March 10, 2025

Improving Access to Mental Health Services for Children and Adolescents in South Africa.

Dr. Eva Mulutsi (IPPHL Cohort 3) is the Chief Clinical Psychologist and Head of Mental Health Services for Tshwane District Health Services in Gauteng, South Africa. Her responsibilities include overseeing mental health services, establishing and reviewing implementation programs, developing referral pathways and standard operating procedures, and ensuring the provision of adequate, accessible, and quality mental health services in the district. In an interview with IPPHL, she talks about improving access to mental health services to children and adolescents in her district in South Africa.

Q: Could you please give us a brief overview of your current project and what it seeks to achieve?
A: My current project focuses on improving access to mental health services for children and adolescents in my district. Mental health issues are prevalent across all populations and
genders, significantly impacting quality of life and contributing to 30% of the global disease burden. Lower socioeconomic status is strongly linked to higher rates of mental disorders due
to its negative effects on literacy, employment, and productivity. The COVID-19 pandemic and natural disasters have only exacerbated these challenges.
In South Africa, 16.5% of the population suffers from mental disorders, and about 20% of children and adolescents are affected. There is a significant treatment gap globally, with 75% of those needing treatment for common mental disorders not receiving it. In South Africa, this gap is around 90%. Our district, with a population of about a million, has only 10 beds available for children suspected of having mental disorders, which is woefully inadequate. My project seeks to improve access to affordable mental health services, addressing the frustration and
limitations of the current system.

Q: What impact do you hope to achieve?
A: The project has already fostered improved communication and collaboration among multidisciplinary health teams at all levels of care, from clinics to tertiary hospitals. Specialists can now directly communicate with primary health professionals, ensuring that children receive appropriate treatment even at lower levels of care. Key outcomes include enhanced referral pathways and systems, clarifying which children require further care and which can be treated locally. The project also aims to develop standard operating procedures for the care and rehabilitation of children with mental health issues, making services more accessible at the primary care level. Additionally, it seeks to decentralize mental health services and improve collaboration with other stakeholders, such as the Departments of Education and Social Development. This ensures that children identified in schools, by police, or in courts receive proper referrals and treatment. Ultimately, the project aims to increase public education and awareness about child and adolescent mental health, enabling communities to better identify and refer children with suspected mental illnesses.

Q: What type of skills and knowledge did you find to be the most useful in addressing the situation?
A: The most useful skills and knowledge I found in addressing the situation include a deep understanding of policies and legislation, effective communication and collaboration, diversity management, and thorough monitoring and evaluation. Understanding the country’s policies and legislative provisions on child and adolescent mental health is crucial for guiding systems and procedures while identifying gaps and recommending practical solutions. Effective communication and collaboration are essential for building
and maintaining relationships with colleagues and external partners, such as the Departments of Education and the police, while diversity management motivates stakeholders to contribute their best in intersectoral collaboration. Finally, monitoring and evaluation systems ensure continuous improvement, allowing for regular revisions and reviews to meet project targets and timelines successful.

Q: What are some of the organizations or stakeholders you’ve worked with, and how did you balance all of them?
A: I’ve worked with a multidisciplinary task team within the Department of Health, including doctors, nurses, psychiatrists, pediatricians, psychologists, registered counselors, and admin officials. Beyond the Department of Health, stakeholders include education, social development, the National Prosecuting Authority, the South African Police Services, and civil society organizations representing mental health user groups. Balancing these diverse interests requires a strategic approach, emphasizing effective communication, conflict management, and active listening to maintain stakeholder engagement and cooperation to advance the project, I utilized tools and frameworks from the International Public Policy and Health Leadership (IPPHL) program, which helped me understand the prevalence of mental illness and service gaps. By analyzing the local context including cultural, political, and socio-economic factors—I identified gaps in content and processes like referral procedures and operating guidelines. The World Health Organization (WHO) pyramid framework further revealed the need for better collaboration and resource allocation, as primary healthcare services are limited. The project aims to standardize procedures, enhance intersectoral collaboration, and improve the overall impact of mental health services for children and adolescents in South Africa.

Q: Do you have any advice for others looking to be leaders in public health, especially women?
A: My advice is to have a clear vision and goals, knowing exactly what you need to achieve and the changes you wish to make. Follow your own path and remember that your work is for the benefit of others, not personal gain. As health professionals, it’s crucial to prioritize the wellbeing of the people we serve.
Stay confident, motivated, open to seeking more information, and be honest if you miss something. Being yourself will help you develop and learn. Increase your visibility within your organization, as your recommendations need approval from higher-ups. For female leaders, capitalize on inherent qualities like empathy, nurturing, and passion to create a supportive environment for stakeholders.

Q: Is there anything else you’d like to talk about or highlight?
A: There has been progress in perceptions of mental health. Previously, people associated mental health with extreme cases, like those visibly distressed in public. However, especially after COVID-19 and natural disasters, there’s a growing understanding that common mental disorders affect everyone. Experiences like stress, grief, and low mood are now recognized as affecting one’s performance and functioning. Public awareness has increased, with prominent figures, like soccer and cricket players, openly discussing their mental health struggles. This has helped reduce stigma and discrimination, although these issues persist. Government efforts are crucial in providing accessible services, as increased awareness leads to more people seeking help. To address the demand, South Africa has employed registered counselors—graduates with degrees in psychology who provide initial psychological services in the community and refer cases as needed. This initiative ensures that mental health services are available at the community level.