When Dr Anusha Lachman, head of the clinical unit, child psychiatry at Tygerberg Hospital, graduated with her PhD in psychiatry last week, she felt more committed than ever to continue contributing to the field of child psychiatry in South Africa and Africa.
“This should be done in an Afro-centric, culturally sensitive manner,” Lachman said in an interview.
Lachman, who convenes the masters programme for infant mental health at Stellenbosch University, was awarded the Bongani Mayosi Scholarship for her PhD work, and completed her doctorate on the prestigious King’s College London Erasmus grant. Her PhD explored a simple observational tool – the shared pleasure paradigm – for clinicians at grassroots level to screen for at-risk babies and their mothers with mental illness in SA.
“It’s really important to me to have completed my PhD,” says Lachman, who, earlier this year, launched an online short course on infant mental health. “It’s difficult for people with full-time clinical jobs to take on a PhD. Much of the decision-making relating to care, resources, and research, is made by researchers in laboratory settings and not by clinicians working in the field. So, I’m excited and relieved that I’ve achieved this. It will give me more credibility, academically.”
Lachman, the daughter of two schoolteachers, grew up in Chatsworth, KwaZulu-Natal, and qualified as a medical doctor in 2001 at the University of KwaZulu-Natal. She worked in the United Kingdom for two years before returning to her postgraduate studies in SA. She graduated as a specialist psychiatrist from the Colleges of Medicine of South Africa (CMSA) in 2009 and completed her sub-specialist degree in Child Psychiatry (cum laude) in 2011.
The programme for infant mental health is the only programme of its kind in Africa that enables the teaching of more Afro-centric maternal infant health. Lachman says most of the current research, literature and thinking about infant mental health focuses on Western, high-income settings. “I’m interested in how maternal and infant health looks in our context and in limited-resource settings.
“There’s no such thing as the universal mother and child. In Africa, children are routinely brought up in communities by aunts, grandmothers or extended families. When we think about child mental health on our continent, we have to also think of the mental health of the caregiver.”
Lachman says she believes child psychiatry has the potential to influence developmental trajectories and impact children’s mental health “where it matters most”. However, the field is “grossly underrepresented” in SA, with less than 45 registered child psychiatrists in the country, with little research being done in child psychiatry in low- and middle-income countries, she says, adding that she hopes to address this by ensuring local research is done.
“There’s a mental health crisis in SA and on the continent,” Lachman says. “Mental illness is hugely stigmatised, and often under recognised, and there’s a hesitation to access care. Additionally, access to care is limited by resource constraints. There is a general lack of political willpower in SA and on the continent to face the large challenge of mental health.”
In Africa, people often “undermine or invalidate” mental health challenges because of the social stresses they face on a daily basis. “The tragedy is that mental illness is treatable if effectively managed and identified early.
“As a clinician-researcher, I hope that, by answering locally relevant and culturally important questions, I can contribute further to the field of child psychiatry in SA and Africa,” she says.
Lachman, who is president-elect of the South African Society of Psychiatrists (Sasop), is the first child psychiatrist to hold this position, which is traditionally held by adult psychiatrists. “I hope this position allows me some influence at governmental and policy levels to increase the focus on child and adolescent mental health,” she says.
“Child and adolescent psychiatry is a field in which early intervention can have the greatest outcome. There’s still potential to influence the trajectory of the life course of a child, especially when looking at infant mental health from ages zero to three. That’s the time we can optimise brain functioning, if we intervene early, and protect developing brains from adversity, mental illness and psychosocial stresses.”