Background: Children and adolescents with mental health problems have
poor service cover in low- and middle-income countries. Little is known
about the resources that would be required to provide child and
adolescent mental health services (CAMHS) in these countries. The
purpose of this study was to calculate the human resources and
associated costs required to scale up CAMHS in South Africa.
Methods: A spreadsheet model was developed to calculate mental health
service resources, based on an estimation of the need for services in a
given population. The model can be adapted to specific settings by
adjusting population size, age distribution, prevalence, comorbidity,
levels of coverage, service utilisation rates, workloads, length of
consultations and staff profile. Steps in the modelling include
population identification; estimates of prevalence, service utilisation
and staffing; and costing.
Results: Using a nominal total population of 100,000 (of which 43,170
would be children and adolescents under 20 years of age), the following
full-time equivalent staff are required at minimum coverage level: 5.8
in PHC facilities, .6 in general hospital outpatient departments (OPDs),
.1 in general hospital inpatient facilities, 1.1 in specialist CAMHS
OPDs, .6 in specialist CAMHS inpatient facilities, .5 in specialist
CAMHS day services, and .8 in regional CAMHS teams. This translates into
roughly $21.50 and $5.99 per child or adolescent per annum nationally
for the full coverage and minimum coverage scenarios respectively. When
comparing the results of this model with current realities in South
Africa, there remains a substantial shortfall in existing levels of
Conclusions: The model can be used as an advocacy tool to engage with
planners and policy makers on a rational basis. It can also be adapted
for use in other countries, and is intended to support wider calls for a
global scaling up of mental health services.
See the spreadsheet model.
Lund, C.; Boyce, G.; Flisher, A.J.; Kafaar, Z.; Dawes, A. Scaling up child and adolescent mental health services in South Africa: human resource requirements and costs. Journal of Child Psychology and Psychiatry (2009) 50 (9) 1121-1130. [DOI: 10.1111/j.1469-7610.2009.02078.x]
Scaling up child and adolescent mental health services in South Africa: human resource requirements and costs.