A new parent support group introduced by the Outreach Unit of the Division of Child and Adolescent Psychiatry could hold the key to sustainable mental health care among beleaguered families in poor areas.
Under the yoke of social and political problems - unemployment, substance abuse and unsafe communities - the fallout among these families is reflected in an increase in psychosocial disorders among children and adolescents.
Parents AnonymousÂ®, introduced by the Outreach Unit to the Retreat community in July last year, is a network of organisations that strengthens families by getting parents involved in and leading support groups, with peripheral professional help.
"It's clear that treating children on a one-on-one basis can't be expected to produce a substantial reduction of these disorders in society," said Mona Roper, a senior clinical psychologist and senior lecturer in the Division of Child and Adolescent Psychiatry of UCT and Red Cross Children's Hospital.
There are simply not enough clinicians to see all the children who display psychosocial problems.
In addition, the drop-out rate of families who do begin treatment is significant; between 40% and 60%.
"Long waiting lists can also result in a worsening of conditions."
Roper said it had become apparent from the unit's focus groups that lasting psychological change occurred only when social conditions change.
"We know from research that broad societal changes may explain the trend of increasing emotional and behavioural problems in children and adolescents and that factors such as poverty, and specifically poverty in the context of socio-economic inequality, are strongly associated with mental health problems and violence in society. We can't afford to ignore these findings."
When the unit did their qualitative analysis last year, it showed parents felt disempowered in various areas of their lives, through unemployment, substance abuse, personal safety, lack of parental control and so on.
One respondent's comment underlined this: "The child has more rights than the parent nowadays. So what is a mother to her child?"
With a veritable time bomb in the community, the Outreach Unit looked for a parenting programme that would alleviate the situation, something that was affordable and sustainable, something that allowed for South African social and cultural contexts.
After an extensive search, Parents AnonymousÂ® put up its hand, an international network of organisations that works to strengthen families, founded in the US in 1969.
In a nutshell, Parents AnonymousÂ® works through ongoing weekly child and parent group meetings, run by volunteer parents.
They are trained and supported by health professionals from the division's Outreach Unit.
Having been piloted in Retreat last year, the programme is being rolled out in Heideveld and Hout Bay.
It's most striking feature is that it puts parents in charge; it's the parents who run the groups, providing parenting solutions while the professional practitioners like Roper assist from the wings, providing support, material and guidance.
"We work with them until they're confident to run the group themselves," Roper explained. "There's a lot of skill in the community. Often, they just need guidance and support to find their own solutions."
The groups promote a sense of community, providing social roles and role models and creating a network of social relationships that offer both emotional and instrumental support.
"In groups I got support. Now I feel strong and I don't feel alone anymore," one respondent said.
The programme holds hope for other communities.
The idea is also that group leaders will seed new groups.
"Once these groups are established the work will expand to other areas," Roper said.
"The long-term vision is to develop a strong network of support for parents and their families across the province and country."
Some parents become involved in developing material for the media, to spread the word, others in advocacy work in the community, trying to create the kinds of spaces and places that are good for healthy development: playgrounds, recreational areas and other types of resources like adequate schooling and after-school activities.
"One of our tasks is to be prepared for the provincial health department's 2010 mental health care plan, where the bulk of service provided will be at primary health care level," Roper added.
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