Table 1 Summary of workshop data
Group (s) | Why bottlenecks—Causal factors. | What can be done—possible solutions. |
|---|---|---|
1 | Poor identification/screening and assessment Lack of training for stakeholders Lack of community education Family system—Mothers not trained to pick up the red flags despite having the road to health cards, grandmothers raising children, parent denial Limited CAMH facilities and resources (human resources and Screening tools) | Educate caregivers and encourage active involvement Conduct routine awareness campaigns through community structures, e.g., NPOs and Ward Based Primary Health Care Outreach Teams (WBPHCOTS) Develop user-friendly screening tools, train educators to identify and do basic screening in schools and provide basic community support |
Inappropriate referral pathway Poor referral structures Limited training specifically within the educational sector and NPOs Lack of knowledge on structures that exist in some facilities, e.g., conferencing (communication structures) for DOE/DOH Poor communication between stakeholders | Adequately define referral pathways Communicate all relevant information to stakeholders Implement referral policies for each department | |
2 | Limited CAMH promotion and awareness CAMH not prioritized Lack of funding/budget allocation Lack of training and campaign materials Lack of community dialogues around CAMH and awareness programs Lack of structured and consistent awareness campaigns | Consistent awareness campaigns Prioritizing awareness/pro-active measures rather than an immediate reaction to an unfortunate event Prioritize staff training Engage in small/less costly awareness campaigns more often Use of school health nurses, NPOs and counselors in schools to create awareness among learners and destigmatize mental health all the time |
Community-based interventions A poor intersectoral working relationship Inadequate attention to CAMH interventions Lack of dialogues with young people | An improved working relationship between the departments Availability of recreation facilities Involve youth in decision making Make the community aware of chill rooms in clinics Establish more buddy with youths (mentorship programs) | |
3 | Poor management structures The low priority given to CAMH by the government Management attitude to implementing procedures at all levels (lack of understanding within each sector and intersectorally) Lack of budget allocation Poor planning | Intersectoral CAMH liaison forum Advocacy for budget allocation in all the departments The different departments need to inform and educate each other on the different policies Collaborative activities such as designing and implementing CAMH interventions |
Task sharing Limited specialists Increasing workload Shifting of responsibilities (within the different departments) Shortage of school health team | Increase CAMH specialists Mentorship and specialist supervision Train staff in all departments (educators, nurses, school health team) Managers must ensure that they take up the responsibilities to deliver adequate CAMH services |