IN the face of deep inequality, unemployment, high rates of crime and violence, and the social and economic fallout from the COVID-19 pandemic, the mental health trajectory for young South Africans looks bleak.
Mental health is multi-faceted. It enables people to cope with the stresses of life, realise their abilities, learn well and work well, and contribute to their community. When people face social and economic adversity, their risk of developing mental illness increases if they don’t have support that could protect them.
Data on the exact burden of child and adolescent mental disorders in South Africa is limited. But it’s clear that many children are failing to thrive, due to widespread violence, discrimination and poverty.
Since 2005, the University of Cape Town’s Children’s Institute has published an annual report, the South African Child Gauge. The publication has a different theme every year and strives to bring into sharp focus the rights of South African children.
The latest issue of the South African Child Gauge focuses on child and adolescent mental health. It explores how early experiences of adversity ripple out across the life course and future generations, at great cost to individuals and society.
Schools as points of contact
South Africa is one of the most “unequal” societies in the world, with children and adolescents facing different threats to their futures. But one thing they have in common is that most are enrolled within the country’s education system.
Schools and educational institutions are therefore a precious resource for mental health.
In the chapter we contributed to the 2021/22 South African Child Gauge, we describe the current and potential role of these institutions in promoting and protecting mental health in the South African context. We consider existing policies, provisions and challenges. And, using case studies, we highlight opportunities for intervention in the education system to address gaps in psycho-social provision and support.
Children and adolescents’ well-being is deeply rooted in the environments they live and function in. We hope that with this chapter, policymakers and implementers will appreciate and act on schools’ powerful potential to promote and protect young people’s mental health.
Schools have many advantages as centres of care. They have existing infrastructure. They are generally well-linked to the communities they serve, and to local and provincial governments that govern how they work. They tend to be a contact point between teachers, learners, parents and caregivers, and other community organisations and services. They are staffed by people trained in child and adolescent learning and development. They also offer formal opportunities for ongoing professional development.
Schools provide support to learners living in fragile families. Supportive child-teacher relationships can protect mental health. It’s also known that school-based interventions can be delivered effectively by mental health professionals, teachers, paraprofessionals, lay counsellors and peers. Schools are often more accessible – and less stigmatised – than specialised mental health services.
A learner who feels connected to their school – who feels accepted, respected, and included in the school – is more likely to experience a sense of belonging and positive self-esteem. They are likely to be able to regulate their emotions, and have motivation to achieve.
For all their potential, though, schools exist in complex systems involving multiple stakeholders. Structural issues such as poverty, violence, and social and gender inequality greatly influence how they operate. They also tend to be overburdened and have limited capacity to provide mental health support. These factors in turn affect child and adolescent mental health.
Schools can also be environments where children and adolescents are exposed to negative influences, including abuse and violence from peers and teachers.
Care at all levels of education
Mental health support in schools should respond to a learner’s context, age and developmental stage. The continuum of care should cover the promotion of positive mental health, prevention of mental health conditions and access to treatment and recovery services.
South Africa has a well-developed policy response to address learners’ needs. But there are unique challenges influencing implementation at each stage and some areas that require additional attention.
For example, national early childhood development policies make provision for health screening and support services, but are less focused on early identification and referral. Building teachers’ skills to identify behavioural problems is an effective strategy that has worked in other low resource contexts. Early childhood development centres are a good place to reach parents and caregivers and put them in contact with services.
At primary school level, policy provides for screening and psycho-social support, and provides linkages to primary healthcare facilities. Health education curricula include topics relating to mental health. Future investments could focus on training of health personnel and educators to implement school health policy. It’s also important to prevent bullying and promote school-connectedness.
Similarly, at secondary school, there are provisions for screening and psycho-social support, other health services, school safety and health education. Schools are required to provide counselling and support for pregnant and parenting girls. Practical difficulties in implementing these policies can sometimes be overcome by linking with community-based programmes.
There is no overarching policy response for mental health in higher education in South Africa, but various tertiary institutions have their own policies. They generally include a commitment to providing services to students experiencing challenges.
Across the different stages of education, our research identified some priority opportunities to improve mental health.
- Focus on transitional periods – moving to a new learning environment can be stressful in various ways.
- Address racism, sexism and discrimination – examples of programmes include Teaching for All, which has been widely rolled out in South Africa.
- Support educator well-being – South African educators experience high levels of stress at work and often do not feel equipped to deal with issues.
- Include learners with disabilities – they are at increased risk of developing mental health disorders.
While it’s clear that schools and other educational institutions face a number of challenges, future efforts could draw on existing resources and evidence to incrementally provide the type of mental health support that young people in South Africa need.
Dr Sarah Skeen and Kelly Gemmell are contributors to the South African Child Gauge 2021/2022. This annual report on the status of South Africa’s children is published by the Children’s Institute, University of Cape Town in partnership with the DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand; UNICEF South Africa; the Standard Bank Tutuwa Community Foundation and The LEGO Foundation.