Some 250 million children under five (43%) in low to middle income countries are at a higher risk of not achieving their full potential due to extreme poverty and not receiving nurturing care .

Although an increasing number of children in developing countries are surviving beyond birth, they start life at a major disadvantage because of multiple adversities in their early, formative years, says Dr Anusha Lachman, the South African representative of the African Association for Child and Adolescent Mental Health (AACAMH).

Dr Lachman joined Merentia van der Vent in conversation on The Honest Truth on Wednesday 26 September, listen to the conversation here:

The combination of poverty, poor health and nutrition, leading to difficulties in learning and academic performance, not only affects the child’s future earning potential, but also contributes to transferring poverty to the next generation.

Dr Lachman was addressing delegates from across the continent attending the third African Diaspora Global Mental Health Conference held yesterday (18 September) in Cape Town, and said that “mental health policies are seriously lacking in early detection and prevention of lifelong suffering.”

The conference is hosted by the Africa Global Mental Health Institute (AGMHI) which brings psychiatrists and mental health professionals from all over the world together to create a collaborative network that shares resources and opportunities for development in the field of psychiatry.

Dr Lachman says that by young children not receiving the basic human right of nurturing care necessary for their physical and psychological development, “this poor start in life is estimated to result in a loss of about a quarter of average adult income per year while countries may forfeit up to twice their current GDP expenditures on health and education.²”

Over 45% of Africa’s population is made up of infants, children and adolescents and by 2030 it is estimated that the continent will have the greatest number of children under 18 years of age in the world³. Yet child mental health remains a stigmatised and isolated area of child and adolescent health, while sexual and reproductive health, infectious diseases, HIV and malnutrition still take the priority of policymakers on the continent.

“Only a fraction of children and adolescents have been reached and the most vulnerable in our societies – those living in rural areas, in extreme poverty, living with disabilities, and out of school children – have little or no access to mental health programmes and activities.”

“All indications are that we must reach families from—or even before—the time of conception, and that support is vital in the first 1000 days of a child’s life. Young children have the best chance of maximising their potential when they are well nourished, cared for, exposed to learning opportunities from birth onwards, and protected from disease, violence, and stress.”

Dr Lachman says that early childhood is not only a period of special sensitivity to risk factors, but also a critical time when the benefits of early interventions are amplified and the negative effects of risk can be reduced. “The most formative experiences of young children come from the nurturing care received from parents, other family members, caregivers, and community-based services.”

She characterises nurturing care as a stable environment that promotes children’s health and nutrition, protects children from threats, and gives them opportunities for early learning, through affectionate interactions and relationships. But she warns that “for nurturing care to be effective, we need mentally well primary caregivers. Unfortunately, maternal mental disorders are approximately three times more prevalent in lower income countries, and less than 10% access treatment⁴.”

Child development starts at conception and the development of the young child’s brain is dependent on good nutrition and on certain types of experiences. Most families provide these experiences for their young children, but many cannot because of stresses and conditions that interfere with their ability to parent. The influence of some of these factors starts during the preconception period.

Families must be supported to provide nurturing care; they need material and financial resources, and the knowledge, time, and skilled assistance when required. Families can be supported through the implementation of national policies, affordable quality childcare, and provision of population-based services.

She says that services and interventions to support early childhood development are essential to ensuring that everyone reaches their potential over their life course and into the next generation. “We need to highlight the importance of political prioritisation, legislation, and policy, and the use of existing systems and financing in up-scaling support for families and improving maternal and child health services.”

“Services should be two-pronged, considering the needs of the child as well as the primary caregiver, and include both care for child development as well as maternal and family health and wellbeing. Even though the practice of Child and Adolescent Mental Health has witnessed significant growth on the African continent in the last half-decade with an increase in trained professionals, services developed, research activities and regional and country collaborations and meetings, the task is still enormous.”

“Expanding existing maternal and child health services to include interventions that promote nurturing care is an important entry point for multisectoral collaborations that support families and reach very young children.”

“Essential among these are strengthened maternal, infant, and young child nutrition; family support; social protection, and capacity to access services; and education, for quality early learning opportunities. Prof Bonga Chiliza, Director of the AGMHI says that there are 1.4 mental health workers per 100,000 people in the African region, compared to 16.2 per 100,000 in the Americas and 43.5 per 100,000 in the European region⁵.

“The lack of professionals places enormous pressure on the health system at the expense of those suffering from mental illness. Along with the need for psychiatry education programmes, many African countries have limited mental health services available. Poor recruitment, shortages, high clinical loads, and limited networking opportunities challenge rural health services. For individuals, a general lack of transportation services and limited medical facilities create difficulties in accessing mental health services and the unique challenges of other health concerns such as HIV, language barriers and stigmatisation of Western treatment methods, all hamper access to psychiatric care.”

“However, the AGMHI is actively working on identifying targeted solutions that address current challenges across the four domains of mental health which are research, training and education, clinical care delivery, and policy. More specifically, the AGMHI serves as a platform for exchange of knowledge on best practices in the field of global psychiatry, contributes to creating platforms where research, education and training opportunities in Africa are easily shared and accessible, and  facilitate the creation of new regional Research Centres of Excellence on the content in collaboration with the University of KwaZulu Natal and Boston University in the USA, that are able to secure funding for multifaceted programmes such as clinical trial networks, robust databases, biobanks, and career development opportunities.”