | 609 | 17,595 (3.46%) |
Central Karoo District | 3066 | 49 | 3115 (1.57%) |
Eden District | 16,347 | 850 | 17,197 (4.94%) |
West Coast District | 11,834 | 462 | 12,296 (3.76%) |
Total | 180,069 | 8300 | 188,369 (4.4%) |
Geographic service area | Age distribution | ||
---|---|---|---|
> 18 years | < 18 years | Total (% children) | |
City of Cape Town | 10,242 | 561 | 10,803 (5.19%) |
Cape Winelands District | 1083 | 132 | 1215 (12.19%) |
Central Karoo District | 162 | 29 | 191 (15.18%) |
Eden District | 2064 | 248 | 2312 (10.73%) |
West Coast District | 1059 | 175 | 1234 (14.18%) |
Total | 14,610 | 1145 | 15,755 (7.27%) |
Availability of child and adolescent mental health inpatient facilities, and number/proportion of children and adolescents treated
Geographic service area | Age distribution | Total (% children) | |
---|---|---|---|
> 18 years | < 18 years | ||
City of Cape Town | 13,824 | 473 | 14,297 (3.31%) |
Cape Winelands District | 1339 | 105 | 1444 (7.27%) |
Central Karoo District | 131 | 14 | 145 (9.66%) |
Eden District | 889 | 82 | 971 (8.44%) |
Overberg District | 487 | 42 | 529 (7.93%) |
West Coast District | 795 | 79 | 874 (9.03%) |
Total | 17,465 | 795 | 18,260 (4.35%) |
Availability of child and adolescent mental health day facilities, community residential facilities, forensic facilities or hospitals
Community or other residential facilities
Child and adolescent forensic and other residential facilities
Interventions (medications): psychotropic medicines appropriate for children and adolescents included on the essential medicines list, free access to essential psychotropic medicines, and availability of medicines in outpatient and inpatient settings at secondary and tertiary levels of care
Interventions (psychosocial): access to psychosocial interventions in outpatient and inpatient settings at secondary and tertiary levels of care
WHO-AIMS Domain 3: child and adolescent mental health in primary healthcare
Refresher training in child and adolescent mental healthcare provided to primary healthcare doctors, nurses or other staff and interactions of primary healthcare with specialist child and adolescent mental health services
Availability of medicines and psychosocial interventions in primary healthcare facilities
WHO-AIMS Domain 4: human resources
Human resources in child and adolescent mental health services
WHO-AIMS Domain 5: public education and links with other sectors
Public education and awareness campaigns about child and adolescent mental health
WHO-AIMS Domain 6: monitoring and research
Monitoring of child and adolescent mental health services
Research in child and adolescent mental health
Research theme | Topic of research | Reference (First author, journal, volume: pages) |
---|---|---|
Infant Mental Health | Infant mental health and early childhood [38] | Worthman, Social Science and Medicine, 154: 62–69 |
Reflective practice in infant mental health [39] | Berg, Infant Mental Health Journal, 37: 684–691 | |
Autism and ADHD | Autism in Africa [40] | de Vries, Current Opinion in Neurology, 29: 130–136 |
Performance of South African children on the CSBS, a tool for autism [41] | Chambers, International Journal of Language and Communication Disorders, 51: 265–275 | |
Theory of mind in autism [42] | Hamilton, Journal of Child and Adolescent Mental Health, 28: 233–241 | |
Management of ADHD in children and adolescents: clinical audit of ADHD assessment and treatment [43] | Vrba, Journal of Child and Adolescent Mental Health, 28: 1–19 | |
HIV/AIDS | HIV-associated neurocognitive disorders in 6–16-year olds [44] | Hoare, Neurology, 87: 86–93 |
The impact of household HIV on child development [45] | Sherr, Child Care Health and Development, 42: 890–899 | |
Mental health resilience in children who lost parents to HIV/AIDS [46] | Collishaw, Journal of Abnormal Child Psychology, 44: 719–730 | |
Social support for children affected by HIV/AIDS [47] | Sharer, Aids Care—Psychological and Socio-Medical Aspects of AIDS/HIV, 28: 110–117 | |
Resilience in HIV-affected adolescents in South Africa [48] | Bhana, Aids Care—Psychological and Socio-Medical Aspects of AIDS/HIV, 28: 49–59 | |
Correlates of emotional and behavioural problems in children with perinatally-acquired HIV [49] | Louw, Aids Care—Psychological and Socio-Medical Aspects of AIDS/HIV, 28: 842–850 | |
Adolescent Mental Health | Mental health inequalities in adolescents [50] | Das-Munshi, PloS One, 11: 5 |
Adolescent substance abuse [51] | Weybright, Journal of Adolescence, 49: 158–169 | |
Impact of family structure on adolescent psychological profile [52] | Davids, Journal of Psychology in Africa, 26: 351–356 | |
Social protection and adolescent health [53] | Cluver, PloS One, 11: 10 | |
Parenting programme to prevent abuse of adolescents [54] | Cluver, Trials, 17: 328 | |
Reducing adolescent abuse in LMIC [55] | Cluver, BMC Public Health, 16: 567 | |
Factors associated with readmission of adolescents discharged from inpatient units [56] | Pieterse, Journal of Child and Adolescent Mental Health, 28: [incomplete] | |
Tuberous Sclerosis Complex (TSC) | Clinical trial of everolimus for epilepsy in TSC [57] | French, Lancet, 388: 2153–2163 |
Everolimus for neurocognitive problems in TSC [58] | Randell, Trials, 17: 398 | |
Long-Term use of everolimus for SEGA in TSC [59] | Franz, PloS One, 11: 6 | |
Towards an improved understanding of TSC-Associated Neuropsychiatric Disorders [60] | Leclezio, Advances in Autism, 2: 1–8 | |
Everolimus for renal angiomyolipomas in TSC [61] | Bissler, Nephrology, dialysis and transplantation, 31: 111–119 | |
Other themes | Fatal child abuse [62] | Mathews, South African Medical Journal, 106: 22–25 |
Theory of mind in children with FASD [63] | Lindinger, Alcoholism—Clinical and Experimental Research, 40: 367–376 | |
Cultural adaptation of the DISC-IV for Sotho-speaking South Africans [64] | Skinner, Journal of Ethic & Cultural Diversity in Social Work, 25: 1–19 |
Discussion
WHO-AIMS Domain | Gaps in CAMHS |
---|---|
Domain 1 Policy and legislative framework | • No provincial CAMH policy or implementation plans • No dedicated financing for CAMH |
Domain 2 Clinical services for children and adolescents with mental health disorders | • No dedicated leadership and governance structure for CAMH • No dedicated CAMH services and lack of psychosocial interventions at secondary level • No specialist CAMH services in rural districts |
Domain 3 CAMH in primary healthcare | • Inadequate documentation on training of professionals on CAMHS at primary care level • Lack of dedicated resources at secondary and tertiary care levels to support and train colleagues at primary level, particularly in rural districts • Lack of psychosocial interventions at primary care level |
Domain 4 Human resources | • Limited information systems to access human resources data on CAMH • Limited human resources for CAMH at secondary and tertiary care levels |
Domain 5 Public education and links with other sectors | • Limited public health campaigns on CAMH • Limited intersectoral collaboration about CAMH |
Domain 6 Monitoring and research | • Lack of disaggregated and accessible information systems for CAMH |