Adolescent psychiatric care in Cape Town: A Q&A with Dr. Anusha Lachman

A Stavros Niarchos Foundation (SNF) grant made as part of our Global Health Initiative (GHI) aimed to help upgrade the Adolescent Psychiatry Unit by transforming its secure outdoor space into a garden and recreation area, supplying new furnishings, improving the aesthetics of the facilities, and adding equipment for activities like sports, crafts, crafts, and education.

We recently had the chance to visit to see the renovations in progress and meet with Dr. Lachman, who trained as the hospital’s first subspecialist in child psychiatry after finishing her general psychiatry fellowship. Hear from her about why these changes to the treatment setting matter and about the special considerations involved in treating adolescents.

How are recreation, access to nature, and the feel of the hospital environment connected to care? 

All patients deserve to receive mental health care in an environment that is non-threatening, safe, and promotes healing beyond just the administration of medication. Admission to a mental health facility anywhere in the world can be a traumatic experience for adolescents regardless of the privilege of the setting. Additionally requiring admission for a serious mental illness is both scary and unpredictable for a child who is now needing to be separated from home and a familiar environment. Allowing the ward to operate in a way that supports holistic healing is critical. This requires one to remember that we don’t recover only with medication, but we also need to feel that the space is kind, calming, and safe. Green spaces, outdoor activity, and also indoor spaces that are adolescent friendly—simple things like comfortable sofas, subtle colors, access to a quiet containing space to read, paint, interact with peers, or think—is crucial. We heal from an environment that recognizes we are more than just physical bodies with an illness. Our minds and emotional needs also require support. An admission facility that recognizes the adolescents also enjoy peer engagement, are curious, and need to be active is an environment that holistically heals. 

What does being at a public institution mean for your work? 

It is both rewarding and humbling. A public and teaching facility like Tygerberg Hospital allows you to work in a public mental health space that supports and delivers on universal access to mental health care for all. It helps that we can be at the front of new innovative ways to rethink how children and their caregivers can access mental health services in a fair and equitable way. 
 
How is treating mental illness in adolescents different from treating it in adults? 

Children and particularly adolescents are not small adults. That is the fundamental misconception: that we can treat them in the same way as we do adults but with lower doses of medications, for example.
Adolescence presents a great opportunity for impacting and solidifying brain growth and change that can have lasting consequences into adulthood. It’s the only other time in your development (like the first 1,000 days of life!) where there is rapid brain growth, specialization and plasticity, so the opportunity for intervention is great, but conversely the impact of harm (adverse exposures, substance use, etc.) is also amplified. So consider that adolescence offers the chance for meaningful emotional and cognitive development while navigating the ambivalence of growing up and negotiating hormonal changes as a teenager. So treating mental illness effectively in this period offers a chance to change the lifespan trajectory.
  
What trends are you observing in adolescent mental health? 

There is far too much exposure to adversity too early for young children and adolescence as a consequence of socioeconomic factors like poverty, violence, food insecurity, and substance use. This escalates exposure to and vulnerability to the risk for developing mental illnesses early in life. Caregivers are also overwhelmed and unable to support adolescents to navigate a rapidly changing technical world, and this often leads to poor recognition and late access to care for mental health needs in this population. 
 
What’s one thing you wish people would understand better about youth mental health? 

That it is so much more than just “adolescent mood swings and rebellion.” It’s a difficult time of negotiating their adolescence skills, their maturation of relationships and defining their place in the adult world. They are extremely vulnerable during this brain growth stage of development and require support that is tailored to their needs. Also it’s a time of great opportunity if we recognize the illness early, we have a greater potential to intervene successfully.