Launch of child-friendly mental healthcare sees a rise in patient numbers

Growing up in the rural Eastern Cape, Zimasa (surname withheld) knew as young as 13 that something was wrong, but just like everyone who surrounded her, she blamed her behaviour on teenage hormonal changes.

“I knew I was different from my peers, but I couldn’t put my finger on it. Sometimes I would be in high spirits and a few days later I would be at my lowest point, so much so that I wouldn’t even want to get out of bed. My mother used to shout at me for being ‘cheeky and rebellious’ and some of my friends avoided me as they said I had mood swings.”

It was after her 19th birthday and failing matric for the second time that the mother of two was diagnosed with bipolar mood disorder after a major depressive episode.

Looking back, she believes if she had received help earlier the disorder would have been brought under control more quickly and she probably wouldn’t have dropped out of school.

Zimasa is among millions of young people who have experienced treatment gaps in accessing mental healthcare services in SA and the world.

According to the most recent issue of the SA Child Gauge, an annual publication by the Children’s Institute at the University of Cape Town, despite a significant number of adolescents living with mental health conditions in SA most remain untreated and as a result their development lags behind.

Only one in 10 children with a treatable mental health disorder is able to access care.

Due to failure to address mental health conditions, which is worsened by a shortage of psychiatrists and inadequate child and adolescent mental healthcare services, many teenagers are falling through the cracks and their conditions extend to adulthood.

Due to the absence of suitable facilities, many end up in adult psychiatric wards which are not child-friendly and further traumatise these young people as they are housed with more violent, psychotic patients.

But a Western Cape health department pilot project offering dedicated mental healthcare services to adolescents at various clinics and district hospitals in the Khayelitsha eastern substructure is bearing fruit.

The project, the only one in SA, and possibly the world, started treating teenagers separately from adults in August, resulting in a lot more young people seeking mental healthcare services from clinics and lower-level hospitals.

Dr Stella Mokitimi, a trained nurse and clinical programme co-ordinator for mental health at the Khayelitsha eastern substructure who started the programme at nine clinics, said creating separate clinic days to provide a child/adolescent-friendly service that suited school times has seen the number of teens seeking services at clinics rising by 4.2% or 893 cases.

Admissions at participating district hospitals — Khayelitsha, Eerste River and Helderberg — increased by 18% since January.

At least one facility, Khaylitsha District Hospital, has a dedicated adolescent room in the emergency psychiatry ward. It is available to all adolescents who require admission. Staff at the hospitals identified “low-risk” areas in their adult psychiatric wards which are located close to the nurses' station and these are being  used for vulnerable adolescents to ensure better monitoring and visibility.

In addition to having dedicated clinic days and separate rooms, Mokitimi, who last year graduated with a PhD for her work on child and adolescent mental health services in the Western Cape, also arranged to have medication and folders ready on clinic days to avoid young people having to wait in long queues.

Mokitimi said during her research she found that not having dedicated services resulted in many adolescents feeling left out, while being treated in the same space as patients with other diseases often left many feeling more anxious.

Adolescents and their caregivers complained of not being prioritised and as a result of sitting in long queues many missed school while their parents missed work.

Fear of being among psychotic patients, exposure to contagious infections and trauma when admitted in general wards at hospitals or dealing with incompetent staff often worsened children’s mental health problems.

Poor training of staff in dealing with young psychiatric patients also meant healthcare workers were sometimes rude, necessitating training when the dedicated service was started.

Apart from the increase in the number of teenagers seeking mental healthcare services since the inception of this initiative, there had also been zero incidents of assault on young patients by older, uncontrollable psychiatric patients or deaths.

Mokitimi said one of the biggest lessons from this project was a lack of resources couldn't be used as an excuse for not being innovative or providing dedicated mental healthcare services to young people.

“From these efforts, we can see this has been done without creating a new infrastructure but using the available resources within facilities. We have started with baby steps and will not suddenly make changes to infrastructure or have separate clinics as the funds don't allow us to do so. This project shows [one] can start small and make a different to these young patients' lives.”

While no formal research has been done to get feedback from patients on the new service, Mokitimi's research into earlier pilots showed having the child-friendly service at clinics was well received. Patients highlighted the collection of folders and medication from mental health sections and not the clinic's reception areas made the service quick and allowed them to attend school on time.

One adolescent at a primary healthcare clinic said: “Since they started putting the medication there where we see the doctor first, we come out now earlier ... that’s a good thing.” 

Mokitimi said during her research she didn't find any country in the world that ran a similar programme.

“To date I have not found any evidence of a similar kind of service in other parts of the world and I hope that other parts of the world can learn from us.”

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