Innovations to
strengthen child and adolescent mental
health services in low- resourced communities
Dr. Stella Mokitimi
Clinical Program Coordinator (Mental Health)
Western Cape Department of Health, Khayelitsha Eastern Substructure (KESS)
Mokitimi PhD Lack of dedicated CAMH services at primary and secondary level of care Impact:
• Psychological trauma in C&A
• Non-compliance to treatment
• Lack of access to MH care
• Lack of safety
• Risk of contracting contagious diseases
❖ CAMHS need to be strengthened locally
A multilevel synthesis model to understand CAMH services
The stark reality of CAMH in South Africa
Western Cape Situational Analysis (Mokitimi et al., 2022) Conservative estimate of CAMH disorders = 10%
Western Cape findings based on all available data (level 1, 2, 3) <10% of the 10% received treatment in health facilities in the province
Treatment gap in CAMH in Western Cape >90%
Fewer than 1 in 10 children and adolescents with a diagnosable and treatable mental health disorder received care
Practical tips to strengthen existing services that support children and adolescents with mental health disorders:
Primary healthcare level. (Mokitimi Thesis)
2. Make the space child- and adolescent-friendly within the service
1. Create dedicated CAMH spaces within the existing mental health services
7. Encourage staff to propose innovations to strengthen CAMH service delivery and acknowledge their innovations
3. Separate the time of child and adolescent clinic from adult mental health patients
8. Set up a clear plan for communication with and training of parents/caregivers 6. Provide Training in CAMHS
4. Create links with other departments within the facility in order to generate support for child- and adolescent-friendly services that you have created
5. Organise your child and adolescent clinic to deliver a more effective services
Research
Practice
The Implementation boundaries
Type of service Service provider Informal services Self-care
Informal community care (by traditional healers, teachers, police, village health workers, non- governmental organizations, family associations and lay persons)
Formal services (level 1/2/3)
Primary healthcare services at Community mental health services Specialist community mental health services
Psychiatric services based in general hospitals Specialist mental health services
Long stay mental health services
Khayelitsha Eastern Sub-district (KESS):
Low-resourced community with high rates of poverty, crime
and substance abuse
The innovation process: Since August 2021
1. Stakeholder engagement with community mental health nurses, facility and operational managers
• To discuss the importance of separate CAMHS
• To provide orientation on the new MH service structure
• To facilitate support for MH nurse
• To provide training
2. Training: Group and individually On-site
• Developing a MH service structure
• Review the child and adolescent caseload
• Determining the amount of time to be allocated for that caseload
• Choosing/allocating a day or a slot for C&A
3. Progress on Implementation
• 31st December 2021: 90% (8/ 9) primary health care facilities had separate CAMHS
• 31st January 2022: all 9 (100%)
• New CAMHS SA times : 07h00-13h00 or 13h00- 16h00 (dependent on context and user needs).
4. Development of Standard operating procedure (SOP):
With MH nurses, operational & facility managers
5. Training continues (virtual & face to face) Topics: diagnostic assessment & interview, assessment tools, referral care pathways
6. Developing links with CAMH tertiary units
An example of the new MH service structure
with separate CAMHS
Next steps
Provision of CAMH resources
(assessment &
intervention tools)
Specific CAMH specialist clinical
supervision
Collaborations with the
provincial CAMH
coordinator Increase time for
CAMHS as caseload increases
Monitoring & Evaluation
• During “Plan-Do-Review”
(PDR) session of 2022
• Review of SOPs
Development of a
‘Community CAMHS’
service model
• Evaluation through research
Research
Practice
Research
Practice
Acknowledgements
• PhD Thesis supervisors: Professor Petrus J de Vries and professor Marguerite Schneider
• Dr Kim Jonas for assisting in data analysis
• To the funders of the PhD Thesis
• the Department of Psychiatry, University of Cape Town
• The Spirit of 68 Scholarships, University of Cape Town
• Western Cape Department of Health
• SAMRC Research Development Grant
• To service providers and users who participated in the study
• To KESS Community MH nurses, PHC facility managers, Operational managers,
• To KESS deputy Director (Facility Based services)
THANK YOU!!!!!!!!!!!!!!!!
Academy of Science of South Africa (ASSAf)
ASSAf Research Repository http://research.assaf.org.za/
B. Academy of Science of South Africa (ASSAf) Events I. Other
2022
Priorities for child and adolescent
mental health research and services in South Africa
Academy of Science of South Africa (ASSAf)
Academy of Science of South Africa (ASSAf)
Academy of Science of South Africa (ASSAf), (2022). Priorities for child and adolescent
mental health research and services in South Africa. [Online] Available at: http://hdl.handle.net/20.500.11911/237 https://youtu.be/CoOEpxPzHJs
Downloaded from ASSAf Research Repository, Academy of Science of South Africa (ASSAf)
