SA CHILD GAUGE

Poverty can erode mental health of children

Cal Flyn, in her award-winning book Islands of Abandonment: Life in the post-human landscape, provides a desolate as well as genuinely hopeful take on our future. She describes 12 locations around the world that have been abandoned, such as Chernobyl and the collective farms of the former Soviet Union. But amid the desolation, she describes how each “offer their own flavour of melancholy and hope”, because no matter the scale of destruction, nature — if given time — invariably reclaims those places.

Our world is in flames as climate breakdown, the pandemic and the global impact of the war in Ukraine pose existential threats to children’s health, survival and development. But if there has been a single positive to come from the pandemic it is that there is a new focus and attention on mental health. This, coupled with the radical hope that Flyn offers, is the context in which we want to frame how we understand — and respond to — the drivers of child and adolescent mental health in SA.

When we talk about mental health, we often focus on persistent or disabling mental disorders. Yet, mental health is defined by the World Health Organisation as young people’s ability to cope with life’s challenges and stresses — and it is this critical question that runs throughout the 16th issue of the South African Child Gauge as it reflects on how poverty, violence and climate change are undermining children’s mental health, and asks: how can we build the resilience of our children so that they are equipped to meet the challenges to come?

Violence is unrelenting and all-pervasive in many parts of SA — with up to 99% of children in Soweto having experienced or witnessed violence in their home, school and/or community. Violence and trauma may then manifest as anxiety, post-traumatic stress disorder, depression or substance use disorders

— and also increase the risk of victimisation or perpetration later in life in ways that drive an intergenerational cycle of violence and trauma.

Poverty is a form of “slow violence” that erodes the mental health and wellbeing of children, families and communities, with nearly two-thirds of SA’s children living below the poverty line. Exposure to adverse economic events intensifies stress and conflict in the home and compromises families’ mental health and their capacity to care for children. Poverty also reduces families’ ability to travel to and pay for mental health services, helping fuel a cycle of poverty and poor mental health.

These intergenerational cycles of violence and poverty have their roots in our brutal history of slavery, colonialism and apartheid, and present-day corruption and failure to remedy the structural inequalities which continue to shape the distribution of privilege and power in society. Despite the promise of freedom, SA remains the most unequal country in the world, where racial discrimination and economic exclusion continue to trap the majority of young black South Africans in postapartheid poverty.

Children with disabilities and their families remain especially vulnerable to mental health problems as they face ongoing battles to access health care, education, transport, and other services, and have to deal with stigma, bullying and discrimination.

There is a growing recognition of how these experiences of discrimination along the lines of age, race, class, gender, ability and other individual characteristics are not isolated but “intersect” with one another in complex, cumulative and often mutually reinforcing ways. And it is children at the intersection of such discrimination who are most likely to be silenced, rendered invisible and left behind.

Humanitarian crises and shocks such as conflict, climate change and pandemics further intensify inequalities and highlight the fragility of our support systems. For example, Covid provoked widespread fear and uncertainty, coupled with high levels of loss and grief — at a time when repeated lockdowns cut children off from friends, schools and support networks, and stretched the capacity of families to provide a stable and secure environment for children.

From the floods in KwaZulu-Natal to the drought in the Eastern Cape, climate breakdown is threatening to further destabilise communities and increase stress and the propensity for aggression. This is impacting on child and adolescent mental health, giving rise to anxiety, depressed mood and trauma, and young people’s feelings of anger, fear, despair and grief as they witness the government’s failure to address this and other existential threats to their future.

It is clear SA’s children are facing multiple risks and uncertainties, but it is also essential to recognise how these global forces are mediated in significant ways by families, friends, schools and communities. We know that families and schools are foundational to children’s optimal development and that the love, guidance and support of parents, caregivers and teachers are essential in shielding children from harm and building their resilience and ability to cope with life’s challenges.

In the context of our current crises, where so much of what young people are facing today is structural and seemingly “out of our hands” as citizens, reclaiming our agency and rekindling a sense of hope take on a new urgency. Agency and hope are liberating at an individual and societal level and by listening, respecting and working with young people we have the potential to shift the balance of power and build a more inclusive, caring and sustainable society.

The crisis we are in offers us the potential of doing things differently, of working together with youth to leverage agency and hope.

The love, guidance and support of parents, caregivers and teachers are essential in shielding children from harm

✼ Tomlinson is co-director of the Institute for Life Course Health Research at Stellenbosch University; Lake is a communication and education specialist at the Children’s Institute, University of Cape Town; and Kleintjes is professor of intellectual disability in the department of psychiatry & mental health at UCT