FACTORS INFLUENCING CHOICE OF PATHWAYS TO CHILD AND ADOLESCENT MENTAL HEALTH CARE SERVICES IN KENYA

Abstract

Background Studies worldwide reveal that 10-20% of children and adolescents suffer from a mental illness and majority of them are unable to access care. With many of these disorders being treatable, early intervention is key for a good prognosis. In Kenya, not much is known about the determinants of mental health service use in this age group. Understanding the pathways and barriers to specialist mental health care is crucial to planning for and providing optimal child and adolescent mental health services. In addition to outlining pathways into mental health services for children and adolescents, this study determined the socio-demographic and clinical factors associated with the pathways, the perceived challenges experienced while seeking to access the specialist services and service user’s perspectives on ways to improve the services. Methodology This was a cross sectional descriptive study conducted at the Kenyatta National Hospital’s child and adolescent mental health clinics. Data was collected over 10 weeks from 166 participants and their caregivers. Instruments used were a researcher designed socio-demographic questionnaire, a modified WHO Encounter form and the Kiddie- Schedule for Affective disorders and Schizophrenia- Present and Lifetime (K SADS-PL 2009 Working Draft). Quantitative data was analysed using SPSS (Statistical Package for Social Scientists). Bivariate and logistic regression was conducted to check whether the socio-demographic and clinical variables influenced the choice of pathway, while cox regression analysis was used to check whether the socio-demographic and clinical variables were related to time taken to seek intervention. Themes related to barriers to care were extracted from the qualitative data using ATLAS. ti software. Results There were more males (56%) than females in this study. The participants’ ages ranged from 2 to 18 years, with a mean age of 13.6 years. Substance abuse disorders were the most prevalent presentation (30.1%) followed by depressive disorders (13.9%). The medical pathway was accessed by 83% of the participants with 36% accessing the child and adolescent mental health services directly. In the non-medical pathway, 6% visited religious leaders. Care was mainly initiated by the caregiver (48.8%) while the child’s teacher-initiated care in 30.1% of the study participants. The median time taken to seek any type of help after the onset of symptoms was 11 months (IQR 11.5 months). Being female was found to be predictive of the use of a medical intervention (OR 2.9, 95% CI=1.17-7.77) after adjusting for type of guardian, disruptive disorders and suicidality. Having a disruptive disorder was associated with a longer time to help-seeking than not having a disruptive disorder (HR 1.77, 95%CI=1.23-2.57). The main barriers to care themes identified by the study participants were the inability to recognize the symptoms, lack of awareness of the existence of the facilities and financial problems. Lack of knowledge by the previous medical provider was the main barrier identified related to health care providers. Hospital-related barrier themes derived were long waiting time, long-distance of travel and inadequate facilities. Conclusion This study indicates a preference for the medical mediated pathway in accessing care for mental disorders in children and adolescents who presented at the Kenyatta National Hospital. It also highlights the existence of non-medical pathways and the possibility that many children with mental disorders may not be able to access comprehensive mental health care. The main barriers themes identified in this study were the inability to recognise symptoms and not knowing where to seek help. Increasing mental health literacy among health care workers and the community through awareness campaigns and training would go a long way in improving access to the available child and adolescent mental health services.