2019 NL4040 R&D: CDCP Detection and Stigma Reduction

"Children growing up in environments of conflict, and exposed to so much adversity, are a particularly vulnerable group. They are not only confronted with the direct impact of the war itself, but also with the secondary adversities such as poverty, parental loss and displacements which puts children at high risk of developmental problems, and impaired psychological health and well-being . Previous studies have identified high levels of exposure to war-related events and concurrent mental disorders in children. These conditions and daily stressors in children’s life tend to “pile-up”, meaning they are not only risk factors for poor mental health, but also for experiencing maltreatment. A key element in the care of children with mental health problems is early identification. Nearly a third of global ‘years lived with disability’ is attributable to mental health. Yet less than 25% of those living with mental health problems in lower and middle income countries (LMIC) receive treatment. Even in high income countries, less than a quarter of children with mental disorders are identified and referred to relevant available services. Solving this problem is not simply a matter of closing the treatment gap by increasing the availability of services: it also requires looking at the demand side. Lack of awareness of service availability, lack of recognition of mental health problems in oneself or family members, stigma, and perceived ineffectiveness of treatment pose huge barriers to those in need of mental health care. This is particularly so for children, who are unable to seek services of their own accord. Screening for mental health problems within existing health care systems overlooks the fact that many of those with problems do not access health care in the first place. Also, such approaches are expensive and therefore less useful in low-resource setting, where health care budgets are already under pressure. Stigmatisation – a process of stereotyping, prejudice and differential treatment and discrimination for being different from what local norms expect – it negatively impacts on physical and psychosocial well-being. Its manifestations of being rejected, ignored, expelled or otherwise targeted hampers access to services and opportunities and delays help seeking. Furthermore, it impedes positive participation and collaboration in the community. The community context – its societal norms, power structure, citizens and leaders, history – is a crucial element in the stigmatisation process. A stigmatized population group - such as people with a mental illness, being from a certain ethnicity or having acted outside of the social norm - in one community can be stigmatized for other reasons, or even accepted, in another community. Despite a growth in stigma reduction interventions in LMIC in the last decade, there is a lack of scalable stigma reduction interventions. Within communities, children are one of the most vulnerable groups to the impact of war and violence. Armed conflicts continuously result in grave violations committed against children as it no longer only takes place among armed parties – isolated from the daily life of many children - but it occurs in the heart of civilian locations. The evidence-base for interventions for children in areas of armed conflict, including for interventions focusing on the role of families and communities in the protection of children, is mixed and significant gaps in knowledge persist. Acknowledging the pivotal role that communities themselves play in addressing these challenges is necessary to move forward to improve children’s psychosocial wellbeing and strengthen their resilience. However, for example a review of evidence on existing community child protection mechanisms shows that the ownership often lies fully or to a large extent with the implementing agency, and not with the community members."