Mental health care for children and young people needs to reach them earlier, in schools, families and communities rather than waiting for them to arrive at hospitals and clinics, health experts have said.

The experts who attended the Africa HealthTech Summit in Kigali on October 1 said schools, community health services and digital platforms can help identify young people who need support and connect them to care, but technology should complement rather than replace health workers.

ALSO READ: Activists speak out on drivers of mental health issues among youth

Dr Darius Gishoma, Division Manager for Mental Health at Rwanda Biomedical Centre (RBC), said many African countries have a shortage of trained mental health professionals, especially those specialising in child and adolescent mental health.

He said the shortage makes it difficult for systems that depend heavily on specialists to respond to the needs of children and adolescents, and services in many countries remain concentrated around psychiatric hospitals.

"Systems that are built on specialists cannot thrive and respond to needs, especially for children and adolescents that sometimes have additional barriers to get care,” Gishoma said.

He said Rwanda has spent the past three decades decentralising mental health services by establishing mental health units in district hospitals and health centres.

However, the official noted that decentralising services alone is not enough, arguing that care must reach children in the places where they spend most of their time.

"The most important part is where children and adolescents are. We don't find them in hospitals, we find them in schools,” Gishoma said. "That is why we have a school-based mental health programme, developed by the Ministry of Health in partnership with the Ministry of Education and UNICEF, where school counsellors can identify children who may need help, provide support and refer them for further care.”

How technology can extend care

Gishoma said technology could help health workers provide services in places where specialists are not readily available.

He added that electronic medical records can help give health workers access to patient information and support clinical decision-making through alerts.

At community level, he said mobile phones used by community health workers had helped during a campaign against illicit substances and alcohol by enabling them to identify people experiencing addiction-related problems and link them to care.

He also gave an example of the use of mobile EEG devices, which can send recordings through smartphones to specialists at referral hospitals. This could allow a specialist to support a health worker at a health centre when dealing with conditions such as epilepsy.

Joyce Nakabende, Senior Lecturer in the Department of Computer Science at Uganda's Makerere University, said digital tools could similarly support people who are already providing mental health care in schools and communities. For example, teachers, peer counsellors and people with lived experience could use such tools to identify conversations that may require further attention from a health worker.

However, Nakabende said the tools need to be accessible to young people in the languages they understand.

She said many young people may prefer speaking rather than typing, while some existing tools do not adequately support African languages.

"If you look at the work that is being done around screening, you can actually be able to automate that and use voice and make sure that you can provide the context around the screening being done in a local language,” she said.

Nakabende said technologies developed for other groups should not be transferred to African countries without testing whether they work for the people they are intended to serve.

"It’s okay to have an AI model that gives you 99% accuracy, but it must be tested for the people it is intended to serve. This is particularly important for children, whose language differs from adults, and because some AI applications can reinforce harmful conversations, including suicidal thoughts. AI applications intended for children therefore need to be tested specifically for them before use,” Nakabende said.

Evelyne Munezero, a youth advocate with the UNICEF Youth Advocates Network, said social media can help young people access health information and connect with service providers, but cautioned against relying on it for mental health support.

Reaching young people earlier

Aladin Borja, mental health expert at UNICEF, said mental health systems should not wait until a young person reaches a clinic or hospital before offering support.

He explained that governments should strengthen systems that already surround children, including schools, primary healthcare, child protection, social protection and community platforms.

These systems, he said, should have people with the skills and tools to recognise distress early, provide basic support and refer young people to specialised services when necessary.

Borja said the aim is not to turn everyone into a mental health specialist, but to build layered systems of support. He said governments also need to make better use of information collected across health, education, child protection and social services.

He added that the information is often fragmented between sectors, making it difficult to see where young people may be falling through gaps in the system. Better links between the systems, he said, could help governments identify issues earlier and respond before young people require clinical care.

Borja added that digital spaces should be considered part of this support system because young people already use social media and other digital platforms to seek information, advice and support.

"There is real potential in the use of social media to provide credible, age-appropriate mental health information, challenge stigma, promote healthy coping and help seeking and connect young people to trusted services.”

However, he cautioned that having access to information online does not mean a young person has access to quality mental health care.

"Digital reach is not the same as access to quality care. A campaign, chatbot or helpline is only meaningful if there are trained people, functioning referral pathways and quality services behind it,” Borja said.