A broader perspective on childhood maltreatment and mental health care.

Objective - The data collection began as a clinical audit for service monitoring and development purposes. However, what emerged showed major areas of deficit in society's response to children and their needs. Method - Clinical records were retrospectively examined for attenders at a child mental health outpatient facility in Pietermaritzburg over a one-year period. Demographic and clinical variables were recorded and analysed, using descriptive statistics. Results - Of the 143 attenders, 40.8% of the girls had recent histories of sexual abuse, of whom family or friends abused 82.6%. Children from fractured families constituted 72% of the attenders. Almost 70% of the children spoke isiZulu as a first language, although extremely few psychologists and psychiatrists speak isiZulu. Almost one-third of the children traveled distances up to 200km to access this mental health resource. Conclusions - Clearly sexual abuse and the breakdown of family life appear to be significantly implicated in child mental health referrals in the region, pointing to the dire need for preventive efforts. The mental health system must ensure that practitioners are able to communicate with their patients in their home languages to ensure high quality care. It is essential that mental health services be widened beyond the metropolitan areas, in order to improve access by rural communities.