motivation of health workers to provide quality mental health services alongside an unreliable networking infrastructure (Patel et al., 2007b). To close the gap of unmet needs in LMIC, it is necessary to develop effective evidence-based interventions (EBIs) which are culturally appropriate and acceptable (Jordans et al., 2016). Problematically, interventions that do exist either lack robust evidence-base (Kohrt, 2013) or have been translated from high income countries (HIC) (Klasen & Crombag, 2013). Programmes targeting child mental health problems in LMIC should be planned in relevant and culturally appropriate ways (Jordan et al., 2016). To achieve this, it is necessary to first understand the strengths, barriers and relevant cultural issues from the local community perspective (Patel et al., 2010). When community stakeholders are engaged, even in difficult circumstances, it has been demonstrated that their concepts of mental health are not that incongruent from those western countries (Ahmed & Palermo, 2010); and that they tend to seek individual, family and community supports for their children ( et al., 2013). Such consultation has been found to be feasible and to enhance the validity of interventions and research findings (Bryan & Henry, 2012; Yamey, 2012). If both care and research are and client-driven, they are more likely to be acceptable to communities, thus resulting in evidence-based interventions in their sociocultural context that can also be sustainable. Research aims and context The rationale for this was to examine such stakeholders’ perspectives in a disadvantaged community in Kenya. The aims of this study were to: a) explore community stakeholders’ views on children’s mental health needs and culturally acceptable interventions in Kenya, and; b) to ascertain the most appropriate ways to integrate global service standards with a culturally-specific framework.
This was conducted in Nakuru County, Kenya, which has approximately 1.7 million inhabitants from different ethnic groups (Getanda et al., 2015). The area was selected for both service and research purposes, because of the high proportion of internally displaced population following ethnic violence, which is now exposed to extreme socioeconomic deprivation. Participants were recruited from a slum in Nakuru city. Purposive sampling was used to recruit key community stakeholders to four focus groups. These consisted of children, aged 14-17 years from a selected school, their parents, teachers, and professionals in contact with children such as probation officers, social workers, counsellors, police officers, church leaders and administrators. The school was selected because of its population in terms of poverty and internal displacement. Participating children were selected following the first three children on the register of each year (14, 15, 16 and 17 years), while their parents and teachers were also invited to take part. Professionals operating in the same area were identified through teachers. The groups thus consisted of seven children, seven parents, nine teachers and 11 professionals or community leaders. Focus groups were conducted either in English or Swahili (the local language) by the lead author of the paper, who also provided any translation needed. Focus groups were guided by a relatively open schedule of questions that focused on the general areas of mental health need and emotional wellbeing, with some questioning regarding the useful translation of mental health interventions (strengths and challenges). All focus groups were audio-recorded, alongside taking field notes, until saturation was reached. Thus, sampling adequacy was assured, which meant that data collection continued until no new issues were discussed, as this is an appropriate quality indicator for thematic research (see O’Reilly and Parker, 2013). In accordance with
(Policeman) “What you are going to guide the children or the community should come from the heart, so that you can be able to deliver what is right.” (Teacher 8) In many ways, the solutions suggested by participants for managing through economic crises mirror those for any country, as ultimately some of these the solutions lie with practitioners on the frontline. ‘Passion’, ‘commitment’ and delivering support ‘from the heart’ are attributes that are important when working with children; and identifying and retaining these individuals is part of a solution. Of course, additional resources remain essential, if we are to meet the global need for prevention and treatment of child mental health as “there is no health without mental health” (WHO, 2005) and it was argued that government budgets were important in meeting this. “The governments should also set a budget specifically for...mental health.” (Psychologist) The issue of resources is clearly advocated by this psychologist, who also positions some responsibility with the ‘government’ by claiming that there should be a specific ‘budget’ for ‘mental health’. Indeed, this is an issue globally, as it is well known that even in high income countries, budgets that are specific to mental health tend to be rather low (London School of Economics and Political Science, 2012). Theme Two: Limited mental health knowledge and lack of culturally appropriate interventions
“The parents must be sensitised through various awareness programmes, so that they can take their rightful roles on issues of mental health.” (Psychologist) “Train peer counsellors, the children themselves.” (Teacher 1) “To and actually to employ the counsellors who will actually be facilitating, or who will be teaching the issues of the mental health care.” (Chief 1) Notably, the need for training was viewed as multidimensional and reaching out to a of different stakeholders, including ‘peer counsellors’ and ‘the children themselves’, as well as ‘parents’ who should be ‘sensitised through various awareness programmes’. Similarly, it was suggested that professionals such as counsellors, should have regular training to provide sustainable quality services. The suggestion therefore is that education is a key way forward in tackling the problem of mental health. DISCUSSION The purpose of this study was to examine the views of community stakeholders improving awareness of and response to child mental health problems in Kenya. These reflected their experiences of challenges facing poor communities in the developing world. Consistent with the literature (e.g. Patel et al., 2007b; Kleintjes et al., 2010), the major challenges identified