From detection to utilisation Overcoming demand-side barriers to mental healthcare for children and adolescents in low- and middle-income countries

This dissertation explores how to overcome demand-side barriers to mental healthcare for children and adolescents in low- and middle-income countries (LMICs), with a focus on proactive case detection. Central to the research is the Community Case Detection Tool (CCDT, now known as ReachNow), a simple, illustrated tool developed to support trusted community members in detecting children with potential mental health needs based on everyday observations and promoting help-seeking among families.
The research was conducted as part of a broader programme by the War Child Alliance, a humanitarian organisation dedicated to supporting children and families affected by conflict. Through a combination of a systematic review and empirical studies, this dissertation evaluates the accuracy, effectiveness, and optimisation of the CCDT across diverse conflict-affected settings, including the occupied Palestinian territories, Sri Lanka, and Uganda.
Findings show that the CCDT accurately detected around three-quarters of referred children in the occupied Palestinian territories, and over two-thirds in Sri Lanka. In Uganda, its implementation led to an average 17-fold increase in service utilisation compared to standard practices. An enhanced version of the tool (CCDT+), which included data-driven supervision and motivational interviewing techniques for gatekeepers, further improved both detection accuracy and help-seeking behaviour.
Overall, the findings demonstrate that, with minimal training and a low-cost tool, community members can play a critical role in linking children to available mental health services. It also highlights the importance of addressing both demand- and supply-side barriers to close the persistent mental healthcare gap for children.