Johannesburg - South African youngsters continue to face several challenges that erode their mental health, the South African Child Gauge 2021/2022 report found.
And while 10-20% of children will develop a mental disorder and/or a neurodevelopmental disability, this is just the tip of the iceberg, the research added.
This 16th annual review of the situation of the country’s children is published by the Children’s Institute (CI) and The University of Cape Town (UCT).
The study was conducted in partnership with UNICEF South Africa; the DSI-NRF Centre for Excellence in Human Development, University of the Witwatersrand; the Standard Bank Tutuwa Community Foundation and The LEGO Foundation.
“Every single child in South Africa needs support so that they can develop the strength and resources to meet life’s challenges and the ordinary support of parents, teachers and communities can help build resilience and set children on a positive trajectory,” Professor Mark Tomlinson from the Institute for Life Course Health Research at Stellenbosch University, said.
The latest edition of the South African Child Gauge report focused on the status of Child and Adolescent Mental Health. It was released to coincide with Youth Day, which focused on “Promoting Sustainable Livelihoods and Resilience of Young People for a Better Tomorrow”.
“Yet 25 years into our constitutional democracy and its promise to improve the quality of life and free the potential of all citizens, widespread poverty, inequality, and violence continue to affect the mental health of young people,” said Zanele Twala, CEO, Standard Bank Tutuwa Community Foundation.
Advocate Bongani Majola, Chairperson of the South African Human Rights Commission, in his foreword to the publication, added that as a result of the historical neglect and underinvestment in mental health, there were serious gaps in the prevention and care of children and adolescents in South Africa.
“These gaps often lead to gross human rights violations that rob children and adolescents of their quality of life, and potential to build resilience,” Majola said.
The South African Child Gauge 2021/2022 report authors have called on government and society at large to create a more supportive and enabling environment to nurture youngsters’ mental health, protects them from harm, and enable them to access care and support.
“It is essential that our laws and policies, our services for children and families, our leaders and their decisions, and our everyday interactions with one another help to foster, create and maintain conditions that enable all children to be part of powerful loving relationships that comfort them in times of adversity, celebrate their strengths and encourage them to thrive,” Professor Linda Richter, Director of the DSI-NRF Centre of Excellence in Human Development at Wits University added.
Meanwhile, the report’s authors believe that the environment in which young people live have a profound impact on their mental health.
“The characteristics of a neighbourhood – whether it is peaceful and clean or violent and dirty – has a bigger impact on the mental health of the people who live in it than their own individual predispositions,” Professor Shanaaz Mathews, Director of the Children’s Institute said.
This is reinforced by the latest statistics which show that two-thirds (63%) of children in South Africa live in poverty, frequently in environments where the stress of material insecurity is made worse by inadequate services, discrimination and violence.
Meanwhile, 39% of children live beneath the food poverty line, where food insecurity further intensifies the pressures and conflict within the home.
“These children and adolescents are at particular risk of poorer mental health which can perpetuate an intergenerational cycle of poverty, violence and ill health,” Professor Mathews added.
In addition, nearly 1 in 2 children in South Africa (42%) have experienced violence including physical violence (35%) and sexual abuse (35%). Violence was revealed to be pervasive in some areas, with 99% of children in the Birth to Thirty Study undertaken in Soweto, experiencing or witnessing some form of violence in their homes, schools, and/or communities.
Research has also found that in the immediate aftermath of a violent event, children may experience waves of fear, anxiety, panic and shock; and without appropriate support, these feelings may give rise to post-traumatic stress disorder, depression, substance use and other mental health challenges.
“Given the scale and intergenerational nature of violence against children, our response to trauma needs to extend beyond dedicated psychological and psychiatric services,” said Professor Mathews.
“Other services such as education, health, social services and the criminal justice system need to recognise and respond to the physical, social, and emotional impact of trauma on children, and on the professionals and caregivers who are there to help them heal,” she added.
The authors of the South African Child Gauge report also believe that families play a pivotal role in protecting children from harm and helping them cope with stress and adversity.
But they found that poverty and hardship undermine caregivers’ capacity to provide and care for their children, and many families require resources and support.
They said that the Child Support Grant had strong positive effects on the mental health of caregivers and their children by helping to improve food security, reduce stress, and increase their feelings of independence and control over resources and the future.
The benefits of income support can also be boosted with parenting or family strengthening interventions to promote positive parenting, reduce caregiver depression, and improve family relationships.
But parental mental illness is also an important risk factor, and the report’s authors said that support services need to adopt a family-centred approach to help parents with mental illness cope with the challenges of parenting, and to help their children who may be struggling with feelings of shame, isolation and self-blame.
In regards to the mental health of youngsters, the South African Child Gauge report authors explained that the first 1000 days are an essential foundation and set the course for adolescent and adult mental health.
This suggests that programmes that promote mental health among all children – irrespective of their socio-economic background – would be most valuable in delivering preventative rewards for the whole of society.
“Support to families – which translates into young children receiving quality healthcare and nutrition, protection from harm, as well as opportunities for learning and to build solid relationship with caregivers – is very important to buffer children from adversity,” Kerry Kassen, Director of the LEGO Foundation South Africa said.
She added that early childhood education programmes can also help in promoting the socio-emotional development of children and supporting their caregivers.
“However, it is also important to sustain programmes beyond the early years as mental health scaffolds over time and may be offered in different ways as a child grows and their world expands,” said Professor Tomlinson.
He added that all children go through stressful periods of transition – starting school or the onset of puberty, for example – and additional efforts should be made to support children during these times.
“Interventions for adolescents may be better placed in schools or communities.”
The annual review of the situation of the country’s children also found that schools were an essential resource for youngsters’ mental health.
The authors believe that the extent to which children and adolescents feel accepted, included and valued in their schools contributed to their socio-emotional development and motivation to achieve. Alternatively, children who feel alienated or discriminated against because of their race, gender or disability are at risk of experiencing poor mental health.
“Schools need to be capacitated to address discrimination and create more inclusive classrooms,” Professor Sharon Kleintjes, Professor of Intellectual Disability in the Department of Psychiatry and Mental Health at UCT said.
“These programmes should also support educators who also experience high levels of stress which may undermine their ability to build positive educator-child relationships.”
Kleintjes added that the national government had already put a number of valuable policies and programmes in place to promote mental health.
“These include a focus on life skills in the curriculum, a national school safety framework to prevent violence, care and support for teaching and learning, and school health services.”
“Implementation and coordination however remain a challenge, and greater efforts are needed to improve the physical and psychological health of the school, and to strengthen links to health services and other community resources,” she added.
Schools can also play a role in normalising mental health care and Country Representative at UNICEF South Africa, Christine Muhigana, said the organisation’s U-Report found that 65% of young people with mental health issues did not seek help.
“ It is therefore vital that we do more to challenge the silence and stigma that prevent people from seeking care.”
She added that as 50% of adult mental health disorders are established by age 14, schools can also help identify and refer children in need of additional support to the health sector.
The Child Gauge report authors have also called for the expansion of access to mental health services as youngsters who do need treatment are likely to encounter a health sector ill equipped to give them the necessary care and support.
“South Africa’s Child and Adolescent Mental Health (CAMH) services are in crisis: child and adolescent psychiatrists and other mental health professionals are available in only a handful of urban centres; while limited services and human resources compromise care at district level,” Petrus de Vries, Sue Struengmann Professor of Child and Adolescent Psychiatry explained.
She said that as a result, only one in 10 children with diagnosable mental disorders were able to access treatment.
“Increasing capacity at primary and secondary levels in the communities where people live is a priority,” said Dr Simphiwe Simelane from the Centre for Autism Research at the University of Cape Town.
Simelane said that primary health care clinics and district hospitals should also be able to identify and care for children close to home.
“It is also vital that CAMH services are included in the National Health Insurance (NHI) baskets of care in order to uphold children’s rights to basic mental health care and financial risk protection,” said Dr Simelane.
The latest Child Gauge report also stressed that discrimination against children with disabilities must be urgently addressed as youngsters with physical, intellectual or sensory impairments are at a higher risk of developing mental disorders.
This is particularly the case when they live in environments in which they and their families face daily discrimination and battle to access health care, education, transport and other services.
“Meaningful participation is central to the mental health of all children and is an area where children with disabilities are most likely to encounter significant barriers, including stigma and inaccessible environments,” said Professor Kleintjes, Professor of Intellectual Disability in the Department of Psychiatry and Mental Health at UCT.
“To address this problem, we need to adopt a twin-track approach: mainstream environments and communities need to become more inclusive and welcoming, while at the same time, more targeted support should be provided to individuals to enable their participation.”
Meanwhile, Professor Tomlinson stressed that choosing to ignore the mental health care needs of youngsters comes at a cost South Africa cannot afford.
He said that the Covid-19 pandemic had highlighted how external environmental events can erode individuals’ mental health.
‘Children and adolescents were not immune to the stress brought on by the pandemic,” he said.
“In fact, it has only compounded hardships already present and is a minor dress rehearsal for the shocks that climate breakdown will bring.”
“The children of today are going to have to live with the consequences of our actions – and we have a window of opportunity to put in place solutions to support our next generation.”
Tomlinson said solutions required a whole-of-society approach to address the social and environmental drivers of ill health, and create supportive environments that enable children to thrive.
“Government, communities, schools and early learning programmes, civil society and families all have a role to play in building an ecosystem of support for South Africa’s children and adolescents.”
He believes that building children’s confidence and capacity to take initiative, cope with adversity and contribute to community life are critical ingredients of mental health and active citizenship.
“And as we work on building solutions, we need to work in partnership with young people and harness their energy, creativity and clarity of thought to design policies, services and programmes that are responsive to their needs and prepare them for the challenges to come,” he said.