Table 2 Themes identified in this study of grassroots service providers that overlapped with the SWOT analysis of senior stakeholders [7]
Overarching theme | Service provider themes (this study) | SWOT analysis Themes [7] (Mokitimi et al. 2019) | Illustrative examples/quotes |
|---|---|---|---|
Lack of resources | Lack of CAMH infrastructure | Inadequate infrastructure and other resources | “… I mean there’s no specific psychiatry ward; so many adolescent patients have to be admitted to normal ward with our other sick patients, which raise a lot more other issues. Even for the children, they also have to be admitted to the paeds (paediatric) ward with other sick children, and then you have this very disruptive kid amongst other sick children which is a challenge…” Child & adolescent psychiatrist (secondary level, urban district) |
Heavy workload | Workload demands | “… all the different clinics have their different challenges … and I'm gonna say that … to expect clinic sister to see children is … it's not … it's not realistic. They barely get to see their 50–60 adults, sometimes they’re 70 adults in the clinic per day … they barely get to see those patients the way they should be seen …” District child & adolescent psychiatrist (secondary level, urban district) | |
Lack of financing | Lack of dedicated funding for CAMH services | “… mental health patients don't get the same quality of care as general patients do … even if you look at the departmental budgets … even psychiatry tends to get a smaller portion of budgets … so … you know … we are not able to provide services to exactly the standard that we would want …” Medical officer (secondary level, urban district) | |
Inequitable distribution of available resources | Inadequate and inequitable resource allocation | “… there is inequity of service … which is very obvious … for example if I look at the size of my team here, the [tertiary CAMHS unit in one substructure] team is three times the size than is of [the other tertiary CAMHS unit in another substructure] … separate psychologist for each thing at outpatients, nurses seperate for each thing … it is really an imbalance in terms of distribution of resources … which is really challenging …” Child & adolescent psychiatrist (tertiary level, urban district) | |
Lack of intersectoral collaboration | Silo working of the Departments of Health, Education and Social Development | Silo working of agencies | “… big challenge is education, the department does not pick up these disorders soon enough. Social development is overloaded too …” Child & adolescent psychiatrist (secondary level, urban district) “… the social development system is overloaded and dysfunctional so that when a child has had a psychiatric experience, it becomes incredibly difficult to place them …” Child & adolescent psychiatrist (tertiary level, urban district) |
Limited training | Limited training | Limited training | “The challenge is … the staff (in non-mental emergency inpatient units) is not trained to work with mentally ill patients and with adolescents … I feel for them because now they must deal with psychiatric patients …” Mental health nurse (secondary level, urban district) |
External contributing factors | Stigma | Societal stressors | “… sometimes stigma is an issue, no parent wants their children to be labeled as a psychiatric patient…” Child & adolescent psychiatrist (secondary level, urban district) |