CATCH IT EARLY OP-ED: Mental healthcare for young South Africans needs a wider front door

Youth mental health care needs to move from a crisis response to early prevention and intervention. This could be achieved through expanding school-based ‘task sharing’ programmes like EASE-SA, where trained non-specialists deliver evidence-based emotional support to young adolescents.

Child mental health systems are still too often organised around crisis, even though the strongest opportunities for prevention come much earlier. Mental health difficulties frequently emerge during childhood and adolescence , and young people often experience more than one difficulty at the same time. Anxiety and depression, for example, commonly co-occur in children and adolescents , alongside challenges that can affect relationships, schooling and everyday functioning. Delays in recognising and responding to these difficulties can allow distress and impairment to become more entrenched.

This is one reason that recent international work has called for youth mental health systems to place much greater emphasis on prevention and early intervention . In South Africa, that challenge is especially pressing. Specialist child and adolescent mental health services remain scarce and unevenly distributed , while symptoms of depression and anxiety are common among young adolescents . Expanding specialist services remains essential, but the size of the treatment gap means that support also has to be available earlier and through a wider range of people and settings.

Schools have an important place within this response. Young people spend much of their lives there, relationships with peers and adults are formed there, and changes in behaviour, participation or wellbeing may first become visible there. Schools can create opportunities for mental health promotion, prevention and early support , provided that this work is accompanied by appropriate training, supervision and attention to implementation , with links to further care when needed.

One increasingly important approach is task sharing . This involves training people who are not specialist mental health professionals to deliver specific evidence-based interventions within clearly defined roles and with appropriate supervision . In settings where the demand for mental health support far exceeds the number of psychologists, psychiatrists and other specialists available, task sharing can extend the reach of care without expecting every difficulty to be managed by specialist services.

A useful example is the World Health Organization (WHO) and Unicef’s Early Adolescent Skills for Emotions programme , or EASE. It was developed for adolescents aged 10 to 14 experiencing emotional distress, including symptoms of anxiety and depression. The programme consists of seven group sessions for adolescents and three sessions for caregivers, and draws on cognitive behavioural approaches. Importantly, it was designed for delivery by trained and supervised non-specialist helpers.