Understanding the stigma of Childhood Mental Illness

This Youth Day (16 June), Life Healthcare, one of South Africa’s leading hospital groups, emphasises the importance of education around adolesccent and childhood mental illness in an effort to reduce the stigma and ensure early intervention.

According to the World Health Organisation, worldwide 10-20% of children and adolescents experience childhood mental illness. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. In addition the National Youth at Risk Survey conducted in South Africa, which focuses on children and adolescents between grade 8 and 11 highlighted that 24% of the youth surveyed had experienced feelings of depression, hopelessness and sadness while a further 21% had attempted suicide at least once.

Research shows that a lot of youth experience a painful tug-of- war filled with mixed messages and conflicting demands from parents, teachers, coaches, employers, friends and themselves. Growing up negotiating a path between independence and reliance on others is not always easy. It creates stress, and it can create serious depression for young people ill-equipped to cope, communicate and solve problems. Myths, confusion, and misinformation about mental illnesses cause anxiety, create stereotypes, and promote stigma. Dr. Riyas Fadal, the National Manager of Life Mental Health, stresses that mental illness may present as a learning disorder, however persons with learning disorders do not necessarily have a mental health condition and that this should be further explored.

“A starting point to reduce stigma is with the child and family. When adults accept mental illnesses, it becomes easier for them to talk to others in their immediate social network, neighborhood and community. The knowledge that mental illness is fairly common and affects anyone helps break the barrier of stigma,” says Dr Ismail Moola, child psychiatrist at Life St Joseph’s based at Life Entabeni Hospital.

The most common mental health issues faced by young people in South Africa relate to:
  • the use, misuse, or abuse of prescription and nonprescription drugs;
  • exposure to various forms of violence and sexual abuse;
  • the effects of the HIV epidemic on their parents and families;
  • teenage pregnancies;
  • and adjustment disorders (related to new situations, divorce change of schools, bereavement etc.)

With this range of external factors impacting mental health, Charlene van Rooyen, social worker at Life Poortview, a Life Healthcare facility offering a dedicated adolescent mental health programme, highlights the importance of a high index of suspicion and early intervention. Charlene further states that a lack of awareness and failure to notice red flags may result in a prolonged and increasingly devastating effect on the child’s progress and development within society.

While children may exhibit signs of mental illness, it’s important that a mental health professional (psychiatrist and clinical psychologist) makes a full assessment before the appropriate measures are put in place to help manage their illness.

Childhood Mental Illness

“Should the parents, caregiver or teacher identify a need for an assessment they may either visit their general practitioner. The GP will assess and then refer the adolescent or child to either a psychologist or psychiatrist. Which depends on the assessment and the behaviour they present with, or the adolescent may visit the psychologist or psychiatrist directly. Treatment and intervention may range from medication, admission to hospital or attending out-patient counselling sessions,” says van Rooyen.

The mental health of parents must also be considered when tackling childhood mental illness. Unfortunately, families, professionals and society often pay most attention to the mentally ill parent, and ignore the children in the family. Providing more attention and support to the children of parents with mental illness is an important consideration when treating the parent.

“Individual or family psychiatric treatment can help a child toward healthy development, despite the presence of parental psychiatric illness. The mental health professional can help the family work with the positive elements in the home and the natural strengths of the child. With treatment, the family can learn ways to lessen the effects of the parent’s mental illness on the child,” concludes Dr Moola.

Early signs of childhood mental illness

Below are a few signs which may indicate that a child is suffering from a mental health issue. If problems persist over an extended period of time or if others involved in the child’s life are concerned, consider speaking with your family doctor.

Younger Children
  • Unexplained changes  in school performance
  • Unexplained learning disability despite the child’s increased efforts
  • Severe worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the child’s age
  • Frequent physical complaints like headaches and stomach aches.
  • Hyperactivity; fidgeting; constant movement beyond regular playing with or without difficulty paying attention
  • Persistent nightmares
  • Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures
  • Frequent, unexplainable temper tantrums
  • Threatens to harm or kill oneself
  • Social withdrawal, quiet behaviour
  • Reduced activity and unwillingness to socialise
Pre-Adolescents and Adolescents
  • Unexplained  changes  in school performance
  • Inability to cope with problems and daily activities
  • Marked changes in sleeping and/or eating habits
  • Extreme difficulties in concentrating that gets in the way at school or at home
  • Sexual acting out
  • Sustained and prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death
  • Mood swings
  • Worries or anxieties that get in the way of daily life, such as at school or socializing
  • Repeated use of alcohol and/or drugs
  • Intense fear of becoming obese with no relationship to actual body weight, excessive dieting, throwing up or using laxatives to lose weight
  • Persistent nightmares
  • Threats of self-harm or harm to others
  • Self-injury or self-destructive behavior
  • Frequent outbursts of anger, aggression
  • Repeated threats to run away
  • Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism
  • Strange thoughts, beliefs, feelings, or unusual behaviors
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