MHM Magazine

34 | MENTAL HEALTH MATTERS | 2022 | Issue 4 MHM promote positive parenting, reduce caregiver depression, and improve family relationships. Parental mental illness is an important risk factor, and a family- centred approach is essential to help parents with mental illness cope the challenges of parenting, and to reach out and support children who may be struggling with feelings of shame, isolation and self-blame. Use schools to promote mental health Schools offer a second powerful platform for investing in children’s mental health, and the extent to which children and adolescents feel accepted, included and valued in their schools contributes to their socio-emotional development and motivation to achieve. Yet, children continue to be discriminated against because of their race, gender, sexual orientation or disability – and greater efforts are needed to create more welcoming and inclusive schools that value diversity. The Department of Education has put in place a number of policies and programmes designed to promote mental health, including 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. But implementation remains a challenge, and greater efforts are needed to improve the physical and psychological health of the school. This includes programmes to promote teachers’ mental health, and to build their capacity to support children’s emotional wellbeing, manage disruptive behaviour in the classroom, and identify and refer children in need of support. Expand access to mental health services When children and adolescents seek treatment, they’re unfortunately likely to encounter a health sector ill equipped to give them the necessary care and support. Child and adolescent psychiatrists remain concentrated in a handful of urban centres with often little to no care at the district level. Increasing capacity at primary and secondary levels of care is therefore a priority. Primary health care clinics and district hospitals should be able to identify and care for children close to home, with supervision and support from child and adolescent mental health specialists caring for children with more complex conditions at secondary and tertiary hospitals. Strong provincial leadership, ring-fenced budgets and clear implementation plans are also essential to realise this vision of an affordable, accessible and community-based child and adolescent mental health service. Prevent violence and respond to trauma Exposure to violence increases children’s risk of developing PTSD, depression, substance use, and other mental health challenges, and it also increases their risk of becoming victims or perpetrators of violence. It is therefore vital to intervene early to interrupt this intergenerational cycle of violence. For example, parenting programmes have proven effective in promoting positive parenting, stress management and non-violent forms of discipline, and in reducing child maltreatment and behaviour problems. Violence against women and children share the same risk factors, and often occur in the same households. We therefore need to adopt an integrated response that supports both women and children. Given the scale and intergenerational nature of violence against children, our response to trauma also needs to extend beyond psychological and psychiatric services, and infuse our education, health, social services and the criminal justice system to ensure these services 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. End discrimination and support meaningful participation Children with disabilities and their families often face ongoing battles for access to health care, education, transport, and other services, as well as stigma, bullying and discrimination, on top of the everyday demands of coping with an impairment. Confronting these challenges daily can give rise to feelings of anxiety and depression in both children and parents, who are at a higher risk of developing mental disorders. Meaningful participation in family, school and community life is central to the mental health of all children and is an area where children with disabilities are most likely to encounter significant barriers. Addressing these challenges requires a twin-track approach where mainstream environments and communities need to become more inclusive and welcoming; coupled with targeted support to support the participation of individual children such as the provision of quieter spaces at school for children on the autism spectrum, and adjusted schoolwork programmes to allow children time to access therapeutic support or catch up after an episode of illness. Build resilience and the capacity to respond to crises such as COVID-19 and climate change The COVID-19 pandemic has shed light on how external environmental events can grind down individuals’ mental health and intensify the hardships already present in our society. Yet it is a minor dress rehearsal for the shocks that climate breakdown will bring. The children of today are going to have live with the consequences of our actions, and we need to make the most of this window of opportunity to support our next generation. This includes developing resilient systems and services that have the capacity to adapt and respond in agile ways to emerging shocks and crises. 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. Moving forward we need to work in partnership with young people to design policies, services and programmes that are responsive to their needs and that equip them and our society to cope with the shocks and challenges to come. The secret to building this resilience is rooted in what Ann Masten called ‘ordinary magic’, including ‘close relationships with competent caring adults, committed families, effective schools and communities, [and] opportunities to succeed, where belief in the self is nurtured by positive interactions in the world’. The South African Child Gauge 2021/22 and accompanying poster and policy brief are available on the CI website: http://www.ci.uct . ac.za/ci/cg2021-2022-child-and- adolescent-mental-health