Child mental health – The role of early intervention
Mental health can be a sensitive subject for many, and something that people may be ashamed about. However, mental health has been in the spotlight recently with a number of internationally recognised celebrities speaking out about their mental health challenges and calling for the stigma associated with mental health to fall away.
Among these campaigners is the Duke of Cambridge (Prince William), who together with his wife the Duchess of Cambridge and brother Prince Harry, support Heads Together, promoting mental health awareness in the UK. Prince William has said: “We need to make mental health normal, we need to treat it the same way we treat physical health, it has to be seen in the same way.”
This is not only a call to action on some far off first world island. There are many people within our own borders who want more help for people struggling with mental health and to remove the stigma that prevents many people from seeking help. Moneybags journalist Jessica Anne Wood looks at child mental health and the role that early intervention plays.
It has been stated that mental health conditions in adults often show signs in childhood, and receiving the correct treatment at this stage can make the world of difference, rather delaying it and only receiving treatment in adulthood.
Charlene van Rooyen, a social worker at Life Poortview, notes: “Once the parent/caregiver or teacher identifies any abnormal behaviour which persists on a continues basis the adolescent may be referred for an assessment with a general practitioner, psychiatrist or psychologist as to determine if any further treatment and intervention is needed. Depending on the assessment the type of treatment/intervention will be determined.”
However, mental health issues are not easy to detect as they may present themselves at a time when some young people undergo behavioural changes simply because they are reaching puberty or going through hormonal changes.
Karen Smith* is an advocate for family support groups and has experienced mental illness first hand after her daughter was diagnosed and treated for bipolar and borderline personality disorder. Her daughter’s behavioural changes started when she was about 15, a time when many parents and children will clash as their children push boundaries and fight for their independence.
Dr Mvuyiso Talatala, a psychiatrist and former president of the South African Society of Psychiatrists, stresses that early intervention is important, as for “most psychiatric disorders, their onset is in childhood or young adulthood.”
He adds that from birth and into adolescents is when your brain develops. As such “anything that happens in terms of how you are cared for, substance abuse and whatever happens that will then predispose you to mental illness in adulthood. But also, if you were to have a mental illness in terms of genetics, if we had a better care for children and pick up things early, we could mitigate the onset of the illness itself, or even the severity of the illness.”
Recognising the signs
So how do you know when you should seek professional assistance or address any behavioural changes yourself?
Smith relays: “We thought it was the teenage behaviour thing, but also, she was in denial. So we would go to a psychologist or a behavioural specialist and then, it’s like once she takes the meds, she feels better after a little while and then it’s ‘there’s nothing wrong with me’ and you stop or think ‘I don’t need to [take medication]’, until the next episode or the next thing happens again.”
Talatala highlights that there is not enough done within the school environment to identify potential mental health issues and provide any intervention that may be required.
“There will be schools, like private schools where teachers are aware, where there have even been accusations that teachers are over-diagnosing ADHD. But the biggest [challenge] is where our children are at the public schools [and] in the townships and the rural areas. That is where I think children actually get missed because the teachers are not trained. Even if they are trained, they are not sure of what to do,” says Talatala.
One possible solution to help schools and teachers could be to have educational psychologists on hand at schools. Talatala elaborates: “They assist with the testing and assessment of the child. But remember that whatever a school is going to do will be successful if there is proper community health facilities.”
Allan Sweidan, the CEO of Akeso Clinic advises: “I think that if a caregiver, parent or teacher is worried about a child then they should take the child for an assessment to the closest mental health facility. This is not always a community clinic, but probably a regional hospital. Whenever children display a marked change in behaviour that lasts for any significant period of time- say more than two weeks- then that might be an early warning of something that requires attention. More significant problematic behaviours such as school refusal, bed-wetting or encopresis should be attended to immediately.”
If you identify a need for assessment in a child in your care, there are a few steps you can follow to get assistance or treatment, according to van Rooyen:
- Visit your general practitioner (GP) who can assess the situation and refer you to a psychologist or psychiatrist depending on assessment and the behaviour that the child represents.
- Alternatively you may see the psychologist or the psychiatrist directly for an assessment, after which they may recommend treatment and intervention if required. This may range from medication, admission to hospital or attending out-patient counselling sessions.
However, there is a question of whether or not there is enough care offered by government. Sweidan notes: “When one talks about ‘enough care’ one is describing both access to care, as well as the quality of that care that is provided. In terms of access, in the public sector, I think there are maybe enough actual beds to serve the population, but facilities are very unevenly distributed among the provinces.”
He adds that a few years ago there was a significant undersupply of beds in the private sector, however, this situation has improved a lot in the past few years.
With regards to the quality of treatment available, Sweidan states that there are probably not enough mental health practitioners in the public sector, impacting the quality of care. “Other factors that impact negatively on quality of care in the public sector may include access to medication which has been previously reported in the media. In the private sector, there is a healthier ratio of mental health professionals and easier access to medication,” says Sweidan.
In addition to the medical facilities, doctors and nurses involved in the treatment of mental health conditions, there is also a role to play for the family through support. Karen says that family involvement, from her experience, is important, even though it can sometimes be hard. “To be part of the process I think is important, so that they know there is a safe space to come back to.”
The cost of seeking treatment
Van Rooyen explains that private mental health care facilities admit patients with the use of medical aid. Most of the treatment/intervention is covered by the medical aid. Patients covered by medical aid are however limited to the duration of admission regarding their prescribed minimum benefits.
In contrast, patients in government facilities are not limited to duration of stay and all costs regarding treatment and medication is covered by government. Aftercare treatment is also covered by government.
“As government caters for a vast amount of patients the availability of the treatment team may be of concern and regular follow-up sessions may not be possible thus resulting in medication not being adequately monitored,” adds van Rooyen.
Compared to the mid-1990s when Smith’s daughter was diagnosed, the mental health sector has changed. However, despite this, Smith believes that more still needs to be done. One thing that Smith is a strong believer in is the need for family support groups.
“The more you talk about it, the more it’s out there, the less people will have the stigma. And that’s why when I approached SADAG to do the support groups for the family, one of the places I looked at for a venue was at the hospitals in our area, because if our support group is at the hospital, then people might start associating mental illness as a medical condition,” reveals Smith.
Another challenge when it comes to mental health issues is the feeling of isolation.
“The biggest pain is when you think you are the only one affected, or you are the one who is unique or it’s something that’s wrong with you or you are possessed or it’s a spell from the ancestors. But if you realise that 20-30% of people will be affected at some stage in their lifetime, then you have a better approach,” says Talatala.
- South African Depression and Anxiety Group – 011 234 4837
- Dr Reddy’s Help Line – 0800 21 22 23
- Pharmadynamics Police &Trauma Line – 0800 20 50 26
- Adcock Ingram Depression and Anxiety Helpline – 0800 70 80 90
- Destiny Helpline for Youth & Students – 0800 41 42 43
- Department of Social Development Substance Abuse Line 24hr helpline – 0800 12 13 14
- Suicide Crisis Line – 0800 567 567
- Akeso Psychiatric Response Unit 24 Hour – 0861 435 787
*Name changed at the request of the source to maintain her and her daughter’s privacy.