![]() ![]() Of those theories, this study was particularly informed by the impact of culture on help-seeking. Reasons for these limited resources in LMIC can be attributed to poverty and competing demands on the fiscal budget, broader systemic challenges (within welfare, education and healthcare), shortages of trained staff, and lack of prioritization of psychosocial care (Patel & Rahman, 2015 UNHSP, 2017).Ĭulture is a key factor in a child’s macro-system, therefore, it is important to consider theories and evidence on its influence on child development, onset and expression of mental health problems, parenting practices, attitudes to supports and services, and design of interventions (Reardon et al., 2017). These barriers are compounded by lack of designated policy and limited resources in terms of skilled professionals, infrastructure and available services (Patel et al., 2018). Help-seeking barriers further hinder the problem and include stigma of mental illness, parental engagement and culturally appropriate interventions (Getanda et al., 2017). Lack of early intervention and supporting systems can affect children’s later psychosocial outcomes along different life domains (Frankish et al., 2018 Patel et al., 2018).ĭespite this evidenced high level of mental health need, access to appropriate mental health and related services remains limited in LMIC (Academy of Medical Sciences, 2018 Pedersen et al., 2019). In these contexts, children are more susceptible to maltreatment, illegal labour and sexual exploitation (Pandian & Lakshmana, 2017 Reza & Bromfield, 2019). Vulnerabilities are more pronounced in low- and middle-income countries (LMIC), especially in deprived communities like urban informal settlements (Bele et al., 2013). These prevalence rates rise to at least double in areas of disadvantage, because of associated risk factors such as poverty, family and community violence (Hussain et al., 2012), and to 40–50% among groups exposed to multiple and recurrent traumatic events such as refugee, street and orphaned children (Ali et al., 2020 Eruyar et al., 2018 Myburgh et al., 2015). It is established that one in ten children and young people under 18 years have mental health problems that would benefit from assessment and intervention (Skokauskas et al., 2019). Impact on children’s mental wellbeing can be achieved through a co-ordinated strategy that involves designated policy, capacity-building, and interdisciplinary networks with meaningful community involvement.Ĭhildren’s mental wellbeing is increasingly becoming a global concern (UN, 2014). ![]() Child mental health service transformation in LMIC, especially in areas of deprivation, needs to build on existing resources and strengths by co-producing psychosocial outcomes with a range of professional and community stakeholders. Participants wished to see strategies that ensured sustainability of impact, namely child mental health policy, stakeholder engagement, interdisciplinary working, and capacity-building for all stakeholder groups. Beneficiaries were identified at child, family, community and service level. Impact was defined as a process of change, with child-centred outcomes and measures that were broader than mental health symptoms improvement. Data were analysed through a thematic approach and three related themes were identified. Participants represented education, welfare and health care agencies as well as community and religious groups. Semi-structured interviews were conducted with 18 stakeholders from disadvantaged urban communities in Kenya, South Africa, Turkey and Brazil. The objective was to establish how stakeholders in low- and middle-income countries (LMIC) conceptualize child mental health impact. ![]()
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