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Barriers and Facilitators to Child and Adolescent Mental Health Services in Low-and-Middle-Income Countries: a Scoping Review

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Abstract

Introduction

Despite the severe consequences of under-prioritising child and adolescent mental health (CAMH) problems, mental health services for this population remain scarce in low-and-middle-income countries (LAMICs). The purpose of this review was to identify the barriers and facilitators of access to CAMH services in LAMICs.

Method

This study adopted a scoping review methodology. A systematic search of the literature on CAMH in LAMICs from Medline, PsycINFO, PsycARTICLEs, EBSCOHOST Web, Google Scholar, Web of Science and PubMed databases yielded 28 papers meeting the inclusion criteria.

Results

The gap between CAMH needs and service provision results from a paucity of policies, a shortage of CAMH specialists, insufficient financial resources dedicated to CAMH and a scarcity of culturally appropriate CAMH assessment tools. Adequate access to CAMH services in LAMICs requires strategically maximising available limited resources using task sharing.

Conclusion

There is an urgent need to encourage research in the field of CAMH service development in LAMICs to facilitate policy development, implementation and scale-up of CAMH services.

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References

  • Aarons, G. A., Monn, A. R., Leslie, L. K., Garland, A. F., Lugo, L., Hough, R. L., & Brown, S. A. (2008). Association between mental and physical health problems in high-risk adolescents: a longitudinal study. Journal of Adolescent Health, 43(3), 260–267.

    Google Scholar 

  • Akhtar-Danesh, N., Dehghan, M., Morrison, K. M., & Fonseka, S. (2011). Parents’ perceptions and attitudes on childhood obesity: AQ-methodology study. Journal of the American Academy of Nurse Practitioners, 23(2), 67–75.

    Google Scholar 

  • Alameda-Lawson, T., Lawson, M. A., & Lawson, H. A. (2010). Social workers’ roles in facilitating the collective involvement of low-income, culturally diverse parents in an elementary school. Children & Schools, 32(3), 172–182.

    Google Scholar 

  • Alexander, S. T. (2013). Children of the book: parents, bedtime, and Jewish identity. Journal of Jewish Education, 79(3), 174–198.

    Google Scholar 

  • Al-Obaidi, A., Budosan, B., & Jeffrey, L. (2010). Child and adolescent mental health in Iraq: current situation and scope for promotion of child and adolescent mental health policy. Intervention, 8(1), 40–51.

    Google Scholar 

  • Angell, M. E., Bailey, R. L., & Stoner, J. B. (2008). Family perceptions of facilitators and inhibitors of effective school-based dysphagia management. Language, Speech, and Hearing Services in Schools.

  • Apostolopoulou, A., & Skourteli, M. (2015). An investigation into counselling psychologists’ research activity: motives, facilitators and barriers–a contextual perspective. Counselling Psychology Review, 30(2), 47–66.

    Google Scholar 

  • Arksey, H., & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32.

    Google Scholar 

  • Atif, N., Lovell, K., Husain, N., Sikander, S., Patel, V., & Rahman, A. (2016). Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study. International Journal of Mental Health Systems, 10(1), 24.

    Google Scholar 

  • Austrian, K., & Anderson, A. D. (2015). Barriers and facilitators to health behaviour change and economic activity among slum-dwelling adolescent girls and young women in Nairobi, Kenya: the role of social, health and economic assets. Sex Education, 15(1), 64–77.

    Google Scholar 

  • Azale, T., Fekadu, A., & Hanlon, C. (2016). Treatment gap and help-seeking for postpartum depression in a rural African setting. BMC Psychiatry, 16(1), 196.

    Google Scholar 

  • Bakri, M. H., Ismail, E. A., Elsedfy, G. O., Amr, M. A., & Ibrahim, A. (2014). Behavioral impact of sickle cell disease in young children with repeated hospitalization. Saudi Journal of Anaesthesia, 8(4), 504–509.

    Google Scholar 

  • Barnicot, K., Couldrey, L., Sandhu, S., & Priebe, S. (2015). Overcoming barriers to skills training in borderline personality disorder: a qualitative interview study. PLoS One, 10(10), e0140635.

    Google Scholar 

  • Barry, M. M., Clarke, A. M., Jenkins, R., & Patel, V. (2013). A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle-income countries. BMC Public Health, 13(1), 835.

    Google Scholar 

  • Bayer, J. K., Hiscock, H., Ukoumunne, O. C., Price, A., & Wake, M. (2008). Early childhood aetiology of mental health problems: a longitudinal population-based study. Journal of Child Psychology and Psychiatry, 49(11), 1166–1174.

    Google Scholar 

  • Belfer, M. L. (2008). Child and adolescent mental disorders: the magnitude of the problem across the globe. Journal of Child Psychology and Psychiatry, 49(3), 226–236.

    Google Scholar 

  • Betancourt, T., Scorza, P., Kanyanganzi, F., Fawzi, M. C. S., Sezibera, V., Cyamatare, F., et al. (2014). HIV and child mental health: a case-control study in Rwanda. Pediatrics peds-2013.

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

    Google Scholar 

  • Clavirate Analytics. (2017). EndNote version x7.7.1 software.

  • Cortina, M. A., Sodha, A., Fazel, M., & Ramchandani, P. G. (2012). Prevalence of child mental health problems in sub-Saharan Africa: a systematic review. Archives of Pediatrics & Adolescent Medicine, 166(3), 276–281.

    Google Scholar 

  • Cortina, M. A., Fazel, M., Hlungwani, T. M., Kahn, K., Tollman, S., Cortina-Borja, M., & Stein, A. (2013). Childhood psychological problems in school settings in rural Southern Africa. PLoS One, 8(6), e65041.

    Google Scholar 

  • Das-Munshi, J., Lund, C., Mathews, C., Clark, C., Rothon, C., & Stansfeld, S. (2016). Mental health inequalities in adolescents growing up in post-apartheid South Africa: cross-sectional survey, SHaW study. PLoS One, 11(5), e0154478. https://doi.org/10.1371/journal.pone.0154478.

    Article  Google Scholar 

  • Dever Fitzgerald, T., Hunter, P. V., Hadjistavropoulos, T., & Koocher, G. P. (2010). Ethical and legal considerations for internet-based psychotherapy. Cognitive Behaviour Therapy, 39(3), 173–187.

    Google Scholar 

  • Downing, J., Boucher, S., Daniels, A., & Nkosi, B. (2018). Paediatric palliative care in resource-poor countries. Children, 5(2), 27.

    Google Scholar 

  • Eaton, J., McCay, L., Semrau, M., Chatterjee, S., Baingana, F., Araya, R., Ntulo, C., Thornicroft, G., & Saxena, S. (2011). Scale up of services for mental health in low-income and middle-income countries. The Lancet, 378(9802), 1592–1603.

    Google Scholar 

  • Espinola-Nadurille, M., Vargas Huicochea, I., Raviola, G., Ramirez-Bermudez, J., & Kutcher, S. (2010). Mental health care reforms in Latin America: child and adolescent mental health services in Mexico. Psychiatric Services, 61(5), 443–445.

    Google Scholar 

  • Faculty of Child and Adolescent Psychiatry, Royal College of Psychiatrists (2015). Physical health of children and adolescents: what specialist child and adolescent psychiatrists need to know and do. https://www.rcpsych.ac.uk/pdf/FRCAP02.pdf.

  • Fazel, M., Patel, V., Thomas, S., & Tol, W. (2014). Mental health interventions in schools in low-income and middle-income countries. The Lancet Psychiatry, 1(5), 388–398.

    Google Scholar 

  • Fisher, J. R., & de Mello, M. C. (2011). Using the World Health Organization’s 4S-framework to strengthen National Strategies, policies and services to address mental health problems in adolescents in resource-constrained settings. International Journal of Mental Health Systems, 5(1), 23.

    Google Scholar 

  • Flisher, A. J., Dawes, A., Kafaar, Z., Lund, C., Sorsdahl, K., Myers, B., Thom, R., & Seedat, S. (2012). Child and adolescent mental health in South Africa. Journal of Child & Adolescent Mental Health, 24(2), 149–161.

    Google Scholar 

  • Gartstein, M.A., Bridgett, D.J., Dishion, T.J., & Kaufman, N.K. (2009). Depressed mood and maternal report of child behaviour problems: Another look at the depression-distortion hypothesis. Journal of Applied Developmental Psychology, 30(2), 149–160.

  • Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. The Lancet, 373(9657), 68–81.

    Google Scholar 

  • Gulliver, A., Griffiths, K. M., & Christensen, H. (2012). Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry, 12(1), 157.

    Google Scholar 

  • Idro, R., Kakooza-Mwesige, A., Asea, B., Ssebyala, K., Bangirana, P., Opoka, R. O., Lubowa, S. K., Semrud-Clikeman, M., John, C. C., & Nalugya, J. (2016). Cerebral malaria is associated with long-term mental health disorders: a cross sectional survey of a long-term cohort. Malaria Journal, 15(1), 184.

    Google Scholar 

  • Jordans, M. J., Tol, W. A., Komproe, I. H., & De Jong, J. V. (2009). Systematic review of evidence and treatment approaches: psychosocial and mental health care for children in war. Child and Adolescent Mental Health, 14(1), 2–14.

    Google Scholar 

  • Jordans, M. J., Pigott, H., & Tol, W. A. (2016). Interventions for children affected by armed conflict: a systematic review of mental health and psychosocial support in low-and middle-income countries. Current Psychiatry Reports, 18(1), 9.

    Google Scholar 

  • Juengsiragulwit, D. (2015). Opportunities and obstacles in child and adolescent mental health services in low-and middle-income countries: a review of the literature. WHO South-East Asia Journal of Public Health, 4(2), 110–122.

    Google Scholar 

  • Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O., Rohde, L. A., Srinath, S., Ulkuer, N., & Rahman, A. (2011). Child and adolescent mental health worldwide: evidence for action. The Lancet, 378(9801), 1515–1525.

    Google Scholar 

  • Kigozi, F. (2007). Integrating mental health into primary health care–Uganda’s experience. African Journal of Psychiatry, 10(1), 17–19.

    Google Scholar 

  • Klasen, H., & Crombag, A. C. (2013). What works where? A systematic review of child and adolescent mental health interventions for low and middle-income countries. Social Psychiatry and Psychiatric Epidemiology, 48(4), 595–611.

    Google Scholar 

  • Kleintjes, S., Lund, C., & Flisher, A. (2010). A situational analysis of child and adolescent mental health services in Ghana, Uganda, South Africa and Zambia. The African Journal of Psychiatry, 13(2).

  • Kohrt, B., Asher, L., Bhardwaj, A., Fazel, M., Jordans, M., Mutamba, B., Nadkarni, A., Pedersen, G., Singla, D., & Patel, V. (2018). The role of communities in mental health care in low-and middle-income countries: a meta-review of components and competencies. International Journal of Environmental Research and Public Health, 15(6), 1279.

    Google Scholar 

  • Low, N. C., Dugas, E., O’Loughlin, E., Rodriguez, D., Contreras, G., Chaiton, M., & O’Loughlin, J. (2012). Common stressful life events and difficulties are associated with mental health symptoms and substance use in young adolescents. BMC Psychiatry, 12(1), 116.

    Google Scholar 

  • Lund, C., Boyce, G., Flisher, A. J., Kafaar, Z., & Dawes, A. (2009). Scaling up child and adolescent mental health services in South Africa: human resource requirements and costs. Journal of Child Psychology and Psychiatry, 50(9), 1121–1130.

    Google Scholar 

  • Marten, R., McIntyre, D., Travassos, C., Shishkin, S., Longde, W., Reddy, S., & Vega, J. (2014). An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). The Lancet, 384(9960), 2164–2171.

    Google Scholar 

  • Mellins, C. A., Xu, Q., Nestadt, D. F., Knox, J., Kauchali, S., Arpadi, S., Kvalsvig, J., Shrout, P. E., & Davidson, L. L. (2018). Screening for mental health among young south African children: The use of the strengths and difficulties questionnaire (SDQ). Global Social Welfare, 5(1), 29–38.

    Google Scholar 

  • Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989.

    Google Scholar 

  • Mokitimi, S., Schneider, M., & de Vries, P. J. (2018). Child and adolescent mental health policy in South Africa: history, current policy development and implementation, and policy analysis. Int J Ment Health Syst, 12(1), 36. https://doi.org/10.1186/s13033-018-0213-3.

    Article  Google Scholar 

  • Morris, J., Belfer, M., Daniels, A., Flisher, A., Villé, L., Lora, A., & Saxena, S. (2011). Treated prevalence of and mental health services received by children and adolescents in 42 low-and-middle-income countries. Journal of Child Psychology and Psychiatry, 52(12), 1239–1246.

    Google Scholar 

  • Ngui, E. M., Khasakhala, L., Ndetei, D., & Roberts, L. W. (2010). Mental disorders, health inequalities and ethics: a global perspective. International Review of Psychiatry, 22(3), 235–244.

    Google Scholar 

  • Nyirandagijimana, B., Edwards, J. K., Venables, E., Ali, E., Rusangwa, C., Mukasakindi, H., et al. (2017). Closing the gap: decentralising mental health care to primary care centres in one rural district of Rwanda. Public Health Action, 7(3), 231–236.

    Google Scholar 

  • Ogden, T., & Hagen, K. A. (2018). Adolescent mental health: prevention and intervention. Routledge.

  • Panter-Brick, C., Eggerman, M., Gonzalez, V., & Safdar, S. (2009). Violence, suffering, and mental health in Afghanistan: a school-based survey. The Lancet, 374(9692), 807–816.

    Google Scholar 

  • Panter-Brick, C., Goodman, A., Tol, W., & Eggerman, M. (2011). Mental health and childhood adversities: a longitudinal study in Kabul, Afghanistan. Journal of the American Academy of Child & Adolescent Psychiatry, 50(4), 349–363.

    Google Scholar 

  • Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). Mental health of young people: a global public-health challenge. The Lancet, 369(9569), 1302–1313.

    Google Scholar 

  • Patel, V., Flisher, A. J., Nikapota, A., & Malhotra, S. (2008). Promoting child and adolescent mental health in low and middle-income countries. Journal of Child Psychology and Psychiatry, 49(3), 313–334.

    Google Scholar 

  • Patel, V., Kieling, C., Maulik, P. K., & Divan, G. (2013). Improving access to care for children with mental disorders: a global perspective. Archives of Disease in Childhood, archdischild–archdisc2012.

  • Paula, C. S., Lauridsen-Ribeiro, E., Wissow, L., Bordin, I. A., & Evans-Lacko, S. (2012). How to improve the mental health care of children and adolescents in Brazil: actions needed in the public sector. Revista Brasileira de Psiquiatria, 34(3), 334–351.

    Google Scholar 

  • Paula, C. S., Bordin, I. A., Mari, J. J., Velasque, L., Rohde, L. A., & Coutinho, E. S. (2014). The mental health care gap among children and adolescents: data from an epidemiological survey from four Brazilian regions. PLoS One, 9(2), e88241.

    Google Scholar 

  • Petersen, I., Swartz, L., Bhana, A., & Flisher, A. J. (2010). Mental health promotion initiatives for children and youth in contexts of poverty: the case of South Africa. Health Promotion International, 25(3), 331–341.

    Google Scholar 

  • Petersen, I., Lund, C., Bhana, A., Flisher, A. J., & Mental Health and Poverty Research Programme Consortium. (2011). A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings. Health Policy and Planning, 27(1), 42–51.

    Google Scholar 

  • Petersen, I., Lund, C., Bhana, A., & Flisher, A. J. (2012). A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings. Health Policy and Planning, 27(1), 42–51. https://doi.org/10.1093/heapol/czr012.

    Article  Google Scholar 

  • QSR International. (2015). NVivo version 11 NVivo 10 software for unstructured data analysis.

    Google Scholar 

  • Rocha, T. B. M., Graeff-Martins, A. S., Kieling, C., & Rohde, L. A. (2015). Provision of mental healthcare for children and adolescents: a worldwide view. Current Opinion in Psychiatry, 28(4), 330–335.

    Google Scholar 

  • Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. The Lancet, 370(9590), 878–889.

    Google Scholar 

  • Sharifi, V., Shahrivar, Z., & Alaghband-Rad, J. (2016). Child and adolescent mental health care in Iran: current status and future directions. Archives of Iranian Medicine, 19(11), 797–804.

    Google Scholar 

  • Stasiak, K., Merry, S. N., Frampton, C., & Moor, S. (2018). Delivering solid treatments on shaky ground: feasibility study of an online therapy for child anxiety in the aftermath of a natural disaster. Psychotherapy Research, 28(4), 643–653.

    Google Scholar 

  • Taylor, C. B., & Luce, K. H. (2003). Computer-and internet-based psychotherapy interventions. Current Directions in Psychological Science, 12(1), 18–22.

    Google Scholar 

  • Theobald, S., Brandes, N., Gyapong, M., El-Saharty, S., Proctor, E., Diaz, T., Wanji, S., Elloker, S., Raven, J., Elsey, H., & Bharal, S. (2018). Implementation research: new imperatives and opportunities in global health. The Lancet., 392(10160), 2214–2228.

    Google Scholar 

  • United Nations. (2014). World Economic Situation and Prospects (WESP). (https://www.un.org/en/development/desa/policy/wesp/wesp_current/2014wesp_country_classification.pdf) (Accessed 20th May 2019).

  • van Rensburg, H. C. (2014). South Africa’s protracted struggle for equal distribution and equitable access–still not there. Human Resources for Health, 12(1), 26.

    Google Scholar 

  • Wagner, J. L., Wilson, D. A., Smith, G., Malek, A., & Selassie, A. W. (2015). Neurodevelopmental and mental health comorbidities in children and adolescents with epilepsy and migraine: a response to identified research gaps. Developmental Medicine & Child Neurology, 57(1), 45–52.

    Google Scholar 

  • Wainberg, M. L., Scorza, P., Shultz, J. M., Helpman, L., Mootz, J. J., Johnson, K. A., Neria, Y., Bradford, J. M. E., Oquendo, M. A., & Arbuckle, M. R. (2017). Challenges and opportunities in global mental health: a research-to-practice perspective. Current Psychiatry Reports, 19(5), 28.

    Google Scholar 

  • Watters, C., & O’Callaghan, P. (2016). Mental health and psychosocial interventions for children and adolescents in street situations in low-and middle-income countries: a systematic review. Child Abuse & Neglect, 60, 18–26.

    Google Scholar 

  • WHO. (2017). Mental health atlas 2017. Geneva: World Health Organization.

    Google Scholar 

  • Wissow, L. S., van Ginneken, N., Chandna, J., & Rahman, A. (2016). Integrating children’s mental health into primary care. Pediatric Clinics, 63(1), 97–113.

    Google Scholar 

  • World Bank. (2019). World Bank Country and Lending Groups. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups (Accessed 20th May 2019).

  • World Health Organization. (2003). Investing in mental health.

  • World Health Organization. (2010). mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (mhGAP)–version 1.0. World Health Organization https://apps.who.int/iris/bitstream/handle/10665/44406/9789241548069_eng.pdf;jsessionid=125A641F39127C2528FD0BDEF853A095?sequence=1.

  • World Health Organization. (2018). Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health (Accessed 7th May 2019).

  • Xu, J., Wang, J., King, M., Liu, R., Yu, F., Xing, J., et al. (2018). Rural–urban disparities in the utilization of mental health inpatient services in China: the role of health insurance. International Journal of Health Economics and Management, 1–17.

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Funding

This study is an output of the PRogramme for Improving Mental health carE (PRIME). This work was financially supported by the UK Department for International Development (201446).

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Authors and Affiliations

  1. Centre for Rural Health, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa

    Gbotemi Bukola Babatunde, André Janse van Rensburg, Arvin Bhana & Inge Petersen

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  1. Gbotemi Bukola Babatunde
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  2. André Janse van Rensburg
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Contributions

G.B.B conceptualised the review, G.B.B and A.J.V conducted the searches, also G.B.B, A.J.V and IP performed the quality assessment. G.B.B drafted the manuscript. A.J.V, A. B and I. P reviewed the manuscript, provided substantive revision and approved the final manuscript.

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Correspondence to Gbotemi Bukola Babatunde.

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The views expressed do not necessarily reflect the UK Government’s official policies. The funder did not have any involvement in the study design, collection, analysis or interpretation of data or writing of the manuscript.

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Babatunde, G.B., van Rensburg, A.J., Bhana, A. et al. Barriers and Facilitators to Child and Adolescent Mental Health Services in Low-and-Middle-Income Countries: a Scoping Review. Glob Soc Welf 8, 29–46 (2021). https://doi.org/10.1007/s40609-019-00158-z

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