This special issue of the IRP is devoted to child mental health. The focus is on pragmatic issues not usually addressed in an era emphasizing biological psychiatry and evidence-based medicine. Yet, the topics identified in the papers included in this issue are critical to the development and delivery of child mental health services throughout the world, particularly in low income countries.
The issue begins with a paper focused on policy development. Harper and Cetin show the complex nature of policy development in the ‘real world’ outside the ruminations and research of policy ‘wonks’. Of particular importance is the role played by forces outside the control of policy makers that must be addressed in the development of policy and the enduring influence of the way children are viewed by society. Olayinka Omigbodun extends the discussion of policy with a particular focus on concerns that arise in the course of service development in low income countries. Vince Whitman and colleagues provide a comprehensive understanding of the development of modern school consultative services that embrace mental health. They look at the large international initiatives including those of the World Health Organization. Using China as an example they demonstrate the interplay of forces shaping the delivery of services and the importance of these services for child mental health in resource-poor settings. Again, policy is critical to programme implementation. Hsia and Belfer take on the challenge of explicating the role of economic issues in furthering the development of child mental health services. They identify a way of demonstrating the economic impact of poor child mental health in an effort to add to the tools of those advocating for child mental health policy. An important part of policy development is the mobilization of consumers, parents and other interested parties. The WPA/WHO/IACAPAP Presidential Global Programme on Child Mental Health offered the opportunity to develop a manual on how to mount an awareness campaign. An awareness campaign goes beyond the usual anti-stigma campaign and this particular effort provided substantial education to the community on child mental health. The development and evaluation of the Awareness manual described by Hoven, et al. is informative for all those interested in advocacy and policy development.
Policy needs to be informed by accurate and relevant information. In western countries this information is more readily obtainable because of adequate professional resources and money. In developing countries obtaining locally relevant and accurate information is a far greater challenge. The paper by Ibeziako details a needs assessment among adolescents in Nigeria. This study is remarkable for its mobilization of local resources to carry out a needs assessment, thus providing a resource model, but also because it illustrates how qualitative and quantitative data can be melded. Collaboration among professionals in different countries is too often difficult in developing countries due to language barriers, political differences and problems with access to study participants. The paper by the EMACAPAP collaborators (El din et al.) is perhaps the first large-scale collaborative study in the eastern Mediterranean region. It illustrates how with a targeted approach with some outside technical support a very meaningful collaborative research project can provide locally relevant data on a child psychiatric disorder of enormous importance, and thus lay the groundwork for the development of policy and programmes.
Facilitating the ability to work with children affected by or at risk for mental disorders in a relevant and sustained manner is the ultimate goal of policy development. The papers by Jones, and Ono and Pameriega look at two very important areas of clinical work. Both areas address complex problems involving not only possible psychopathology in children but the importance of understanding the role of culture and the more subtle manifestations of disorder. Jones in a particularly evocative paper describes the lives of children impacted by the conflict in the Balkans. It brings new understanding to the impact of stress and how children cope. In light of the findings we are challenged to understand what is normal and abnormal. Ono and Pameriega address a subject that is almost taboo in some cultures, namely, intra-familial violence. They unravel the complexity of this phenomenon and suggest a way forward to help avert the devastating consequences of this violence. Betancourt's paper challenges the reader to understand resilience in youths impacted by and perpetrators of violence. Resilience is not a new concept but one that has to be revisited in this era when so many youths in developing countries and throughout the world are subject to the most unbelievable personal stresses. Coupled with the paper by Jones the reader is offered rich resources for understanding this important concept and how it might be incorporated in practice.
It is hoped that the reader of this issue will come away better equipped to engage in the dialogue related to policy implementation in difficult circumstances, and energized to move from policy to programme implementation with the goal of establishing relevant and sustainable programmes.