WOMEN’S UNIVERSITY IN AFRICA

Addressing gender disparity and fostering equity in University Education

FACULTY OF SOCIAL SCIENCES AND GENDER DEVELOPMENT STUDIES

SOCIO-ECONOMIC FACTORS AFFECTING THE GIRL CHILD’S ACCESS TO

MENTAL HEALTH SERVICES AT CHITUNGWIZA DEPARTMENT OF SOCIAL
DEVELOPMENT: A CASE STUDY OF ST MARY'S, CHITUNGWIZA

BY

MELISSA MILAN MDOKA

W211640

RESEARCH PROJECT SUBMITTED TO THE WOMEN’S UNIVERSITY IN

AFRICA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR
BACHELOR OF SCIENCE HONOURS IN SOCIAL WORK

SUPERVISOR: MR J SITHOLE

YEAR: 2025

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DECLARATION
I Melissa Milan Mdoka solemnly declare that the research Socio- Economic factors
affecting the girl child’s access to mental health services at Chitungwiza Department of
Social Development :A case study of St Mary’s, Chitungwiza is based on the my own
work carried out during the course of my study under the supervision of Mr J Sithole. All
sources of information and data have been acknowledged and referenced appropriately. This
work has not been submitted in whole or in part for any other academic degree or
professional qualification.

Signature................................... Date........................

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RELEASE FORM
NAME OF STUDENT : MELISSA MILAN MDOKA

STUDENT NUMBER : W211640

TITLE OF RESEARCH : SOCIO-ECONOMIC FACTORS AFFECTING THE

GIRL CHILD’S ACCESS TO MENTAL HEALTH SERVICES AT CHITUNGWIZA
DEPARTMENT OF SOCIAL DEVELOPMENT: A CASE STUDY OF ST MARY'S,
CHITUNGWIZA

DEGREE TITLE : BACHELOR OF SCIENCE HONOURS DEGREE IN

SOCIAL WORK

YEAR OF COMPLETION : 2025

Permission is hereby granted to Women’s University in Africa to produce duplicates of this

dissertation and to lend or sell such copies for private, scholarly or scientific purposes only.

iii
The author does not reserve other publication rights and neither the dissertation nor extensive
extracts from it may be printed or otherwise reproduced without the author’s consent and
written permission.

SIGNED :

DATE : 12 JUNE 2025

CONTACT DETAILS : 0783930053

HOME ADDRESS : 26 DARIRO CRESCENT ZENGEZA 3 CHITUNGWIZA

DEDICATION
To my beloved Father, the late Mr. S Mdoka though you are no longer here to see this
moment. This work is a tribute to your memory.

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ABSTRACT
This study explored how socio-economic factors influence the girl child’s access to mental
health services in Zimbabwe. To this effect, St Mary's in Chitungwiza District was selected as
this study’s location. This study’s key objectives were to assess mental health services
available for the girl child, establish socio-economic factors hindering the girl child’s access
to mental health services and finally to develop strategies towards improving the girl child’s
access to mental health services. For this academic investigation, the research used social
determinants of health (SDH) theory. Again, this study adopted the qualitative research
approach and more so, case study design informed this study. To this end, data was collected
from participants using a combined set of data collection methods including documentary
review, in-depth and key informant interviews coupled with Focus Group Discussions.
Snowball sampling was used to select the primary participants and purposive sampling was
used to select key informants. Data was analysed using thematic analysis. Mental health
assessments, awareness campaigns, counselling, case management as well as well as
psychosocial support were identified as mental health services available for the girl child.
There are socioeconomic challenges that prevent young girls from accessing mental health
services. These include lack of awareness, social stigma and discrimination, limited financial
resources and opportunity costs. Cognisant of these challenges to this end, it was
recommended that there is need for collaborative training among key stakeholders involved
in mental health service delivery, including social workers, healthcare providers, and
community organizations. Further, CSOs should continue to advocate for the rapid
development and implementation of policies that support mental health services for girls.

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TABLE OF CONTENTS
WOMEN’S UNIVERSITY IN AFRICA----------------------------------------------------------------- I

DECLARATION---------------------------------------------------------------------------------------II

RELEASE FORM-------------------------------------------------------------------------------------IV

DEDICATION-------------------------------------------------------------------------------------------V

ABSTRACT---------------------------------------------------------------------------------------------VI

CHAPTER 1----------------------------------------------------------------------------------------------1

INTRODUCTION AND BACKGROUND---------------------------------------------------------1

1.1 INTRODUCTION-----------------------------------------------------------------------------------1
1.2 BACKGROUND OF THE STUDY---------------------------------------------------------------1
1.3 STATEMENT OF THE PROBLEM-------------------------------------------------------------5
1.4 STUDY AIM------------------------------------------------------------------------------------------6
1.5 STUDY OBJECTIVES-----------------------------------------------------------------------------6
1.6 RESEARCH QUESTIONS------------------------------------------------------------------------6
1.7 JUSTIFICATION OF THE STUDY-------------------------------------------------------------6
Contribution to the Body of Knowledge----------------------------------------------------------6
Policy and Programme Development------------------------------------------------------------7
Improvement of Mental Health Interventions and Programming----------------------------7
Benefits to the Community-------------------------------------------------------------------------8
Advancement of the Social Work Profession----------------------------------------------------8
Support to NGOs and Civil Society Organisations---------------------------------------------8
1.8 DEFINITION OF KEY TERMS-----------------------------------------------------------------9
1.9 DISSERTATION STRUCTURE------------------------------------------------------------------9
1.10 CHAPTER SUMMARY-------------------------------------------------------------------------10

CHAPTER 2--------------------------------------------------------------------------------------------11

LITERATURE REVIEW----------------------------------------------------------------------------11

2.1 INTRODUCTION---------------------------------------------------------------------------------11
2.2 THEORETICAL FRAMEWORK: SOCIAL DETERMINANTS OF HEALTH
THEORY-------------------------------------------------------------------------------------------------11
2.3 MENTAL HEALTH SERVICES AVAILABLE TO THE GIRL CHILD----------------12

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 2.3.1 Crisis intervention services----------------------------------------------------------------12
2.3.2 Counselling services------------------------------------------------------------------------14
2.3.3 School-based mental health programs---------------------------------------------------15
2.3.4 Community outreach and awareness programs----------------------------------------16
2.3.5 Parent guidance and support--------------------------------------------------------------17
2.3.6 Support groups------------------------------------------------------------------------------18
2.4 SOCIO-ECONOMIC FACTORS HINDERING THE GIRL CHILD`S ACCESS TO
MENTAL HEALTH SERVICES--------------------------------------------------------------------19
2.4.1 Poverty and economic constraints--------------------------------------------------------19
2.4.2 Cultural and societal stigma--------------------------------------------------------------20
2.4.3 Limited education and awareness--------------------------------------------------------21
2.4.4 Gender discrimination---------------------------------------------------------------------22
2.4.5 Geographical accessibility and infrastructure------------------------------------------23
2.4.6 Family and household dynamics----------------------------------------------------------24
2.5 STRATEGIES TOWARDS IMPROVING THE GIRL CHILD`S ACCESS TO
MENTAL HEALTH SERVICES--------------------------------------------------------------------24
2.5.1 Training and capacity building for staff-------------------------------------------------24
2.5.2 Strengthening referral pathways----------------------------------------------------------25
2.5.3 Improving resource allocation and infrastructure-------------------------------------26
2.5.4 Enhancing community engagement and education-------------------------------------26
2.5.5 Promoting multi-sectoral collaboration-------------------------------------------------28
2.5.6 Accessibility of Services--------------------------------------------------------------------29
2.6 CHAPTER SUMMARY---------------------------------------------------------------------------30

CHAPTER 3--------------------------------------------------------------------------------------------31

RESEARCH METHODOLOGY-------------------------------------------------------------------31

3.1 INTRODUCTION---------------------------------------------------------------------------------31
3.2 RESEARCH APPROACH-----------------------------------------------------------------------31
3.3 RESEARCH DESIGN----------------------------------------------------------------------------32
3.4 STUDY LOCATION-------------------------------------------------------------------------------32
3.5 TARGET POPULATION-------------------------------------------------------------------------33
3.6 SAMPLING TECHNIQUES---------------------------------------------------------------------33
3.7 SAMPLE SIZE-------------------------------------------------------------------------------------34
3.8 METHODS OF DATA COLLECTION AND INSTRUMENTS/TOOLS----------------35

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 3.8.1 In-depth Interviews-------------------------------------------------------------------------35
3.8.2 Focus Group Discussion (FGD)----------------------------------------------------------36
3.8.3 Key informants------------------------------------------------------------------------------36
3.9 RESEARCH PROCEDURE---------------------------------------------------------------------37
3.9.1Trustworthiness------------------------------------------------------------------------------38
3.9.2 Credibility-----------------------------------------------------------------------------------38
3.9.3 Transferability------------------------------------------------------------------------------38
3.9.4 Dependability-------------------------------------------------------------------------------38
3.9.5 Conformability------------------------------------------------------------------------------38
3.10 DATA ANALYSIS METHOD------------------------------------------------------------------39
3.11 ETHICAL CONSIDERATION----------------------------------------------------------------39
3.11.1 Seeking Permission------------------------------------------------------------------------40
3.11.2 Informed Consent--------------------------------------------------------------------------40
3.11.3 Confidentiality and anonymity-----------------------------------------------------------40
3.11.4 No Harm------------------------------------------------------------------------------------40
3.12 STUDY LIMITATIONS-------------------------------------------------------------------------41
3.13 STUDY DELIMITATIONS---------------------------------------------------------------------41
3.14 CHAPTER SUMMARY-------------------------------------------------------------------------41

CHAPTER 4--------------------------------------------------------------------------------------------42

DATA PRESENTATION, ANALYSIS AND DISCUSSION---------------------------------42

4.1 INTRODUCTION---------------------------------------------------------------------------------42
4.2 DEMOGRAPHIC CHARACTERISTICS OF STUDY PARTICIPANTS----------------42
4.3 MENTAL HEALTH SERVICES OFFERED AT THE DEPARTMENT OF SOCIAL
DEVELOPMENT CHITUNGWIZA----------------------------------------------------------------44
4.3.1 Mental Health Assessments----------------------------------------------------------------44
4.3.2 Awareness Campaigns---------------------------------------------------------------------45
4.3.3 Counseling Services------------------------------------------------------------------------46
4.3.4 Case Management--------------------------------------------------------------------------47
4.3.5 Psychosocial Support-----------------------------------------------------------------------48
4.4 SOCIO-ECONOMIC FACTORS HINDERING ACCESS TO SERVICES AMONG
GIRLS IN CHITUNGWIZA--------------------------------------------------------------------------49
4.4.1 Lack of Awareness--------------------------------------------------------------------------49
4.4.2 Social Stigma and Discrimination--------------------------------------------------------51

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 4.4.3 Limited Financial Resources--------------------------------------------------------------51
4.4.4 Opportunity Costs---------------------------------------------------------------------------52
4.5 STRATEGIES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AMONG
GIRLS IN CHITUNGWIZA--------------------------------------------------------------------------53

4.5.1 COMMUNITY ENGAGEMENT------------------------------------------------------------53

4.5.2 Strengthening collaborations and partnership------------------------------------------54

4.5.3 Increasing online presence of support services-----------------------------------------55
4.6 CHAPTER SUMMARY---------------------------------------------------------------------------56

CHAPTER 5--------------------------------------------------------------------------------------------57

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS------------------------------57

5.1 INTRODUCTION---------------------------------------------------------------------------------57
5.2 SUMMARY OF STUDY FINDINGS-----------------------------------------------------------57
5.3 CONCLUSIONS-----------------------------------------------------------------------------------59
5.4 IMPLICATIONS ON SOCIAL WORK--------------------------------------------------------60
5.5 RECOMMENDATIONS--------------------------------------------------------------------------61
5.5.1 The role of government---------------------------------------------------------------------62
5.5.2 The role of Civil Society Organizations--------------------------------------------------62
5.5.3 The role of the community-----------------------------------------------------------------63
5.5.4 The role of education institutions---------------------------------------------------------63
5.6 AREAS FOR FUTURE STUDIES-------------------------------------------------------------63
5.7 CHAPTER SUMMARY---------------------------------------------------------------------------64

REFERENCE LIST-----------------------------------------------------------------------------------65

APPENDICES------------------------------------------------------------------------------------------70

APPENDIX 1: CONSENT FORM FOR PARTICIPATION IN RESEARCH STUDY----70

APPENDIX 2: SEMI-STRUCTURED INTERVIEW GUIDE FOR GIRL CHILD
PARTICIPANTS---------------------------------------------------------------------------------------72
APPENDIX 3: KEY INFORMANT INTERVIEW GUIDE-------------------------------------74
APPENDIX 4: FOCUS GROUP DISCUSSION GUIDE---------------------------------------76

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10
CHAPTER 1

INTRODUCTION AND BACKGROUND

1.1 INTRODUCTION
The mental health of children, particularly girls, has become an increasingly critical concern
in both developed and developing nations. This study focuses on how socio-economic factors
influence the girl child’s access to mental health services at Chitungwiza’s Department of
Social Development. It explores the availability of mental health services, socio-economic
barriers that limit access, and possible strategies to improve service uptake. This chapter
provides a background to the study from global, regional, and local perspectives, followed by
a clear statement of the problem, overall aim of the study, research objectives and questions.
It also outlines the justification, definitions of key terms, and the structure of the entire
dissertation.

1.2 BACKGROUND OF THE STUDY

Adolescent mental health has emerged as a critical global public health concern, with a
significant proportion of young people experiencing mental health disorders. The World
Health Organization (2021) reports that approximately one in seven adolescents aged 10 to
19 years experiences a mental health disorder with depression, anxiety and behavioral
disorders being the leading causes of illness and disability in this age group. Notably, girls
are disproportionately affected often exhibiting higher rates of internalizing disorders such as
anxiety and depression (Freeman, 2022). In Europe and Central Asia, a WHO survey
revealed that about a quarter of 15 year old girls reported feeling lonely most of the time or
always in the past year compared to about one in seven boys. Similarly, in the United
Kingdom, emergency hospital admissions for children with mental health problems increased
by 65% over a decade with significant rises in self-harm and eating disorders among 5 to 18-
year olds especially girls aged 11 to 15 years. These trends highlight the pressing need for
gender-sensitive mental health services globally.

In Asia, cultural stigma and limited access to mental health services pose significant barriers
to care for adolescents. A study by Lee et al. (2023) found that in countries like China, India
and Vietnam, less than 5% of adolescents with mental health issues sought formal help, with
girls being more likely to seek informal support from friends or family rather than
professional services. This reluctance is often rooted in cultural norms that discourage open
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discussions about mental health particularly for girls who may face additional societal
pressures and expectations. In Japan, despite accessible mental health care, social stigma and
a tendency to delay seeking care contribute to the underutilization of services among
adolescents (Saito et al., 2022). These challenges highlight the need for culturally sensitive
interventions that address the unique barriers faced by adolescent girls in accessing mental
health care.

In United States of America, mental health challenges among adolescent girls are exacerbated
by cultural pressures and systemic barriers. Latina teens have higher rates of suicide attempts
compared to their non-Latina tends often due to cultural expectations, traditional gender roles
and immigrant family pressures (Gonzalez et al., 2021). Stigma and limited access to
healthcare further hinder mental health support within these communities. In Canada,
indigenous adolescent girls face elevated risks of mental health issues including depression
and substance abuse linked to historical trauma and ongoing social inequalities (Smith et al.,
2020).

In southern Africa, adolescent mental health services are often under-resourced and face
significant challenges in accessibility and cultural acceptance. In South Africa, while primary
mental healthcare is available, higher-level care is hindered by means testing, language
barriers and discrimination (Mkhize, 2022). These systemic issues disproportionately affect
adolescent girls who may face additional challenges in accessing care due to gender-based
discrimination. In Botswana and Namibia, mental health services are primarily centralized in
secondary hospitals and specialized facilities with limited resources allocated to other levels
of care, especially at the community level (Dube et al, 2021). This centralization creates
barriers for adolescent girls in rural areas who may lack the means to travel to urban areas for
care. Also cultural beliefs and stigma surrounding mental health can discourage girls from
seeking help, further exacerbating the treatment.

In Zambia, child and adolescent mental health services are underdeveloped, with a severe
shortage of specialized professionals and poor integration of services into primary healthcare
(Chanda et al., 2020). The lack of coordinated inter-sectoral collaboration and formal referral
pathways hinders the delivery of effective mental health care to adolescents. Girls, in
particular, may be affected by these systemic shortcomings, as they are often more vulnerable
to mental health issues due to societal pressures and gender-based violence. In Malawi,
cultural stigma and limited awareness about mental health contribute to low utilization of

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services among adolescents, especially girls (Phiri et al., 2019). Efforts to integrate mental
health education into school curricula and community programs are underway but require
sustained support and resources to be effective.

In Lesotho, mental health services are limited, with few trained professionals and inadequate
infrastructure to support adolescent mental health needs. Girls facing mental health
challenges often rely on informal support systems, such as family or religious leaders, due to
the lack of accessible formal services (Molefe et al., 2018). This reliance on informal support
can delay or prevent access to appropriate care, leading to worsening mental health outcomes.
According to Nyandoro (2020), regional disparities in mental health service provision
highlight the need for comprehensive strategies that address both systemic barriers and
cultural factors influencing adolescent girls' access to mental health care in Southern Africa.

In Zimbabwe, mental health services for children and adolescents are underreported, suffer
from a lack of reliable data, remain stigmatized, and are rarely acknowledged (UNICEF
Zimbabwe, 2021). Challenges to mental health, including depression, anxiety, and suicide,
continue to be misunderstood and associated with negative connotations. Recent research
indicates that mental health-related morbidity and mortality are increasing in Zimbabwe, with
anxiety disorders estimated to affect 2.8% of the population and accounting for 4% of total
years lived with disability. However, these figures may be underestimated due to
underreporting and stigma. A population-based study in Harare and Mashonaland East found
that 37.4% of young people aged 13-24 screened positive for probable common mental
disorders (CMDs), with 11.2% reporting suicidal ideation. These findings highlight the
significant mental health challenges faced by Zimbabwean youth.

The origins of the problem in Zimbabwe can be traced back to the socio-economic crises that
followed the economic downturn in the early 2000s. The collapse of public health
infrastructure and social safety nets disproportionately affected women and children,
especially girls. Over the years, the situation has worsened due to persistent economic
challenges, inflation, school disruptions, and family disintegration due to migration and
HIV/AIDS-related deaths (UNDP Zimbabwe, 2022; Save the Children, 2021; Ministry of
Health and Child Care, 2022). While the government and civil society actors have initiated
programs such as the Friendship Bench and community-based support models, these
interventions have largely targeted adults, with limited focus on adolescent girls’ unique
needs.

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Mental health services for adolescents in Zimbabwe are severely underdeveloped, with very
limited integration of these services into schools, community settings, or primary healthcare
structures (Chikadzi, 2022; Mafa & Makufa, 2021). Girls in particular face structural,
economic, and cultural barriers in accessing mental healthcare, often leading to delayed
treatment or complete neglect of mental health needs. According to Mupambireyi et al.
(2021), adolescent girls in peri-urban and rural settings are more vulnerable to gender-based
violence, early pregnancies, and stigma, which are strong predictors of anxiety and
depression. Despite national policy documents like the Zimbabwe National Mental Health
Strategy (2019–2023), actual implementation on the ground remains limited due to budget
constraints and weak intersectoral coordination (MoHCC, 2021). Furthermore, mental health
is not yet prioritized in the educational curriculum or public health messaging, which leaves
adolescents, especially girls, with minimal knowledge or awareness of available services and
how to access them.

Evidence from urban areas like Harare and Bulawayo indicates an increase in psychosocial
distress among girls due to poverty, family breakdown, and the socio-economic aftermath of
the COVID-19 pandemic (Chikukwa & Nhapi, 2023). In informal settlements and high-
density suburbs, overcrowding, food insecurity, and lack of recreational space further
compound mental health stressors among adolescent girls. A study by Gumbo et al. (2022)
showed that more than 60% of adolescent girls in Mbare and Epworth reported symptoms
consistent with post-traumatic stress and depression, yet less than 10% had ever interacted
with a trained mental health professional. This disconnect between need and service
provision points to a significant mental health treatment gap. NGOs such as the Friendship
Bench have made strides in community-based care, particularly through lay health workers,
but their services remain concentrated in specific areas, leaving a large portion of adolescent
girls underserved (Chibanda et al., 2021).

In rural areas like Uzumba-Maramba-Pfungwe (UMP), Binga, and Mutoko, adolescent girls
face unique mental health challenges related to traditional beliefs, harmful cultural practices,
and extreme poverty (Mutanana, 2021; Mawere & Madzokere, 2022). Early marriages,
sexual exploitation, and limited education opportunities have a direct correlation with poor
mental health outcomes, including depression and suicidal ideation. Moreover, caregivers and
traditional leaders often lack awareness of adolescent mental health, perpetuating stigma and
attributing symptoms to spiritual causes (Chikadzi, 2022). The absence of school-based
counselling services or mental health professionals at local clinics means that adolescent girls

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suffering from emotional or psychological distress are frequently left untreated. These
realities demonstrate the need for a multi-pronged, culturally grounded approach that brings
mental health services closer to girls in both rural and urban communities and addresses
underlying social determinants. Until such systemic changes are made, Zimbabwe's
adolescent girls will continue to face disproportionate mental health burdens with limited
pathways to recovery and resilience.

In Chitungwiza, a densely populated urban settlement, socio-economic hardships are

particularly acute. Unemployment, overcrowding, child-headed households, and high school
dropout rates expose girls to multiple stressors that increase their vulnerability to mental
health problems. A local baseline assessment by Child line Zimbabwe (2022) indicated that
up to 40% of girls in Chitungwiza’s public schools reported feeling persistently sad or
hopeless, but very few accessed counselling or psychiatric services. Reports from the
Department of Social Development reveal that while some psychosocial services exist, they
are not gender-responsive, nor are they adequately funded or known to the community.
Cultural taboos around mental illness and limited parental education also mean that girls are
rarely referred for help, allowing conditions to worsen unchecked (Zimbabwe Human Rights
Commission, 2023; Musasa Project, 2023; Department of Social Welfare, 2022).

1.3 STATEMENT OF THE PROBLEM

Despite the fact that every girl child should have equitable, timely, and confidential access to
comprehensive mental health services that cater to her emotional, psychological, and social
well-being, the girl child remains disproportionately excluded from mental health care due to
layered socio-economic barriers such as poverty, gender discrimination, lack of transport,
school dropouts, stigma, and limited awareness of mental health issues. National data reveals
that approximately 75% of Zimbabweans with mental health conditions do not receive the
treatment they need, with adolescent girls being among the most affected (MoHCC, 2021).
The existing gap between the expected inclusive provision of mental health services and the
actual exclusion of the girl child due to socio-economic barriers constitutes the central
problem under investigation. Efforts have been made through initiatives like the National
Mental Health Strategy (2019–2023) and NGO-led projects like the Friendship Bench and
Zvandiri Programme; however, these are often urban-biased, under-resourced, and not
specifically tailored to the needs of adolescent girls. Most programs fail to address deeply
embedded socio-economic constraints or do not have sustainable community-level outreach
in peri-urban areas like St Mary's, Chitungwiza. Consequently, a significant service delivery

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and policy-practice gap exists, where the girl child’s mental health needs are overlooked.
This study seeks to investigate these gaps and contribute evidence that can inform more
inclusive, contextually grounded strategies to enhance mental health access for the girl child
in St Mary's, Chitungwiza.

1.4 STUDY AIM

The study aims to explore how socio-economic factors influence the girl child’s access to
mental health services in St Mary’s.

1.5 STUDY OBJECTIVES

1. To assess the mental health services available for the girl child in St Mary’s.

2. To establish the socio-economic factors hindering the girl child’s access to mental health
services in St Mary’s.

3. To develop strategies towards improving the girl child’s access to mental health services in
St Mary’s.

1.6 RESEARCH QUESTIONS

1. What mental health services are currently available for the girl child in St Mary’s?

2. What socio-economic factors hinder the girl child’s access to these services?

3. What strategies can be adopted to improve the girl child’s access to mental health services?

1.7 JUSTIFICATION OF THE STUDY

The study also offers critical insights for non-governmental organizations and civil society
actors working in areas of child protection, mental health, education, and gender equity.
Organizations such as Childline Zimbabwe, the Zimbabwe National Council for the Welfare
of Children (ZNCWC), and the Musasa Project can use the findings to design more targeted
interventions for adolescent girls in peri-urban areas. This includes creating focused outreach
programmes, gender-specific awareness campaigns, and strengthened referral mechanisms
between schools, communities, and health institutions. The study can also be used as a
credible evidence base for grant applications and donor engagement, highlighting the urgency
of addressing the socio-economic barriers to mental health access. Also it promotes
partnerships between governmental and non-state actors to develop inclusive, community-
based mental health systems that prioritize the needs of girls.

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Contribution to the Body of Knowledge
This study makes a significant contribution to the existing body of knowledge by addressing
a relatively underexplored area in Zimbabwean research: how socio-economic factors
specifically affect the girl child’s access to mental health services, particularly in peri-urban
settings such as St Mary’s, Chitungwiza. While existing literature discusses adolescent
mental health more generally, few studies isolate gender-specific barriers or contextualize
them within the socio-economic realities of low-income, urban-fringe populations (Chikadzi,
2022; Mupambireyi et al., 2021). By unpacking the intersection of poverty, gender, cultural
expectations, and access to mental health services, this study bridges a critical knowledge gap
often overlooked in broader studies (Mutanana, 2021; Chibanda et al., 2020). It offers
grounded, empirical insights into the lived realities of adolescent girls, which can serve as a
foundation for future research and stimulate interdisciplinary dialogue across fields such as
psychology, sociology, education, and gender studies.

Policy and Programme Development

The findings from this research have the potential to inform and refine mental health policies
that are more inclusive, gender-responsive, and contextually relevant. Although Zimbabwe’s
National Mental Health Strategy (2019–2023) outlines goals for improving access, it does not
adequately address the socio-economic constraints that uniquely hinder the girl child’s ability
to access these services in marginalised communities (MoHCC, 2021). This study sheds light
on critical barriers such as economic dependency, household instability, and lack of parental
support factors often absent from national mental health frameworks (Mafa & Makufa, 2021;
Gumbo et al., 2022). The findings can influence the decentralisation of mental health
services, integration of psychosocial support into schools, and strengthening of intersectoral
collaboration with social protection systems. Additionally, the research can support gender-
responsive budgeting and inform legislative reforms that ensure mental health equity for
vulnerable populations.

Improvement of Mental Health Interventions and Programming

This study can guide the design of more effective, inclusive mental health interventions for
adolescent girls in low-income contexts like St Mary’s. Many existing interventions adopt a
one-size-fits-all approach, often overlooking the gendered nature of mental health
experiences and the socio-economic challenges that hinder service uptake. Thus by
generating context-specific evidence, this research provides practical recommendations for
programme implementers, such as improving financial accessibility, ensuring cultural

7
sensitivity, and strengthening community engagement strategies. Furthermore, the findings
can inform the development of monitoring and evaluation tools that track gender-specific
outcomes, as well as provide relevant content for training mental health professionals in
gender-sensitive and culturally competent service delivery.

Benefits to the Community

In alignment with the principles of Education 5.0 which emphasize innovation, research, and
community engagement this study is designed to promote socially responsive action. By
involving adolescent girls and key community stakeholders in identifying barriers and co-
creating solutions, the research empowers the St Mary’s community to take an active role in
improving access to mental health services. The process amplifies the voices of adolescent
girls and promotes a sense of agency among families and caregivers (Mawere & Madzokere,
2022). Beyond academic output, the study can generate community-based awareness, reduce
stigma, and build local capacity through knowledge-sharing initiatives. In doing so, it
connects academic inquiry with real-world social transformation, ensuring that research
outcomes translate into tangible improvements for the community.

Advancement of the Social Work Profession

This research contributes valuable practice-based evidence that strengthens the social work
profession’s commitment to advocacy, equity, and holistic service delivery for adolescent
girls. It aligns with social work’s core values dignity, service, and social justice by
spotlighting a vulnerable group whose mental health needs are often overlooked in both
policy and practice. The findings can help social workers refine their assessment tools, design
more inclusive intervention models, and adopt preventive strategies that address structural
determinants of mental health. Additionally, the study underscores the importance of the
social worker’s role in multidisciplinary teams, especially in contexts such as community
education, school-based counselling, and policy advocacy in areas like St Mary’s.

Support to NGOs and Civil Society Organisations

The study also offers critical insights for non-governmental organisations and civil society
actors working in areas of child protection, mental health, education, and gender equity.
Organisations such as Childline Zimbabwe, the Zimbabwe National Council for the Welfare
of Children (ZNCWC), and the Musasa Project can use the findings to design more targeted
interventions for adolescent girls in peri-urban areas. This includes creating focused outreach
programmes, gender-specific awareness campaigns, and strengthened referral mechanisms

8
between schools, communities, and health institutions. The study can also be used as a
credible evidence base for grant applications and donor engagement, highlighting the urgency
of addressing the socio-economic barriers to mental health access. Moreover, it promotes
partnerships between governmental and non-state actors to develop inclusive, community-
based mental health systems that prioritise the needs of girls.

1.8 DEFINITION OF KEY TERMS

Social Work practice: is a practice based profession designed to enhance individuals’
functioning through their knowledge of human behaviour and enhance people’s full potential,
and to allow them to cope up with daily stressors in a health way; being guided by values of
social justice and service above self among others (NASW, 2008).

Adolescent Girl: For the purposes of this study, an adolescent girl refers to any female
individual aged between 12 and 18 years, as defined by the World Health Organization
(2021), undergoing the critical transitional stage between childhood and adulthood, marked
by physical, emotional, and psychological development.

Mental health services: These refer to interventions, programs, or institutional services

provided to diagnose, treat, or manage mental health disorders. This includes school-based
counselling, community outreach programs, social work support, psychiatric care, and
psychological therapy provided by licensed professionals (Chibanda et al., 2020).

Socio-economic factors: This term encompasses the various social and economic conditions
that influence individual and community access to health services. These include but are not
limited to income levels, parental employment status, housing conditions, educational
attainment, and access to transportation and healthcare facilities (Mutanana, 2021).

Access: In this context, access refers to the ability of adolescent girls to obtain, afford, and
effectively utilize mental health services when needed. It considers dimensions such as
availability, affordability, cultural acceptability, and geographical proximity (Gumbo et al.,
2022).

Barriers: These are obstacles which are economic, social, cultural, or institutional that
prevent adolescent girls from utilizing mental health services (Chikadzi, 2022).

1.9 DISSERTATION STRUCTURE

This dissertation constitutes fives chapters, that is, chapter one to chapter five in their
chronological order. Chapter one focuses on the introduction and background to the study

9
followed by chapter two which focuses on literature review and a theoretical framework
informing the study. Accordingly, this chapter three which provides the study methodology.
Just after chapter three is chapter four which focuses on data presentation, analysis and
discussion. Finally, there is chapter five that offers a summary of study findings, conclusions
which were drawn from the findings of the study, recommendations, the study implications in
relation to social work practice coupled with the areas for future studies.

1.10 CHAPTER SUMMARY

This chapter has introduced the study so as to establish the research context. The background
to the study, statement of the problem, study aim, objectives coupled with research questions,
justification of the study, the definition of key terms, delimitations of the study have all been
clearly presented. The following chapter therefore, shall provide a brief review of this
research’s related literature while informed and guided by this study’s key objectives.

10
CHAPTER 2

LITERATURE REVIEW
2.1 INTRODUCTION
This chapter presents a review of relevant literature on the discourse of mental health with
much accentuation or stress on socio-economic factors affecting the girl child’s access to
mental health services. The purpose of this chapter is to explore what other researchers have
said about the topic, while identifying gaps that this study aims to address. The theoretical
framework informing the study shall also be outlined in this chapter. Thereafter, an in-depth
review of related literature is done at global, regional and national levels in respect to the
objectives of this study. The review is guided by the study’s three objectives: to assess mental
health services available, to explore socio-economic barriers affecting girls’ access to these
services, and to develop strategies that can improve their access.

2.2 THEORETICAL FRAMEWORK: SOCIAL DETERMINANTS OF HEALTH THEORY

The Social Determinants of Health (SDH) theory was adopted. It is a comprehensive
framework that explains how societal factors beyond biological or individual behaviours
significantly shape health outcomes. The theory was prominently established by the World
Health Organization (WHO) through the Commission on Social Determinants of Health,
chaired by Sir Michael Marmot in 2008. According to Marmot et al. (2008), health disparities
among different populations stem largely from social inequities embedded in everyday living
conditions rather than clinical health care alone. These determinants include income levels,
access to education, employment opportunities, housing conditions, social inclusion, and
availability of health services (Solar & Irwin, 2010).

Central to the SDH theory is the idea that health is socially produced and health inequalities
are avoidable and unjust (Raphael, 2011). The framework outlines several core pillars:
economic stability, access to quality education, health care access, social and community
context, and neighborhood environments (Braveman & Gottlieb, 2014). These pillars interact
to create social hierarchies and unequal health outcomes. The theory further promotes the
“upstream approach,” where efforts are focused on addressing root causes of ill health, such
as poverty and discrimination, rather than merely managing symptoms or outcomes (Marmot
& Bell, 2012). It emphasises a whole-of-society approach, encouraging collaboration
between sectors like health, education, housing, and social services to promote equity. The
SDH framework has also been endorsed by contemporary public health scholars such as
11
Dahlgren and Whitehead (2006), who conceptualized health as a product of layered
influences from individual lifestyle factors to wider socio-economic, cultural, and
environmental conditions. These insights show that health policies must tackle broader
determinants such as low income, marginalisation, and lack of services, which
disproportionately affect vulnerable groups, including girls and young women in low-
resource settings.

The SDH theory is well aligned with the aims of this study, which explores how socio-
economic factors impact the girl child’s access to mental health services. The first objective
of the study, which assesses available mental health services, can be understood through the
lens of health care accessibility one of the key pillars of the SDH framework. According to
Braveman et al. (2011), structural barriers such as limited infrastructure, poor service
distribution, and low public health funding contribute to reduced access to quality mental
health care. These barriers are particularly pronounced in low-income urban communities,
where girls may face double vulnerability due to both gender and poverty.

The second objective to explore socio-economic hindrances finds direct resonance with the
pillars of economic stability, education, and social context. For instance, the lack of financial
resources in households often prioritises other needs over mental health care, which is still
largely stigmatised and misunderstood (Lund et al., 2010). Inadequate education and mental
health literacy among caregivers and girls themselves further exacerbate the situation. These
determinants reflect the SDH theory's stance that social conditions not only affect whether
individuals seek care but also shape their overall mental health outcomes (Marmot & Allen,
2014).

Finally, in proposing strategies to improve access, the SDH framework offers a blueprint for
multi-sectoral intervention. It suggests the need to promote education, address income
inequalities, and strengthen the health system’s responsiveness to vulnerable populations
(Raphael, 2011; Braveman & Gottlieb, 2014). Thus, this theory not only explains the origins
of the problem but also supports transformative strategies to address it holistically, especially
for underrepresented groups like the girl child.

2.3 MENTAL HEALTH SERVICES AVAILABLE TO THE GIRL CHILD

2.3.1 Crisis intervention services
In Europe, countries like Germany have developed robust crisis intervention services that are
designed to address mental health emergencies (Harten et al., 2018). These services are

12
typically structured around 24/7 emergency hotlines, immediate face-to-face counselling, and
mobile crisis teams, which can provide on-the-spot support in urgent situations. Research
indicates that these services are particularly effective in mitigating the risk of mental health
crises escalating and ensuring that individuals receive timely care. In the United States,
programs like the Crisis Intervention Team (CIT) model have been used to help individuals in
mental health crises receive immediate care while preventing unnecessary involvement with
law enforcement (Bachman et al., 2019). These services typically focus on trauma-informed
care, which is essential when addressing the needs of young girls who may have experienced
abuse or trauma. Crisis intervention services are increasingly being incorporated into
community-based mental health programs. These services are designed to provide immediate
assistance to children and adolescents in distress, including those experiencing trauma or
violence (Pillay & Dube, 2018). South African initiatives such as the 24/7 national helpline
for children in crisis aim to ensure that young people can access help whenever necessary.
These services have shown effectiveness in stabilizing youth in acute distress, but research
suggests that the availability and accessibility of these services can vary widely, with urban
areas receiving better attention compared to rural or peri-urban regions.

According to Chiweshe et al. (2019), the Department of Social Development in Zimbabwe

provides mental health crisis intervention through hotlines, community outreach, and in-
person support, which is critical for managing cases of abuse, neglect, and other acute mental
health issues. These services are designed to provide immediate relief and connect
individuals with longer-term care. They have been shown to play a significant role in
managing mental health crises effectively, especially when immediate intervention can
prevent further harm. Mlambo & Nyoni (2019) found that the Zimbabwean government,
alongside NGOs, has been working to improve mental health crisis intervention services,
with a focus on enhancing accessibility for all children. This includes setting up child-
friendly spaces in health and community centers where children, including girls, can access
crisis services. However, this provision still lacks widespread outreach, especially in peri-
urban areas like Chitungwiza. While crisis intervention services in Zimbabwe are well-
established, there is limited research into how these services cater to the specific needs of the
girl child. Much of the existing literature focuses on general mental health interventions
without disaggregating services by gender. This study will fill this gap by exploring the
availability of crisis intervention services for girls in St Mary's,Chitungwiza, examining their

13
effectiveness, and suggesting improvements to ensure these services meet the unique needs of
girls in mental health crises.

2.3.2 Counselling services

Counseling is one of the most widely available and effective mental health services offered to
children, including girls, worldwide. It provides a safe space for individuals to talk about
their emotional struggles, trauma, or mental health challenges and receive professional
guidance. A study by Wheeler & McKay (2017) in the United States emphasizes the
importance of school-based counseling programs, which are accessible to girls in urban and
suburban areas. These programs help address emotional distress due to sexual abuse,
bullying, family breakdown, and other traumatic events. In the United Kingdom, gender-
specific counseling services have been designed to support girls who have been victims of
domestic violence or sexual abuse. A study by Richards et al. (2019) found that counseling
interventions for adolescent girls helped improve their emotional regulation and reduce
anxiety and depression after traumatic experiences. However, despite the positive outcomes,
these services are often limited in scope, and a lack of culturally sensitive counseling
practices can hinder their effectiveness for girls from marginalized communities (Wheeler &
McKay, 2017).

In South Africa, counseling services provided by both governmental and non-governmental

organizations aim to address the mental health needs of girls who have experienced trauma,
abuse, and violence. Research by Shumba & Sithole (2017) found that counseling programs
offered by NGOs such as Childline South Africa provide essential emotional support to girls
in the aftermath of trauma, particularly sexual violence. A study by Chibanda et al. (2016)
found that girls who were provided with individual and group counseling in school and
community settings exhibited improved mental health outcomes. These services aim to
provide not only psychological support but also a sense of empowerment for girls facing
trauma. According to Masimba & Gondo (2020), the Department of Social Development in
Zimbabwe offers counseling services to children, including girls, who have experienced
trauma, such as abuse, neglect, or family breakdown. These services are available at
community centers and through outreach programs targeting vulnerable populations. Despite
the recognition of counseling as a critical mental health service for girls, there are still several
gaps in the literature concerning its availability, accessibility, and effectiveness, particularly
in peri-urban and rural settings. Many studies focus on urban areas, where resources are more
readily available, and there is limited research on how counseling services are delivered to

14
girls in under-resourced areas such as Chitungwiza. This study seeks to fill these gaps by
assessing the current counseling services available for the girl child in St Mary's,
Chitungwiza.

2.3.3 School-based mental health programs

According to a study by Weist et al. (2017) in the United States, school-based mental health
programs have been shown to be highly effective in providing early intervention services,
which are crucial for children facing mental health challenges. These programs often involve
school counselors who offer individual and group therapy, as well as psychoeducation on
mental health topics. For the girl child, school-based programs have proven to be especially
beneficial in addressing gender-specific issues such as bullying, sexual harassment, and
emotional abuse. A study by Ottem et al. (2019) in Norway emphasized the growing need for
specialized mental health services for girls in schools, particularly in response to increasing
rates of anxiety and depression among adolescent girls. These services include counseling,
mental health education, and stress management programs designed to help students navigate
the pressures of school and adolescence. A study by Mhlongo et al. (2018) found that schools
offering mental health services, such as counseling and peer support programs, helped reduce
the stigma surrounding mental health issues, making it easier for girls to seek help. These
programs also focus on providing psycho-social support to girls who may have experienced
trauma, including sexual violence and domestic abuse.

According to a study by Gomo & Chikodzi (2018), several schools in Harare and other major
cities have integrated counseling services and mental health education into their curricula,
aiming to support students' emotional well-being. These programs offer counseling services,
life skills training, and peer support groups, which help address mental health challenges such
as anxiety, depression, and stress. For the girl child, these programs have been particularly
useful in addressing gender-based violence, school bullying, and the pressures of academic
achievement. However, the study found that these programs are not uniformly available
across all schools in Zimbabwe, and schools in peri-urban and rural areas often lack the
resources to implement them effectively. Nyabadza (2019) highlights the growing
recognition in Zimbabwe of the importance of mental health services within schools,
particularly for adolescent girls. However, despite the recognition, there are significant
barriers to implementing school-based mental health programs. These barriers include
inadequate funding, lack of trained counselors, and limited public awareness about mental
health. The literature reveals several key gaps in the availability and effectiveness of school-

15
based mental health programs for girls. While these programs have shown positive outcomes
in urban areas, their accessibility in peri-urban areas, like Chitungwiza, remains a significant
challenge. This study seeks to fill these gaps by exploring the current state of school-based
mental health programs in Chitungwiza, assessing their effectiveness in meeting the needs of
the girl child, and identifying the barriers to their implementation and accessibility in the
area.

2.3.4 Community outreach and awareness programs

According to the World Health Organization (WHO, 2013), community-based mental health
programs have proven effective in raising awareness about mental health issues and reducing
stigma, especially in marginalized communities. These programs play an essential role in
educating families and communities about the signs and symptoms of mental health disorders
in children, including anxiety, depression, and trauma, which disproportionately affect girls.
A study by Patel et al. (2018) in India found that community outreach programs focusing on
mental health awareness were successful in encouraging parents, teachers, and community
leaders to recognize mental health problems early and seek appropriate interventions. For the
girl child, these programs are especially important as they address not only mental health
concerns but also gender-related issues such as early marriages, gender-based violence, and
discrimination. Patel et al. (2018) noted that such programs can help prevent these issues
from escalating into more severe mental health problems. According to Bryant et al. (2016),
awareness programs aimed at schools and communities help reduce stigma and encourage the
early detection of mental health disorders among young girls. These programs often include
activities such as workshops, seminars, and media campaigns that educate the public on the
importance of mental health care. Bryant et al. (2016) found that when these programs are
tailored to address the unique challenges faced by girls, such as bullying or body image
issues, they are more successful in improving mental health outcomes.

According to a study by Nyatsanza et al. (2020), community-based programs aimed at raising

awareness about mental health issues have helped to reduce stigma and encourage early
intervention, particularly in rural and peri-urban areas like Chitungwiza. Nyatsanza et al.
(2020) noted that such programs have been particularly successful in addressing issues such
as gender-based violence and trauma, which can lead to significant mental health problems in
girls. However, the study also found that while these programs are effective in raising
awareness, there is still a significant gap in the availability of mental health services to
support the girl child once they seek help. The literature reveals several gaps in community

16
outreach and awareness programs aimed at improving mental health care for the girl child.
While such programs have been successful in raising awareness and reducing stigma, many
girls still face significant barriers to accessing formal mental health services, including the
lack of specialized care, financial constraints, and cultural stigma. This study seeks to fill
these gaps by assessing the effectiveness of community outreach programs in St Mary's
Chitungwiza and identifying strategies to enhance their impact on the mental health of girls.

2.3.5 Parent guidance and support

According to the American Psychological Association (APA, 2019), parental involvement in
a child's mental health treatment leads to better outcomes in managing mental health
disorders such as depression, anxiety, and trauma. Parental support provides the girl child
with a safe, supportive environment where mental health issues can be addressed openly and
effectively. Research by Fox et al. (2020) in the United States shows that when parents are
actively involved in their children’s mental health care, they not only help children
understand their emotions but also model healthy coping mechanisms. This type of parental
guidance is particularly crucial for girls, as they often face gender-specific pressures such as
body image issues, academic stress, and sexual harassment, all of which can contribute to
mental health challenges. Fox et al. (2020) emphasized that psychoeducation for parents is
essential to guide them on how to support their children effectively, particularly during
adolescence when girls are more vulnerable to mental health issues. According to a study by
Naidoo et al. (2017) in South Africa, parental involvement plays a central role in identifying
mental health issues early and supporting children through treatment. In this study, girls who
had active parental support were more likely to engage in therapy and take prescribed
medications for mental health conditions such as depression and anxiety.

Naidoo et al. (2017) found that when parents are equipped with knowledge about mental
health, they are more capable of providing emotional support to their children. A study by
Nyamukondiwa & Machingura (2017) in Zimbabwe found that parental involvement in
mental health treatment significantly improves the well-being of adolescent girls. The study
noted that girls in Zimbabwe, especially in urban areas like Chitungwiza, benefit from active
parental support that encourages them to engage in counseling and other therapeutic
interventions. The research highlighted the importance of educating parents about mental
health and providing them with tools to help manage mental health issues in their children.
However, Nyamukondiwa & Machingura (2017) also acknowledged that many parents still
lack awareness of mental health issues, often leading to denial or underreporting of

17
symptoms. This lack of awareness makes it difficult for girls to receive the help they need
early, often delaying intervention until the mental health problem becomes more severe.
Despite the critical role that parental guidance and support play in the mental health of the
girl child, several gaps remain in the existing literature. While studies have shown that
parental involvement improves mental health outcomes, there is limited research on how
specific parental attitudes, such as cultural beliefs and socioeconomic status, impact their
ability to support their children's mental health. This study seeks to fill these gaps by
investigating how parental guidance and support impact the mental health of the girl child in
St Mary's ,Chitungwiza.

2.3.6 Support groups

In the United States, a study by Garrison et al. (2019) highlighted the significant benefits of
support groups for adolescent girls facing mental health challenges. Their research found that
support groups provide a safe environment where girls can express their feelings, connect
with others experiencing similar struggles, and develop coping mechanisms. According to
Garrison et al. (2019), the most effective support groups are those led by trained facilitators,
often mental health professionals, who guide the group towards healthy discussions and
strategies for managing mental health. Girls participating in support groups were reported to
show improvements in self-esteem, emotional regulation, and overall mental well-being.
Such groups also reduce feelings of isolation, a common experience among girls dealing with
issues like depression and anxiety. Similarly, in the United Kingdom, a study by Tolan and
Espiritu (2020) explored the impact of support groups for adolescent girls in urban areas. The
research found that peer-led support groups, where adolescents share their mental health
experiences, could be a powerful tool in combating mental health stigma. Tolan & Espiritu
(2020) found that girls in these groups often developed a sense of community and solidarity,
which alleviated their mental health struggles.

A study by Molefe et al. (2017) examined the role of support groups in addressing mental
health issues among adolescent girls in urban South African communities. The study found
that support groups offered girls a platform to discuss issues such as bullying, family
pressures, and academic stress, which significantly contributed to mental health problems.
Molefe et al. (2017) highlighted that these groups also provided education on coping
strategies and encouraged girls to share personal experiences, thereby reducing stigma and
promoting mental well-being. The findings emphasized that peer support was particularly
beneficial for girls who lacked access to individual therapy or professional mental health

18
services. A study by Chikodza & Mavindidze (2019) examined the role of support groups in
promoting mental health among adolescent girls in Harare. The study found that support
groups, particularly those organized within schools, provided a safe space for girls to discuss
issues such as bullying, family stress, and trauma. While the benefits of support groups for
the mental health of the girl child are widely acknowledged, significant gaps remain in the
literature. Most studies highlight the positive impact of support groups, but there is limited
research on the specific types of support groups that work best for girls in different cultural or
socioeconomic contexts, particularly in Zimbabwe. This study seeks to fill these gaps by
examining the role and effectiveness of support groups in Chitungwiza.

2.4 SOCIO-ECONOMIC FACTORS HINDERING THE GIRL CHILD`S ACCESS TO

MENTAL HEALTH SERVICES
2.4.1 Poverty and economic constraints
Poverty is a significant barrier to accessing mental health services for children worldwide.
According to a study by Patel et al. (2015), children from low-income families are less likely
to seek mental health services due to financial constraints, including the inability to afford
treatment costs, transportation, or even the time off school. In many low-income countries,
the cost of mental health care is often out of reach for families, leading to underutilization of
available services. A study by Knapp et al. (2016) in the United Kingdom echoed similar
findings, indicating that children from disadvantaged socioeconomic backgrounds were more
likely to experience mental health issues but were also less likely to receive the necessary
support due to economic barriers. Wu et al. (2017) in their study conducted in Asia found
that, in countries with limited public health resources, children from economically
disadvantaged backgrounds faced significant financial burdens when accessing mental health
care. This often resulted in them either delaying seeking help or forgoing treatment entirely,
leading to a worsening of their conditions. This situation is compounded in developing
countries where even basic healthcare is underfunded, and specialized mental health care for
children is a low priority. The lack of affordable mental health services creates a cycle where
poverty itself exacerbates mental health issues.

A study conducted in South Africa by Herman et al. (2017) highlighted that poverty directly
impacts the ability of families to access mental health care. The study found that low-income
households struggle to afford therapy sessions, medications, and transport to health centers,
especially in rural areas. This is further complicated by the lack of insurance coverage for
mental health services, leaving many children without adequate care. Moreover, Mokwena

19
(2018) found that the high cost of mental health services meant that families in low-income
settings were forced to prioritize immediate needs such as food and shelter over the mental
well-being of their children, particularly girls, who are often socialized to endure emotional
distress. According to Chirisa & Kaseke (2019), the economic challenges facing Zimbabwe,
particularly the inflation and unemployment rates, have meant that many families cannot
afford even basic healthcare, let alone mental health services for children. The cost of
accessing mental health care, which includes transportation to clinics, consultation fees, and
medications, is often prohibitive. Girls in low-income households are especially vulnerable,
as they are frequently the last to receive resources or attention within a family structure where
economic hardship leads to prioritizing immediate needs, such as food and shelter, over
mental health support. While these studies offer significant insight into the role poverty plays
in limiting access to mental health services, there is limited focus on how economic
constraints specifically impact girls, particularly in urban areas like Chitungwiza. This study
seeks to fill this gap by exploring the specific financial barriers that hinder the girl child's
access to mental health services within the context of Zimbabwe’s current economic climate.

2.4.2 Cultural and societal stigma

A study by Sartorius (2016) revealed that in many cultures, mental illness is often viewed as
a personal failure or weakness, leading to stigmatization of those who seek help. This stigma
can be particularly harmful for girls, who may face added pressure to conform to societal
expectations of emotional resilience and self-control. According to Corrigan (2015), mental
health stigma leads to significant negative consequences, such as delayed help-seeking
behavior, reluctance to discuss emotional distress, and a decrease in the likelihood of
receiving proper treatment. In the context of girls, societal expectations about femininity and
emotional expression can complicate their ability to access care. Lee et al. (2017) further
found that in several Asian countries, girls face not only the internalized shame of being
mentally unwell but also the external stigma imposed by their communities, which
discourages them from seeking professional help. This societal pressure to remain strong and
composed often prevents girls from openly addressing their mental health concerns. A study
by Ngwena (2018) in South Africa highlighted that cultural beliefs, including the idea that
mental illness is caused by spiritual or supernatural forces, often lead to stigmatization. This
stigma can be even more pronounced for girls, who are expected to uphold cultural norms
around behavior and emotional expression. Girls who exhibit symptoms of mental health
problems may be perceived as "unruly" or "dishonorable," leading to ostracization or punitive

20
measures. This societal stigma discourages many from seeking help, as they fear judgment or
rejection from their peers, family, or community.

Tavares & Barreto (2017) found that mental health stigma is particularly pronounced in rural
communities, where traditional cultural norms are deeply ingrained. In these areas, mental
illness is often seen as a taboo subject, with children and adolescents, especially girls, being
discouraged from discussing their emotional struggles. The fear of being labeled as mentally
unstable or "cursed" prevents many girls from accessing the care they need. A study by
Chireshe et al. (2018) found that in Zimbabwean communities, mental health issues are often
linked to cultural beliefs about witchcraft, spiritual punishment, or personal weakness. These
beliefs create an environment where mental illness is not discussed openly, and those
suffering from mental health issues are often shamed or ostracized. Chimhowu et al. (2019)
further explored this issue, showing that the fear of being labeled "mad" or "weak" in
Zimbabwean culture leads many girls to avoid seeking help for mental health challenges.
Girls, who are traditionally expected to be the emotional caregivers within their families, are
especially vulnerable to this stigma, as they are often expected to cope with emotional
distress silently or "tough it out." The Zimbabwe National Mental Health Policy (2021)
acknowledges the challenge of stigma in mental health care, stating that societal beliefs
contribute to the reluctance of girls to access care. Gwinji et al. (2020) further emphasized
that cultural norms in Zimbabwe, which prioritize family honor and communal respect,
prevent many girls from seeking mental health services, as they fear the social consequences
of being labeled mentally ill. These cultural barriers are exacerbated in rural areas where
traditional beliefs about mental health are even stronger. While studies have explored the
general stigma around mental health in Zimbabwe, there is limited research focusing
specifically on the stigma faced by the girl child in accessing mental health services. This
study seeks to fill this gap by examining how cultural and societal stigma affects the mental
health help-seeking behavior of girls.

2.4.3 Limited education and awareness

Van Rensburg & Makusha (2016) highlighted that despite advances in mental health policies,
there remains a significant gap in awareness, especially among adolescents in under-
resourced communities. The study showed that many girls lacked the vocabulary to describe
what they were feeling or going through, which made it difficult for teachers or health
workers to identify their struggles. This was particularly true in informal settlements and rural
schools where mental health education was absent from the curriculum. Aidoo & Haruna

21
(2017) in Botswana similarly found that young girls often depended on peers for advice,
many of whom were also uninformed, leading to misinformation and delayed care. Mufune
(2019) found that mental health was seldom discussed in schools, and girls frequently
internalized emotional pain, associating it with hormonal changes or teenage behavior rather
than mental health disorders. Nyamukapa et al. (2017) reported that most adolescent girls in
Zimbabwean communities could not differentiate between normal stress and conditions like
depression or anxiety. Without this understanding, many continue to suffer silently or are
misdiagnosed. In their study across high-density suburbs like Chitungwiza, Mudhovozi &
Chireshe (2018) found that mental health is rarely discussed in schools, families, or churches
key spaces where girls spend most of their time. As a result, symptoms go unnoticed, or girls
resort to unsafe coping mechanisms such as isolation or substance use. Chikowore &
Makusha (2021) explored parental and community knowledge about adolescent mental health
in urban Zimbabwe and found that many adults believed mental health conditions only
affected adults or were caused by evil spirits. These misconceptions meant that young girls
who showed signs of distress were often scolded or ignored instead of being supported.
Although several studies have touched on the low awareness of mental health in Zimbabwe,
there is a noticeable gap in literature that focuses specifically on the mental health literacy of
the girl child and how it influences their access to services. This study aims to address this
gap by investigating how limited education and awareness in communities like St
Mary's,Chitungwiza impact the ability of girls to recognize mental health challenges and seek
appropriate help.

2.4.4 Gender discrimination

According to WHO (2017), women and girls globally are more vulnerable to mental health
challenges such as depression and anxiety, yet gender biases in health systems and
communities result in inadequate attention to their mental health needs. Cavanaugh &
eterman (2019) note that in patriarchal societies, girls are often socialized to suppress
emotional expression and are less likely to be prioritized in receiving health care, including
mental health services. In parts of Asia and Latin America, Barros & Silva (2020) found that
cultural norms often position the mental well-being of girls as less important compared to
their roles as caregivers or family supporters, leading to a neglect of their psychological
needs. Govender & Reddy (2019) reported that despite policy efforts to ensure gender equity
in healthcare, girls in low-income areas still face barriers to accessing mental health services
due to gendered roles and discrimination. Girls are often expected to care for siblings or

22
engage in domestic tasks, leaving little time or support for their personal well-being. Mbele &
Mkhize (2020) found that gender stereotypes in schools and homes in Lesotho discouraged
girls from expressing emotional difficulties, often labelling them as weak or dramatic, which
in turn discouraged them from seeking help. Mwansa & Banda (2017) in Zambia highlighted
that mental health interventions rarely target adolescent girls directly. Programmes are often
designed with generic approaches that ignore gender-specific risks, such as early marriage or
sexual exploitation, which can severely impact mental health. The underrepresentation of
female voices in mental health policy discussions also means services may not reflect the real
needs of girls, making them less likely to use them.

Matendere & Chikowore (2019) argue that societal norms still prioritize the mental well-
being of boys or adults, often dismissing the emotional needs of girls as trivial or attention-
seeking. In many communities, including areas like Chitungwiza, girls are socialized to
endure hardship in silence, making them less likely to report symptoms of mental distress.
Machingura (2020) observed that even in schools and clinics, support services are not always
gender-sensitive, and practitioners may unconsciously minimize the concerns of girl children.
Chimange & Chikanya (2021) found that girls in urban low-income areas often face double
discrimination both as young people and as females. This affects not only how they are
treated within the health system but also how they perceive their own right to mental health
care. Although various studies point to gender disparities in health care access, few explore
how specific gender-based discrimination limits mental health service access for adolescent
girls in urban Zimbabwean communities like Chitungwiza. This study seeks to fill that gap by
focusing on how cultural, institutional, and interpersonal gender biases prevent girls from
receiving timely and adequate mental health support.

2.4.5 Geographical accessibility and infrastructure

Skeen et al. (2019) discovered that adolescent girls in informal settlements often face long
travel distances to reach mental health facilities, which discourages early treatment. The
limited number of specialized services in peri-urban and rural areas forces reliance on
overburdened primary care units that may not be equipped to deal with gender-specific
mental health needs. Similarly, Lund & Flisher (2015) highlighted that in Namibia and
Botswana, infrastructural deficits such as poor roads, lack of safe public transport, and scarce
health facilities in rural areas severely impact the accessibility of services, particularly for
girls who depend on adult accompaniment or school-based referrals.

23
Chikomo & Ndlovu (2017) in Malawi also noted that while some community-based
interventions exist, they are sporadic and inconsistent, particularly in rural districts. Girls
often go unnoticed within these systems due to lack of outreach, awareness, or trained
personnel capable of engaging them meaningfully in their own languages and cultural
contexts. Chibanda et al. (2017) observed that most mental health services are concentrated in
urban centres, creating a serious access gap for girls living in peri-urban and rural
communities. Public transport to city-based clinics is costly and unreliable, and many girls
lack financial support or safe means to travel. Mupambireyi (2019) point out that adolescent
girls who require ongoing support often miss appointments due to these logistical challenges,
leading to poor treatment adherence and relapse. Chitongo & Mudzengerere (2020)
emphasize that even in Chitungwiza itself, some neighborhoods are underserved due to
limited mobile mental health units or satellite clinics. As a result, many girls rely on schools
or religious institutions for psychosocial support, which may not provide professional help.
Poor infrastructure, such as inadequate lighting, lack of signage, and security concerns
around existing clinics, also discourages girls and their families from seeking help,
particularly during emergencies.

2.4.6 Family and household dynamics

According to Reupert et al. (2015), family dynamics such as emotional neglect, lack of
parental involvement, and strained parent-child relationships significantly affect children's
ability to access psychological care. These dynamics are often worse for girls, who may also
be expected to take on caregiving roles within the household, thereby reducing their time and
attention for personal mental wellbeing (Gopalan et al., 2020). A study by Mupambireyi et al.
(2019) found that in many households across Southern Africa, mental illness is often
misinterpreted as a spiritual or behavioural problem, which results in girls being taken to
traditional healers rather than qualified professionals. Mafa (2021) assert that in many
Zimbabwean households, discussions around mental health remain taboo, particularly for
girls, who are expected to remain "strong and silent." This silence perpetuates underreporting
and lack of care. Dube & Dzapasi (2017) also found that some caregivers, especially in child-
headed or grandparent-led households, do not prioritize mental health services due to lack of
awareness, transport, or perceived irrelevance. In many cases, girls who are survivors of
domestic abuse or neglect are either ignored or blamed for their condition, further
discouraging them from seeking help.

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2.5 STRATEGIES TOWARDS IMPROVING THE GIRL CHILD`S ACCESS TO
MENTAL HEALTH SERVICES
2.5.1 Training and capacity building for staff
According to the World Health Organization (2018), building the mental health competence
of frontline workers is essential, especially in contexts where child and adolescent mental
health needs are rising but specialist services are scarce. Patel et al. (2018) emphasise that
capacity building initiatives that include culturally sensitive training, supervision, and
mentorship for staff are associated with improved diagnosis and referral practices for
adolescent girls. In South Africa, Petersen et al. (2019) found that training primary care
nurses and community health workers (CHWs) in adolescent-focused mental health resulted
in more gender-responsive care, especially in underserved areas. Similarly, Breuer et al.
(2016) report that capacity-building efforts among lay health workers improved the
therapeutic alliance between staff and adolescent clients. In Botswana, Molotsi & Nleya
(2020) noted that continuous professional development sessions for social service
professionals improved diagnostic accuracy and increased case referrals from schools and
communities.

Chibanda et al. (2016) illustrate that task-shifting approaches wherein CHWs are equipped to
provide low-intensity psychological interventions are not only cost-effective but also expand
mental health reach in rural areas. Munthali & Chirwa (2018), studying Malawi, reported that
when staff training was coupled with supportive supervision and peer learning, adolescent
mental health service use increased significantly. The Friendship Bench programme
pioneered by Chibanda et al. (2016) is a globally recognized intervention that trains lay
health workers, particularly elderly women ("grandmothers"), to deliver structured problem-
solving therapy. The success of this model demonstrates the value of community-based, low-
cost mental health interventions. However, challenges persist within formal institutions like
the Department of Social Development. Mlambo & Nyoni (2019) found that staff often lack
specialised training in child and adolescent mental health, limiting their ability to identify
early signs of distress. Similarly, Nyatsanza & Matavire (2021) reported that while social
workers were committed, their limited exposure to evidence-based mental health practices
constrained the effectiveness of interventions. Chikomo & Dube (2020) argue that
professional development workshops, especially those including trauma-informed and
gender-sensitive content, are crucial in enabling social service professionals to offer holistic
and timely support to adolescent girls.

25
2.5.2 Strengthening referral pathways
According to the World Health Organization (2021), weak referral systems lead to delays in
diagnosis, loss to follow-up, and poor treatment outcomes. Referral pathways that are clear,
coordinated, and well-documented enhance continuity of care and reduce fragmentation in
mental health services (Patel et al., 2018). Moreover, the Lancet Commission on Global
Mental Health highlights that robust referral systems between schools, primary health care,
and specialist mental health services are key in supporting adolescent mental wellbeing (Patel
et al., 2018). Research by Kieling et al. (2017) shows that integrated referral systems
especially those that link health, education, and social protection are effective in responding
to the multi-dimensional needs of adolescent girls, who often experience co-occurring
psychological, social, and economic challenges.

Lund et al. (2019) found that community health worker involvement and standardized referral
forms significantly enhanced the efficiency of mental health service access for adolescents.
Mavhudzi & Bhunu (2020) found that the lack of formalized referral systems between
schools, clinics, and social welfare departments resulted in service delays and disengagement
from care, especially among girls. However, there are emerging efforts to address this. The
Ministry of Health and Child Care’s collaboration with UNICEF on the Child Protection
Referral Pathway Model has begun to show promise in areas like Mutare and Chitungwiza,
where formal linkages between child protection officers and health workers have led to better
tracking of high-risk cases (UNICEF Zimbabwe, 2022). Chibanda et al. (2016) emphasize
that community-based interventions like the Friendship Bench can serve as critical entry
points into the formal referral system, especially when cases are beyond the scope of lay
health workers. These interventions highlight the need for upward referral from the
community to specialized services.

2.5.3 Improving resource allocation and infrastructure

WHO (2022) stresses the need for governments to invest in adolescent mental health
infrastructure. Patel et al. (2016) found that under-resourced facilities correlate with delayed
intervention and worsened outcomes. In high-income countries, investment in youth mental
health clinics with girl-friendly services has led to improved access and satisfaction
(Thornicroft et al., 2016). In South Africa, Petersen et al. (2019) argue that better
infrastructure, including safe counselling rooms and mobile outreach units, directly improved
girls’ willingness to seek help. In Namibia, Kandjii-Murangi & Haipinge (2021) observed
that infrastructure development, particularly in peri-urban areas, enhanced access for

26
vulnerable groups. Zimbabwe’s mental health budget remains below 1% of the national
health expenditure (Chikomo & Dube, 2020). Motsi (2021) highlight the shortage of girl-
friendly spaces in government-run facilities. Nyatsanza & Matavire (2021) recommend
strategic reallocation of resources to increase staff and improve privacy in counselling spaces.

2.5.4 Enhancing community engagement and education

According to the World Health Organization (2021), community-based awareness
campaigns, peer education, and participatory mental health promotion initiatives can reduce
stigma and increase service uptake, especially when tailored to local contexts. Barry et al.
(2019) argue that mental health education is most effective when it is culturally sensitive,
gender-responsive, and delivered through trusted local actors such as community health
workers, faith leaders, and teachers. The United Nations Educational, Scientific and Cultural
Organization (UNESCO, 2020) also emphasizes the role of education systems in promoting
mental health literacy and creating inclusive school environments. These findings support the
view that engaging communities is not merely a supplementary approach but a core strategy
in creating inclusive, girl-centered mental health systems globally. In South Africa, for
example, community dialogue forums and participatory theatre have been employed to raise
awareness about youth depression, trauma, and gender-based violence (Tomlinson et al.,
2016). Such platforms have proven particularly effective in rural and peri-urban settings
where mental health stigma remains high. A study by Dube and Uys (2020) in KwaZulu-
Natal showed that when local leaders, including traditional healers and church groups, were
involved in mental health promotion activities, community attitudes toward adolescent
mental health improved significantly. Similarly, in Namibia and Zambia, community-based
participatory research has informed the development of psychoeducation toolkits used by lay
health workers to increase awareness among parents and adolescents (Kakuma et al., 2019).

In Zimbabwe, community engagement and mental health education are emerging strategies
with growing support from both government and civil society. The Friendship Bench
program is a notable example of successful community-based mental health intervention. It
trains lay health workers commonly known as “grandmothers” to provide basic psychological
support within communities (Chibanda et al., 2016). Evaluations of the program show that
embedding services within familiar community spaces such as clinics and churches reduces
stigma and enhances accessibility for girls and young women (Chibanda et al., 2017). The
Ministry of Health and Child Care, in collaboration with UNICEF and WHO, has piloted
school-based mental health awareness campaigns aimed at sensitizing students, teachers, and

27
caregivers on signs of distress, with positive reception in areas like Harare and Mutare
(UNICEF Zimbabwe, 2022). A study by Mavhudzi & Bhunu (2020) revealed that in many
peri-urban settings, community members still associate mental illness with spiritual causes,
resulting in delays in seeking formal care. Traditional gender norms often limit girls’ freedom
to express distress, reinforcing silence around trauma, anxiety, and depression. Community
health workers and social workers interviewed in studies by Nyatsanza & Matavire (2021)
emphasized the need for consistent community engagement strategies that focus on girl-
specific needs, using locally relevant narratives and languages. Increasing investments in
community mobilization, culturally appropriate mental health literacy campaigns, and
training of local gatekeepers can play a transformative role in building supportive, stigma-
free environments for girls’ mental wellbeing.

2.5.5 Promoting multi-sectoral collaboration

In a cross-national study, Patel et al. (2018) highlighted that partnerships between education
systems, community-based organizations, and social services enhance the reach and impact
of mental health interventions by ensuring continuity of care and addressing the socio-
structural drivers of mental illness. For example, in Canada and the UK, multi-agency
collaboration models have improved early identification and response for girls exposed to
trauma and abuse (Fazel et al., 2014; Weist et al., 2017). Barry et al. (2019) argue that multi-
sectoral coordination is essential to create girl-centred interventions that are sensitive to
gender, culture, and age. Successful international models, such as the “Integrated School
Mental Health” framework, demonstrate that collaboration between ministries of health and
education leads to timely, school-based mental health care supported by psychosocial
services and referral systems (Wei et al., 2015). The effectiveness of such models lies in
shared accountability, regular stakeholder meetings, and well-defined inter-agency protocols
that guide implementation.

In South Africa, the integration of mental health within the school health policy has
facilitated cross-sectoral partnerships between the Departments of Health, Basic Education,
and Social Development (Shung-King et al., 2018). These collaborations have enabled the
deployment of social workers and mental health nurses into schools, improving access to
psychosocial support for girls, especially in under-resourced communities. Similarly, in
Botswana, cross-ministerial taskforces have been established to coordinate mental health
responses for adolescents, involving law enforcement, education, and community groups
(Mmereki & Monyatsi, 2020). The National Adolescent and Youth Sexual and Reproductive

28
Health Strategy (2016–2020) recognizes mental health as a key component and calls for
collaboration between the Ministry of Health and Child Care (MoHCC), Ministry of Primary
and Secondary Education, and Ministry of Public Service, Labour and Social Welfare.
However, studies by Dambi et al. (2019) and Mavhudzi & Bhunu (2020) reveal that these
collaborations are often ad hoc, with limited institutional backing and unclear frameworks.
The “Friendship Bench” program, though largely community-based, has begun integrating
with public health facilities and social welfare services to ensure a more holistic response for
clients, including adolescent girls (Chibanda et al., 2016). Also, NGOs such as Childline
Zimbabwe and the Zimbabwe National Council for the Welfare of Children have piloted
inter-agency collaboration models in cases involving trauma and abuse, though these remain
small-scale (Makoni & Mugari, 2021). For multi-sectoral collaboration to be truly effective in
Zimbabwe, there is a need for formal inter-agency coordination committees, standardized
protocols, and the active involvement of grassroots stakeholders including caregivers,
teachers, and religious leaders.

2.5.6 Accessibility of Services

In South Africa, for instance, mental health services are primarily concentrated in urban
areas, leaving rural populations underserved (Lund et al., 2019). Adolescents face additional
challenges such as lack of confidentiality, stigma, and absence of school-based mental health
interventions (Skeen et al., 2019). Studies have shown that many girls in Southern Africa
prefer not to disclose their mental health issues due to fear of social repercussions or being
labelled as “possessed” or “weak” (Kauchali et al., 2020). These findings suggest that
physical proximity to services is not enough; psychological safety and cultural sensitivity are
also key to accessibility. In response, some countries have begun to decentralise mental
health services and integrate them with maternal and child health programmes. Botswana, for
instance, has piloted the deployment of community health workers trained in adolescent
mental health, aiming to reach girls in peri-urban and rural areas (Mmereki & Monyatsi,
2021). Similarly, South Africa’s re-engineered Primary Health Care model incorporates
school health teams who conduct screenings and offer psychosocial support (Shung-King et
al., 2018). However, implementation challenges remain, including poor transport systems,
staff shortages, and weak referral linkages (Lund et al., 2019; Skeen et al., 2022).

According to Dambi et al. (2019), Zimbabwe has fewer than 20 psychiatrists for a population
of over 15 million, and the majority of these are based in Harare and Bulawayo, making
access extremely limited for those in peri-urban areas like Chitungwiza. Adolescent girls are

29
especially disadvantaged due to gendered norms that discourage help-seeking and prioritise
silence over emotional expression (Mavhudzi & Bhunu, 2020). This leads to under diagnosis
and a lack of treatment, with many girls suffering in silence or being misdiagnosed in primary
care settings. The Friendship Bench initiative, which trains lay health workers to provide
basic mental health care, has been hailed as a success in extending services to underserved
communities (Chibanda et al., 2016). However, these models are not yet tailored specifically
to girls' unique needs, and adolescent-focused mental health interventions remain sparse.
NGOs such as Childline Zimbabwe have provided telephone-based counselling for youth, but
challenges such as low phone ownership among girls and digital exclusion persist (Makoni &
Mugari, 2021). Strengthening school-based mental health services, subsidising transport for
clinic visits, and promoting peer-led mental health education are recommended strategies to
improve accessibility in Chitungwiza and similar contexts (Nyatsanza & Matavire, 2021).

2.6 CHAPTER SUMMARY

The chapter focused on reviewing literature which is related to the study. The theoretical
framework informing the study has also been outlined in this chapter. This literature review
has been done at global, regional and national levels in respect to the objectives of this study.
The literature reviewed the mental health services available and established socio-economic
factors hindering the girl child’s access to mental health services as well as strategies towards
improving the girl child’s access to mental health services in Zimbabwe. The next chapter
presents the research methodology.

30
CHAPTER 3

RESEARCH METHODOLOGY
3.1 INTRODUCTION
This chapter outlines the research methodology adopted to explore the socio-economic
factors affecting the girl child's access to mental health services. The chapter presents the
concepts of research approach and design, study setting, target population, sampling, data
collection process and instruments used. It also discusses the procedures followed, the
strategies employed to ensure trustworthiness, and the data analysis techniques applied. The
justification for the adopted methodology, rigorous ethical considerations in child-related
researches coupled with the limitations of the study shall all be established in this chapter.

3.2 RESEARCH APPROACH

The researcher utilized a qualitative research approach to explore the socio-economic factors
affecting the girl child’s access to mental health services in Chitungwiza. Creswell & Poth
(2018) defined qualitative research as an approach for exploring and understanding the
meaning individuals or groups ascribe to a social or human problem. This approach enabled
the researcher to gain in-depth insights into the lived experiences, perceptions, and challenges
faced by girl children and the professionals working with them. The qualitative method was
most suitable for this study because it allowed for the collection of rich, descriptive data that
helped to capture the complex socio-economic and contextual realities surrounding access to
mental health services. As the study focused on uncovering underlying factors, qualitative
approach allowed for open-ended data collection tools such as interviews, which are essential
for exploring sensitive and deeply personal topics (Denzin & Lincoln, 2018).

The use of a qualitative approach also provided flexibility in engaging with participants in
their natural settings, which enhance trust and allow the researcher to explore emerging
themes in real time (Silverman, 2020). One of the major strengths of this approach was its
ability to bring out understandings that are often missed in quantitative studies. However,
qualitative research also presented certain limitations. The approach required extensive time
for data collection and analysis, and the findings were not statistically generalizable to the
wider population. In addition, qualitative research can be affected by researcher bias and
subjectivity, which demanded careful reflexivity and ethical vigilance throughout the study
(Bryman, 2016). Despite these challenges, the benefits of gaining context-specific, deep

31
insights outweighed the limitations, particularly for a study aimed at informing community-
based strategies and policy interventions for vulnerable populations.

3.3 RESEARCH DESIGN

The researcher employed a case study research design. A case study design, according to Yin
(2018), involves an intensive analysis of a single unit or a small number of units within their
real-life context. This design was most suitable for the current study because it allowed for a
focused and holistic investigation of the unique experiences, challenges, and dynamics
surrounding mental health access for girls in one specific geographic and institutional setting
the Department of Social Development in Chitungwiza. The case study enabled the
researcher to investigate the problem in depth, using multiple sources of evidence, including
interviews and document reviews, to develop a comprehensive understanding. The advantage
of this design lies in its ability to explore complex social phenomena within their real-world
context (Stake, 2005), which was critical for understanding how poverty, gender roles,
cultural beliefs, and institutional practices interact to shape girls' access to mental health
services. It allowed the researcher to generate rich, contextual data that can inform practice
and policy within similar settings. The use of a case study also provided a framework for
identifying both challenges and potential solutions in a detailed and practical manner.

The case study maintains deep connections to fundamental values and intentions, hence
‘particularistic and heuristic’ (Merriam, 2009:46; Flick, 2011). The latter attributes could not
have been easily and readily offered by other qualitative designs such as narrative and
historical research designs coupled with grounded theory. To this end, it helped the
researcher to best understand the phenomenon of restorative juvenile justice and finally
respond to this study’s objectives. On the same note, this design allowed research findings to
emerge from the key themes inherent in the raw data of the study and finally provided a clear
framework for investigating the phenomenon under study and prioritizing its exploration until
a depth of understanding was achieved. Thus, Creswell (2009:183) supports that this in-depth
understanding is accomplished through paying attention to every detail shared by study
participants through the use of in-depth and key informant interviews and focus group
discussions. However, this design has never gone without criticism from other researchers
who question this design’s lack of objectivity. Yet still, this criticism cannot disqualify this
design’s credibility and capacity in providing quality and aimed answers for this study.

32
3.4 STUDY LOCATION
The research was conducted in St Mary’s, Chitungwiza, and a high-density suburb located
approximately 30 kilometres (19 miles) from the Harare city centre. St Mary’s is
characterised by a high population density, limited access to essential services, and
significant socio-economic challenges, including high unemployment rates and widespread
poverty. These conditions contribute to increased vulnerability among residents, particularly
impacting the mental health and well-being of children and adolescents. The area has been
identified as facing considerable challenges in the provision of and access to social services,
including healthcare, which directly affects the availability and quality of mental health
services for the community.

3.5 TARGET POPULATION

For this study, the target population comprised adolescent girls aged between 15 and 18 years
residing in St Marys, Chitungwiza, who have either sought or required mental health
services.A target population refers to the entire group of individuals or entities who possess
specific characteristics that are relevant to the research inquiry and from whom meaningful
data can be gathered (Creswell & Poth, 2018). These girls were selected because they are the
direct recipients or intended beneficiaries of mental health interventions, and their lived
experiences offer vital insights into the socio-economic barriers hindering their access to such
services.

In addition to the adolescent participants, five key informants were identified to provide
expert, professional, and contextual insights into the factors influencing mental health access
in the area. These included a child protection officer from the local Department of Social
Welfare, a nurse from St Mary’s Clinic, a community care worker, a parent of an adolescent
girl, and an advocate from a community-based organisation involved in mental health and
child welfare. These informants were selected due to their direct involvement in providing
services, support, or guidance related to children’s welfare, and because they possessed in-
depth knowledge of the systemic and community-level barriers affecting girls' access to
mental health services. Their perspectives enriched the study by offering a more holistic
understanding of the issue from service provision and community engagement standpoints.

3.6 SAMPLING TECHNIQUES

The study employed a combination of snowball sampling and purposive sampling, both of
which are non-probability sampling techniques commonly used in qualitative research to

33
select participants with rich, relevant knowledge and experience of the phenomenon under
investigation. Snowball sampling was used to select the primary participants adolescent girls
aged between 15 and 18 years residing in St Mary’s, Chitungwiza.Sampling is a process or
technique of selecting a representative part of a population for the purpose of determining
parameters or characteristics of the whole population (Creswell, 2014). Creswell (2009:152)
supports that this is possible because trends and tendencies in the larger population can be
discovered from individuals.Snowball sampling is a recruitment method where existing study
participants help identify and refer other potential participants who meet the study’s inclusion
criteria (Naderifar, Goli & Ghaljaie, 2017). The researcher began by identifying a few
adolescent girls through community-based organisations, schools, and local health centers,
who had either sought or needed mental health services. After the initial interviews, these
participants were asked to refer peers within their network who shared similar experiences
and met the study's criteria. This method was especially useful for reaching individuals with
potentially stigmatised experiences, such as mental health challenges, who might not be
easily accessible through direct recruitment. Inclusion criteria included being female, aged
15–18, residing in St Mary’s, and having direct or indirect experience with mental health
services. Girls with severe cognitive impairments or those unable to provide informed
consent were excluded to protect ethical standards and ensure meaningful participation.

For key informants, the study applied purposive sampling, a technique in which participants
are deliberately selected based on specific roles, expertise, or knowledge relevant to the
research objectives (Etikan, Musa & Alkassim, 2016). This allowed the researcher to recruit
individuals who are professionally or personally involved in the mental health and child
protection sectors within St Mary’s. The five key informants included a child protection
officer, a nurse from St Mary’s Clinic, a community care worker, a parent of an adolescent
girl, and an advocate from a community-based organisation focused on mental health. These
informants were selected because they possess first-hand insight into the structural and social
barriers that affect girls’ access to mental health services. Thus by combining snowball
sampling for adolescent girls and purposive sampling for key informants, the study ensured
the collection of rich, context-specific data from both the users and providers of mental health
services. This approach enhanced the study’s credibility and depth by capturing multiple,
interrelated perspectives on the issues affecting mental health access in St Mary’s.

34
3.7 SAMPLE SIZE
The sample size for this study was 20 participants, comprising 15 adolescent girls and 5 key
informants. Flick (2011) defines sample size as the total number of subjects involved in a
study. In qualitative research, sample size is generally determined by the principle of data
saturation rather than statistical representativeness (Guest, Bunce & Johnson, 2006). Data
saturation is reached when no new themes or insights emerge from continued data collection,
indicating that further interviews would be redundant. Creswell (2013) suggests that
qualitative studies typically include between 5 and 25 participants, depending on the nature of
the research question and the study scope. In this study, 15 adolescent girls were selected to
provide firsthand accounts of their experiences accessing mental health services in St Mary’s.
The 5 key informants included a child protection officer from the local Department of Social
Welfare, a nurse from St Mary’s Clinic, a community care worker, a parent of an adolescent
girl, and an advocate from a community-based organisation involved in mental health and
child welfare. These informants were chosen for their professional or experiential knowledge
relevant to the research topic. This sample size was sufficient to reach data saturation while
ensuring diverse, in-depth insights into both the service users’ and service providers’
perspectives. Ethical and logistical considerations, such as participant availability and the
need for meaningful engagement, also informed the final sample size.

3.8 METHODS OF DATA COLLECTION AND INSTRUMENTS/TOOLS

Data collection is an integral part of the research process. The study adopted data collection
techniques that enabled the collection of in-depth information and used tools consistent with
the techniques adopted. In-depth interviews, key informant interviews and a focus group
discussion were used in gathering information guided by an interview guide for adolescent
girls, key informant interview guide and a focus group interview guide respectively.

3.8.1 In-depth Interviews

In-depth interviews are one-on-one interactions that allow researchers to collect detailed
narratives from participants (Boyce & Neale, 2016). This method was chosen for its capacity
to elicit personal experiences and emotional accounts, especially on sensitive issues like
mental health. The researcher conducted face-to-face interviews with eight adolescent girls
who met the selection criteria. A semi-structured interview guide was used to facilitate
consistency while still allowing flexibility to explore emerging themes. The guide included
open-ended questions designed to probe into areas such as perceptions of mental health,
accessibility of services, and socio-cultural barriers. The interviews were conducted in a safe,

35
private space to ensure comfort and confidentiality. This method allowed the researcher to
build rapport with participants, enabling them to express their experiences freely. Despite
being time-consuming, in-depth interviews are crucial for gaining deeper understanding and
nuanced data (Alshenqeeti, 2014).

More still, these in-depth interviews were applied to the key informants. Flick (2011) reveals
that key informant interviews are part and parcel of in-depth interviews. As such, key
informants are key subjects whose potion in the context of qualitative study, exposes them to
various spheres of work which later expose them to expertise or credible know-how about
other people, processes or events than any other lay person in the community. For this study,
five key informants were selected purposively: two government social workers, a mental
health nurse, a school guidance counsellor, and a representative from an NGO working on
adolescent health. A separate key informant interview guide was used, tailored to capture
information on institutional practices, policy implementation, service availability, and
professional observations on the accessibility of mental health services for adolescent girls.
Four interviews were conducted face-to-face, while one was done via phone due to
scheduling limitations. The interviews were valuable in providing a structural lens and
offering expert reflections on how systems are or aren’t working in the real world (Creswell
and Poth, 2018).

3.8.2 Focus Group Discussion (FGD)

Focus group discussions are interactive group interviews designed to generate data through
the exchange of ideas and experiences among participants (Krueger & Casey, 2015). In this
study, one focus group discussion was conducted with eight adolescent girls from the St
Mary’s community. These participants were not part of the individual in-depth interview
sample; they were selected separately to ensure a broader range of perspectives and to
prevent duplication of responses. The purpose of the FGD was to explore collective
perceptions, shared challenges, and social norms affecting access to mental health services
among adolescent girls. A semi-structured FGD guide was used, containing thematic prompts
that encouraged open dialogue, storytelling, and reflection. The session took place in a
neutral, youth-friendly environment to create a comfortable and non-threatening atmosphere.
The discussion was moderated by the researcher, with support from a trained female assistant
to help manage group dynamics and ensure inclusivity. This method enabled participants to
build upon one another’s responses, often revealing deeper insights into communal attitudes
and lived experiences that may not have surfaced during individual interviews. Although peer

36
presence can sometimes inhibit honest disclosure, the group was managed sensitively to
promote respectful interaction, equal participation, and confidentiality.

3.8.3 Key informants

Five key informants were identified to provide expert, professional, and contextual insights
into the factors influencing mental health access in the area. The 5 key informants included a
child protection officer from the local Department of Social Welfare, a nurse from St Mary’s
Clinic, a community care worker, a parent of an adolescent girl, and an advocate from a
community-based organisation involved in mental health and child welfare. These informants
were selected due to their direct involvement in providing services, support, or guidance
related to children’s welfare, and because they possessed in-depth knowledge of the systemic
and community-level barriers affecting girls' access to mental health services. Their
perspectives enriched the study by offering a more holistic understanding of the issue from
service provision and community engagement standpoints.

3.9 RESEARCH PROCEDURE

The research procedure was a systematic and structured process that involved several critical
steps, from obtaining permission to composing the final report. The first step in the research
procedure was obtaining ethical approval from the university. Ethical approval is necessary to
ensure that the research is conducted in a manner that protects participants' rights and upholds
research integrity (Bryman, 2016). After receiving approval, permission was sought from the
relevant authorities in the selected study area, St Mary's Chitungwiza, to gain access to
participants and relevant data sources. The permission was vital in ensuring compliance with
local regulations and in fostering a cooperative environment for data collection.

Once the necessary permissions were obtained, the next step involved participant recruitment.
This was done using purposive sampling, as discussed previously, where eligible adolescent
girls who had accessed mental health services were invited to participate. In addition, key
informants, such as social workers and mental health professionals, were identified and
invited for interviews. Recruitment was conducted through personal outreach and
coordination with local organizations to ensure that participants were well-informed about the
purpose of the study and their role in it. According to O’Reilly and Parker (2013), clear
communication about the study's aims and procedures helps to build trust and ensure
participants' willingness to engage. Data collection followed the recruitment phase. As
previously outlined, data collection involved in-depth interviews, focus group discussions,

37
and key informant interviews. Each interview and discussion was conducted in a quiet and
private space to ensure confidentiality and comfort for the participants. The interviews were
audio-recorded with participants’ consent, while field notes were taken during focus group
discussions to capture non-verbal cues and group dynamics.

After data collection, the process of transcribing the interviews and organizing the data
began. The recordings were transcribed verbatim, and the data were coded and categorized
according to the themes that emerged from the interview responses. Thematic analysis, as
suggested by Braun & Clarke (2006), was used to identify patterns and common themes
within the data. Thematic analysis is a qualitative research method that involves organizing
and interpreting data in a way that reveals significant themes related to the research
questions. Once the data analysis was completed, the findings were presented in a detailed
report. The report included a comprehensive discussion of the results, where the themes were
linked back to the literature review and research questions. The report also highlighted the
practical implications of the findings, the limitations of the study, and suggestions for future
research.

3.9.1Trustworthiness
Trustworthiness in qualitative research refers to the rigor and reliability of the study’s
findings, ensuring that the results are credible, dependable, and valid. According to Lincoln
& Guba (1985), trustworthiness in qualitative research encompasses four key criteria:
credibility, transferability, dependability, and conformability.

3.9.2 Credibility
Credibility refers to the confidence that can be placed in the truth of the research findings. It
ensures that the study accurately reflects the participants’ perspectives and experiences
(Merriam, 2009). In this study, credibility was ensured by employing member checking,
where participants were given the opportunity to review and confirm the accuracy of the
interview transcriptions and the themes derived from the data.

3.9.3 Transferability
Transferability refers to the extent to which the findings of a study can be applied or
transferred to other contexts or populations. Lincoln & Guba (1985) assert that transferability
can be established through thick description, where the researcher provides detailed and
comprehensive descriptions of the study context, participants, and research process. In this
study, detailed descriptions of the Chitungwiza setting, the participants, and the research

38
process were provided. This allows other researchers to determine whether the findings might
be applicable to different settings or populations, such as other urban areas in Zimbabwe or
similar settings in Southern Africa.

3.9.4 Dependability
Dependability is the consistency and reliability of the research process. It indicates whether
the study's findings would be consistent if the study were repeated in the same context
(Merriam, 2009). To ensure dependability, the researcher kept a detailed audit trail,
documenting each step of the research process, including data collection, analysis, and
decision-making procedures. This audit trail allows for an external review of the study's
methodology and processes, ensuring that the study's findings are consistent and replicable in
similar contexts.

3.9.5 Conformability
Conformability refers to the objectivity and neutrality of the research, ensuring that the
findings are shaped by the participants’ responses rather than the researcher’s biases (Lincoln
& Guba, 1985). To ensure conformability, reflexivity was practiced, where the researcher
maintained awareness of their own biases and preconceptions and acknowledged how these
could influence the interpretation of data.

3.10 DATA ANALYSIS METHOD

As defined by Creswell (2014), data analysis in qualitative research involves the process of
organizing, reducing, and interpreting the data in ways that are meaningful and relevant to the
research questions. For this research, thematic analysis was employed, as it provides an
effective way to identify patterns and themes within qualitative data. Thematic analysis
involves familiarizing oneself with the data, generating initial codes, identifying potential
themes, reviewing and refining these themes, and eventually defining and naming the themes.
According to Braun & Clarke (2006), this approach allows the researcher to capture both
explicit and implicit meanings within the data, offering a deeper understanding of the subject
matter. In this study, thematic analysis facilitated the identification of key barriers that
prevent girls from accessing mental health services, such as economic constraints, cultural
stigma, and lack of awareness. Thus by organizing the data into these themes, the research
was able to highlight the socio-economic and cultural factors that significantly influence
access to mental health services for girls in the community.

39
The process of data analysis was carried out in several steps, starting with the initial
familiarization with the data, which allowed the researcher to get an overall sense of the
material. This was followed by systematic coding, where the data was segmented and labeled
according to its relevance to the research questions. The codes were then grouped into
broader themes, such as economic barriers or cultural resistance, which were refined and
defined in relation to the research objectives. Braun & Clarke (2006) emphasize that theme
refinement is essential to ensure that each theme accurately reflects the data and the research
focus. Following this, the final step involved reporting the findings, where each theme was
explained in detail and supported by direct quotes from the participants. This rigorous
approach to data analysis ensured that the findings were robust, transparent, and reflective of
the real experiences of the participants, providing valuable insights into the barriers to mental
health access for girls in the study area.

3.11 ETHICAL CONSIDERATION

Owing to the sensitivity nature of adolescents-related issues and concerns, a need for rigorous
ethical consideration was closely upheld by the researcher. Ethics in relation to social work
research to this end, entails the appropriateness of a researcher’s behaviour in relation to the
stipulated rights of the research subjects or those who are directly or indirectly affected by it
(Sanders et al, 2012). In this context, the researcher designed the study in an ethically sound
and methodologically noble manner such that participants’ rights, needs, preferences, desires
and values were fully respected (Creswell, 2014). Therefore, the ethics which were observed
by the researcher as proposed by a number of scholars in social research are discussed
hereunder.

3.11.1 Seeking Permission

Seeking permission is a fundamental ethical step in any research study, ensuring that the
research adheres to the necessary legal and organizational guidelines. In this study,
permission was obtained from Chitungwiza Department of Social Development, before
beginning the research. This ensured compliance with ethical standards and institutional
policies. Creswell (2014) supports that any research that is conducted in institutions just like
in communities, demands one to seek permission from the authority of the people in charge
under which the participants fall under.

40
3.11.2 Informed Consent
The researcher sought consent from participants so as to ensure voluntary participation
among these participants. This was ethically necessary as confirmed by Rubin and Babbie
(2011) who assert that social work research often interferes with people’s lives, disrupts their
usual life activities and requires them to invest a vital portion of their time and energy.
Deception of participants was totally overruled through the provision of written and pre-
signed informed consent with clearly spelt out rights and other issues about the general well-
being of participants as supported by Creswell (2014).

3.11.3 Confidentiality and anonymity

Confidentiality and anonymity are central to protecting participants' privacy and maintaining
trust throughout the research process. All personal identifiers were removed from the data,
and pseudonyms were used to safeguard the participants' identities. Flick (2018) highlights
the importance of confidentiality in protecting participants' information from unauthorized
access. The researcher ensured that all data were securely stored and accessible only to the
research team. This measure was critical in upholding participants' privacy and ensuring that
their responses could not be traced back to their individual identities.

3.11.4 No Harm
The principle of "no harm" ensures that participants are not subjected to any physical,
psychological, or emotional distress during the research process. Guba & Lincoln (1989)
emphasize the importance of minimizing harm and prioritizing the safety and well-being of
participants. In this study, the researcher ensured that the questions were designed to be
sensitive and appropriate, minimizing any risk of distress or discomfort.

3.12 STUDY LIMITATIONS

One of the key limitations of this study was the unavailability of participants, particularly key
informants, due to their busy schedules and commitments. To overcome this limitation, the
researcher ensured that interviews and meetings with key informants were scheduled well in
advance, providing ample notice and flexibility in timing. In cases where in-person
interviews were not possible, alternative arrangements like telephone interviews were offered
to ensure continued engagement and data collection. Another challenge was restricted time
which had been allocated by the department to carry the study, but still, the researcher dealt
with this challenge through the use of a reasonably small size of participants and also by
choosing a closer study location.

41
3.13 STUDY DELIMITATIONS
The study was delimited to the St Mary’s area and focused exclusively on the girl child’s
access to mental health services within this specific community. It examined only socio-
economic factors. The research concentrated solely on mental health services available within
the formal public system in St Mary’s and did not consider services provided by private
clinics, NGOs, or traditional healers. Furthermore, the study targeted only girls of school-
going age, excluding boys and other vulnerable populations.

3.14 CHAPTER SUMMARY

This chapter outlined the research methodology adopted for this study, which employed a
qualitative approach. The chapter detailed the research design, setting, target population, and
sampling techniques, justifying the use of purposive sampling to select participants who had
relevant experiences and insights. Various data collection methods, including in-depth
interviews, focus group discussions, and key informant interviews were described, with a
clear explanation of how they aligned with the research objectives. The chapter also
highlighted the procedures followed, from seeking permission to analyzing the data, ensuring
the trustworthiness and ethical considerations such as confidentiality and informed consent
were maintained throughout. Challenges such as participant unavailability were
acknowledged, and strategies to overcome them were discussed. The next chapter will
present the research findings, research analysis and discussion.

42
CHAPTER 4

DATA PRESENTATION, ANALYSIS AND DISCUSSION

4.1 INTRODUCTION
The chapter focuses on the data presentation, analysis and discussions of the data collected
during the research. The findings presented were married to the objectives which
underpinned this study. The chapter also utilized the literature review on the socio-economic
factors influence the girl child’s access to mental health services at Chitungwiza Department
of Social Development. The section, however commence by providing the demographic
characteristics of the participants who participated in the study.

4.2 DEMOGRAPHIC CHARACTERISTICS OF STUDY PARTICIPANTS

The qualitative nature of the study allowed for an in-depth exploration of the participants'
experiences and perspectives. The 15 primary participants, comprising 8 in-depth interview
participants (P1-P8) and 7 focus group discussion participants (FGDP1-FGDP7), provided a
rich source of data. The ages of participants ranged from 15-18 years old, a critical period for
mental health development and intervention. Their education varied from primary school to
upper sixth form, this influenced participants' understanding and articulation of their
experiences. All participants had experienced mental health issues, ranging from acute to
normal mental health concerns, providing a common thread for analysis. The table below
summarizes the demographic characteristics of primary participants.

Participant ID Data collection Age (Years) Educational Mental health

method level experience
type

P1 In-depth 16 Form 2 Acute mental

interview health concerns

P2 In-depth 17 Form 4 Moderate

interview mental health
concerns

P3 In-depth 15 Upper sixth Normal mental

interview form health concerns

P4 In-depth 18 Form 5 Acute mental

43
 interview health concerns

P5 In-depth 16 Upper sixth Moderate

interview form mental health
concerns

P6 In-depth 17 Form 3 Acute mental

interview health concerns

P7 In-depth 15 Form 1 Normal mental

interview health concerns

P8 In-depth 18 Upper sixth Moderate

interview form mental health
concerns

FGDP1 Focus Group 16 Form 2 Moderate

Discussion mental health
concerns

FGDP2 Focus Group 17 Form 4 Acute mental

Discussion health concerns

FGDP3 Focus Group 15 Form 2 Moderate

Discussion mental health
concerns

FGDP4 Focus Group 16 Form 3 Normal mental

Discussion health concerns

FGDP5 Focus Group 18 Upper sixth Acute mental

Discussion form health concerns

FGDP6 Focus Group 17 Upper sixth Moderate

Discussion form mental health
concerns

FGDP7 Focus Group 15 Form 1 Normal mental

Discussion health concerns

44
The study included 5 key informants, coded as KI1 to KI5, who had direct experience in
providing mental health services to adolescents. Their professional experiences ranged from 3
to 5 years working with adolescents with mental health issues, bringing valuable insights to
the research. Their professional backgrounds were; 2 social workers from the Department of
Social Development, 1 guidance counselor, 1 community health nurse and 1 NGO worker.
Among them 3 were females and 2 were males, providing a balanced perspective.

Key Informant Gender Professional Affiliation Years of

ID Role Experience

KI1 Female Child protection Department of 4 years

officer Social
Development

KI2 Male Community Secondary 5 years

care worker school

KI3 Female Nurse Local clinic 3 years

KI4 Male Community Local mental 4 years

leader health NGO

KI5 Female Social worker DSD 3 years

4.3 MENTAL HEALTH SERVICES OFFERED AT THE DEPARTMENT OF SOCIAL

DEVELOPMENT CHITUNGWIZA
Findings suggest that the department of social development Chitungwiza offer various mental
health services to the girls child. These services are presented, analyzed and discussed in
detail in the following section:

4.3.1 Mental Health Assessments

Findings revealed that mental health assessments are first on the list of the mental health
challenges offered to the girl child at the DSD Chitungwiza. A participant said that;

“Pekutanga ndakatoenda kuDSD ndichitofambirawo nyaya dzeAMTO. Asi

pandakataura neakandibatsira ndakaudzwa kuti ndaitove nedrepression nekuti
ndaitoda kuwana therapy ndiite zvakanaka.” (P8)

45
 (At first I went to DSD to acquire an Assisted Medical Treatment Order (AMTO). But
the person who helped me informed me that I was experiencing depression and that I
required therapy to be well again.)

A key informant added that;

We use mental health assessments to help identify mental health needs, to plan
intervention and to ascertain the critical mental health needs to prioritize for
individuals to be assisted. (KI3)

The above presented findings reveal that mental health assessments are the initial step in
determining a client's needs and required services. These assessments help the professional
plan an intervention that prioritize the needs of a client. Pillay & Dube (2018) established that
such services aim at providing immediate assistance. Immediate assistance resonates with
crisis intervention which aims at reducing the psychological challenges experienced by
individuals. Chiweshe et al. (2019) notes that these services are crucial in managing cases of
abuse, neglect, and other acute mental health issues. As such, early identification of mental
health symptoms is important in determining the needs of an individual and ensures that girls
have access to necessary services. Mlambo & Nyoni (2019) concur that working to improve
mental health crisis intervention or initial services, with a focus on enhancing accessibility for
all children is important. Assessments therefore, form the basis of all mental health services,
as it aims at addressing the symptoms presented by an individual and identify underlying
issues that contributes to the problem. This is in line with the Social Determinants of Health
(SDH) theory, which promotes the upstream approach where efforts are focused on
addressing root causes of ill health, instead of managing symptoms or outcomes (Marmot &
Bell, 2012).

4.3.2 Awareness Campaigns

The findings reveal that girls encountered awareness campaigns on mental health challenges
in their communities as part of mental health services. A Participant said the following;

Chokwadi ndechekuti ndaisaziva zvakawanda nezvemental health until ndaona

mafliers aitaura nezvazvo. Zvakaita kuti ndizive kuti zvandaisangana nazvo
zvangazvisiri normal. Zvakaita ndinzwisise kuti zvakadai zvinowanikwa mukurarama
uye kuti ndinobatsirika sei. (FGDP6)

46
 (The truth is, I didn't know much about mental health until I saw fliers about it. This
made me aware of what that my experiences were not normal. It helped me
understand that it is part of life and how I can be helped.)

Another participant said that;

Ini ndakatanga kuziva nezvemental health zvataurwa tiripaAssembly. Pakauya vanhu

vakatidzidzisa zvataisaziva zvizhinji. (P2)

(I started knowing about mental health when it was mentioned at assembly. People
come and taught us a lot we did not know.)

A Key Informant added that;

“Awareness campaigns have been instrumental in breaking down the stigma

surrounding mental health in communities. Open discussions on mental health issues
have encouraged the girl child to seek help. We have seen a noticeable increase in
referrals from individuals who first learned about our services through these
campaigns” (KI5)

From the findings above highlight that in Chitungwiza awareness campaigns are used as
critical services that seek to promote mental health services. Community events, fliers and
assembly points are avenues utilized in ensuring that girls learn about mental health.
Nyatsanza et al. (2020) confirms that community-based programs are effective in increasing
awareness about mental health issues, reduce stigma and encourage early intervention. These
campaigns are crucial in breaking down social stigma and encouraging individuals to seek
assistance. As they normalize mental health conversations and promote a supportive
environment. A study by Bryant et al. (2016) established that awareness programs in schools
and communities reduce stigma and encourage the early detection of mental health disorders
among young girls. As such, through these services, girls are empowered as they are enabled
to understand their experiences and learn about the available support. Patel et al. (2018) noted
that such programs can help prevent these issues from escalating into more severe mental
health problems. Therefore, awareness campaigns equip girls with the necessary information
they require to navigate mental health issues and normalize seeking help. The SDH theory
also advocates for ending discrimination as way to improve health outcomes of individuals.

47
4.3.3 Counseling Services
Findings suggest that counseling services are rendered to girls who experience mental health
issues at the DSD. A primary participant said that;

“Ndakabatsirwa necounseling kubva kuna case officer vangu, vaiterera zvandaitaura.

Zvatakataura zvakaita kuti ndikwanise kukunda zvaindidya pfungwa. (P1)

(I was helped by counseling by my case officer, who listened to what I said. Our
conversation helped me to overcome what was troubling my mind.)

Another participant narrated that;

Pandakafirwa namai vangu, vekuwelfare vakagara neni pasi vakandibatsira

kugamuchira rufu. Ndainge ndatadza kuzvitambira, asi zvakaita kuti ndikwanise
kuzvigamuchira mbichana mbichacha. (P5)

(When my mother died, DSD people sat me down and helped me accept the death. I
had failed to accept it but it made me accept gradually.)

A Key Informant indicated that;

“We offer counseling services to girls to help them navigate through the mental
challenges they experience. We help them recover from traumatic experiences and
develop positive coping mechanisms. Our services are there to improve their well-
being and social functioning”

From these findings, it is evident that counseling services have a positive effect on girl's
mental health. These services help individuals to overcome mental health challenges and
traumatic experiences. A study by Richards et al. (2019) found that counseling interventions
for adolescent girls helped improve their emotional regulation and reduce anxiety and
depression after traumatic experiences. The provision of a safe space encourage individuals
to open up and receive the necessary support. Chibanda et al. (2016) in their study established
that girls who received counseling exhibited improved mental health outcomes. As such
counseling enables girl's to accept difficult situations, develop coping mechanisms and
improve their overall well-being. This is in line with the SDH theory's Pillar, healthcare
accessibility which advocates for assess to equitable and non-discriminatory services.

48
4.3.4 Case Management
Findings also establish that case management is also used to offer the girl child mental health
support and trace their progress after services are rendered. A key informant noted that;

We use case management to track the progress of clients helped by our mental health
services. This system help us to ascertain whether the client has received timely,
appropriate and comprehensive services they require to lead a normal life. (KI 2)

Another key informant confirmed that;

Case management is a tool used to personalized plans that responds to the mental
health needs a person experience. Individuals are then connected with relevant mental
health services. This is done to ensure that they get the support they need and that
services given respond to their unique needs. (KI1)

A participant also shared that;

Mukadzi akandibatsira kuwelfare akandiendesa kuMusasa project nekuti aiti ndivo

vanonyasoziva nezveDomestic violence. Ndiko kwandakazowana counseling yanyu,
asi ivo vaitondifonera vachivhunza kuti zvikufamba sei uye ndakawana rubatsiro
rwandaida here. (FGDP3)

The woman who helped me at DSD referred me to Musasa project, she said they
specialize in domestic violence issues. I was counselled there but she called asking
about my progress and if I got the assistance I needed.)

The above presented findings suggest that case management is used a tool to provide girls
with comprehensive care and ensure continuity of care in Chitungwiza. Patel et al. (2018)
also found that referral pathways that are clear, coordinated, and well-documented enhance
continuity of care and reduce fragmentation in mental health services. Case management
helps track an individual's progress after receiving mental health services. As such, it enables
the creation of tailored plans that responds to individual mental health needs. Similarly,
Kieling et al (2017) establish that integrated services that link health, education, and social
protection better respond to various needs of girls. It addresses factors including
psychological, social, and economic challenges to ensure better outcomes. Thus, helping case
managers to connect girls with relevant mental health services and follow up to ensure they
continue to receive the necessary support and assistance. UNICEF Zimbabwe (2022) further
establish that this systems enables tracking of high-risk cases. Therefore, case management

49
play a pivotal role in providing personalized mental health support and addresses negative
determinants that deter girls from accessing mental health services.

4.3.5 Psychosocial Support

Findings identify psychosocial support as important mental health services offered to the girl
child by the department of social development Chitungwiza. The following was said by a
participant;

Pandanga ndiri depressed ndatizwa nemukomana ndine nhumbu, ndanga ndisina

wekuzviudza ainzwisisa. Ndakaenda kuDSD ndakawana wekuudza ainge
asingandiJudge. Vakazondibatsira nekundi linker vevamwe vezera rangu vakange
vasanganawo nazvo. Izvi zvakaita ndiwane vekumira navo. (FGDP5)

(When I was depressed after my boyfriend had left me when pregnant, I didn't know
who to tell. I found someone to talk who did not just me went I went to DSD. They
also helped by linking me up with peers who has gone through similar situations. This
made me find support.)

A key infomant added that;

By offering psychosocial support we aim at ensuring that individuals experiencing

mental health challenges get the support they deserve. Often individuals with mental
health issues isolate themselves. We try to involve peers and family members in the
helping process to ensure that individuals are supported socially. (KI4)

From the above findings, it is evident that psychosocial support is an essential support service
in addressing mental health challenges faced by girls in Chitungwiza. The connection with
peers who have experienced similar situations provides a sense of community and
understanding. Tolan & Espiritu (2020) agree with this findings, they state that support help
develop a sense of solidarity. This facilitates the creation of a safe space to share their
concerns and feelings. Similarly, Chikodza & Mavindidze (2019) found that social support
provide a safe space for girls to discuss sensitive issues. Molefe et al. (2017) further
highlighted that peer groups provide education on coping strategies and encourage girls to
share personal experiences, thereby reducing stigma and promoting mental well-being. As a
result, girls develop coping strategies as psychosocial support address their emotional, social
and mental health needs. Findings also suggest that involving family members ensures that
girls receive comprehensive social support. Another study by Fox et al. (2020) in the United

50
States showed that when parents are actively involved in their children’s mental health care,
they help children understand their emotions and model healthy coping mechanisms. As they
feel supported and connected thereby, reducing feelings of loneliness.

4.4 SOCIO-ECONOMIC FACTORS HINDERING ACCESS TO SERVICES AMONG

GIRLS IN CHITUNGWIZA
The study found that girls in Chitungwiza face numerous socioeconomic challenges that
prevent them from accessing mental health services provided by the Department of Social
Development. The following section presents, analyze and discuss them in greater detail.

4.4.1 Lack of Awareness

Finding suggest that lack of awareness hinder girls from accessing mental health services
provided by the Department of Social Development in Chitungwiza. A participant indicated
that;

Ini pandakanzi ndaita depression ndaisatoziva kuti chii uye kuti ndaitova nayo.
Ndanga ndisingazivi kuti kana uine depression zvinooneka sei. Izvi zvakaita
ndinonoke kuwana rubatsiro. (P3)

(When told I was depressed, I did not know what it was and that I had it. I did not
know how to identify its symptoms. This made me delay getting treatment.)

Another participant added that;

Ini ndaisatoziva kuti maservices acho anowanikwepi, kuchipatara ndaingofunga

kunorapiwa zvirwere zvepamuviri, kusocial welfare ndaingogaya kuti kunoitwa
zvekubatsirwa vanhu vanoshaya zvikwanisiro chete. (FGDP7)

(I did not know where to get mental health services, I thought hospitals only
slpecialize with body sicknesses and that DSD only assist those who lack financially.)

A key informant had this to add;

Many young people are unaware of how to access mental health services or where to
find them, which prevents them from seeking help. Some also hold misconceptions
about mental health, such as associating it with madness, leading to fear of stigma
and negative attitudes towards seeking care. (KI2)

The findings above highlight that lack of awareness is a significant barrier to girls accessing
mental health services. Girls lack knowledge about mental health, symptoms and treatment

51
options. These findings resonates with a Malawian study by Phiri et al. (2019), which found
that cultural stigma and limited awareness about mental health contribute to low utilization of
services among adolescents, especially girls. Thus, they are not aware of where to access
mental health services or available services. Some believe that DSD only assist with welfare
issues, not mental health services as established by the study's findings. Mental health is often
associated with madness leading to fear and stigma. Nyamukondiwa & Machingura (2017)
acknowledged that many parents still lack awareness of mental health issues, often leading to
denial or underreporting of symptoms. Chikadzi (2022) further indicates that caregivers and
traditional leaders often lack awareness of adolescent mental health, perpetuating stigma and
attributing symptoms to spiritual causes. This indicates that lack of awareness is determinant
in communities that hinder access to mental health services. SDH theory state that social
conditions affect individuals and shape their overall mental health outcomes (Marmot &
Allen, 2014). As a result, girls may delay to seek help until their conditions worsen thus
preventing them from accessing available mental health services.

4.4.2 Social Stigma and Discrimination

Finding established that social stigma and discrimination impede girls from accessing mental
health services in Chitungwiza. A participant narrated that;

Zvinhu zvinongonyadzisa kunzi une mamental health challenges. Kazhinji kacho

ukaudza vanhu unotonzi anomhanya mushini. Ini ndototya kuzvitaura coz ndogona
kuloser mafriends angu. (P6)

(Its embarrassing to havd mental health challenges. Most of the times if you tell people
the can say you are mad. I fear talking about it because I can lose my friends.)

A key informant confirmed that;

Our society holds negative stereotypes on issues to do with mental health. Most people
fear being labeled as mad if they seek assistance. This make individuals feel ashamed
or embarrassed, delaying treatment. (KI5)

Another key informant added that;

Due to negative stereotypes, individuals internalize negative views about mental

health which perpetuates to self-stigma and negative health seeking behaviors. (KI1)

52
It is evident from these findings that social stigma and discrimination hinder girls from
accessing mental health services. Mental health services are often associated with psychiatric
services and this leads to fear and shame. The fear of being labeled or judged by others if
they seek help deters them from accessing services. Corrigan (2015) notes that stigma leads
to significant negative consequences, such as delayed help-seeking behavior, reluctance to
discuss emotional distress, and a decrease in the likelihood of receiving proper treatment. As
a result, this discourages girls from discussing mental health challenges due to societal
attitudes. Individual internalize negative views about mental health, causing self-stigma and
negative health seeking behaviors. Lee et al. (2017) further found that girls internalize shame
of being mentally unwell and also the external stigma imposed by their communities, which
discourages them from seeking professional help. Studies by Ngwena (2018) and Chireshe et
al. (2018) also noted that in Africa mental health is attributed to supernatural forces such as
witchcraft and spiritual punishment. These beliefs also exacerbate the mental health
challenges experienced by girls. Gwinji et al. (2020) further emphasized that cultural norms
which prioritize family honor and communal respect, prevent many girls from seeking mental
health services, as they fear the social consequences of being labeled mentally ill. Therefore,
stigma and discrimination create significant barriers to accessing mental health services
leading to delayed seeking of help. The SDH theory advocates for addressing underlying
causes of ill health such as discrimination as they deter positive health seeking behaviors.

4.4.3 Limited Financial Resources

Findings suggest that limited financial resources hinder girls from actively assessing mental
health resources available to them in Chitungwiza. A participant shared the following;

Kumba kwedu tinoita hand to mouth, kuti tiwane mari yekuenda kuchipatara
kunobhadhara maservices zvinotonetsa. Ndikatorwara ndinotosvika pakupora ndisina
kumboenda kuclinic kana kupharmacy hako. (P7)

(Hand to mouth is how we get by at home, to get money for hospital visits is difficult.
When sick, I can get well without going to the clinic or even a pharmacy.)

A key informant cemented that;

Poor families of prioritize basic necessities. Some girls may require transport money
to get free services. If families cannot arrange that money, they are not able to access
mental health services at all further complicating their mental health issues. (KI3)

53
From the above presented findings it is clear that limited financial resources is a determinant
that hinder girls from accessing mental health services. Girls from poor background often
struggle to afford hospital visits, transportation, and other related costs. Similarly, Patel et al.
(2015) established that children from poor families are less likely to seek mental health
services due to financial constraints, including the inability to afford treatment costs and
transportation. Poverty forces families to prioritize basic necessities like food over mental
health services. Mokwena (2018) also found that in South Africa, the high cost of mental
health services force low-income families to prioritize immediate needs and girls are
socialized to endure emotional distress. This kind of socialization cause some girls to
develop complex mental health challenges as they bootle up emotions. Financial constraints
also prevent girls from accessing free services due to inability to afford transportation. Wu et
al. (2017) found that in Asia, limited public health resources proportionally disadvantage
children from economically poor backgrounds as they face financial burdens when accessing
health care. As a result, girls may delay or forego seeking services. As lack of access to
mental health services worsen existing mental health issues. Financial constraints therefore,
create significant accessibility barriers to accessing mental health services. The SDH theory
posit that financial constraints creates social hierarchies that causes unequal access to health
services among disadvantaged girls.

4.4.4 Opportunity Costs

Findings show that girls are hindered from accessing mental health services by opportunity
costs. A participant had this to say;

Ndichingobva kuchikoro ndinofanira kunochinja mai pamusika, vanenge vachida

kunogeza vazorore since vanomukira kuMbare. Maweekends ndini ndinotoswera
ndichitengesa. Ndinoshaya nguva yekuenda kunotsvaga rubatsiro. (P4)

(After school, I relive my mother from our stall for her to rest since she wakes up early
to go to Mbare. All weekend I will be at the stall all day. I do not get time to go and
seek assistance.)

Another participant said that;

Ndogara namom nemasiblings angu vachiri kuEcd. Pandodzoka kuchikoro ndinenge

ndichifanira kuita basa repamba nekumirira vana vadzoke kuchikoro. Handikwanisi
kusiya vana voga so ndinoshaya time yekuti ndifambire nyaya dzangu. Mom vangu
vanoshanda 6 to 8. (FGDP1)

54
 (I live with my mother and siblings who are still in ECD. After school, I am supposed
to do house chores and wait for my siblings to come from school. I cannot leave them
alone, so I end up having no time for my affairs. My mother works from 6am to 8pm.)

A key informant said that;

Girls often have to choose between seeking mental health services and fulfilling other
responsibilities, such as school, extracurricular activities, or family obligations. Due
to these competing demands, they may prioritize other duties over their mental health
needs, fearing that seeking help will lead to missed opportunities or added
responsibilities. (KI4)

The above findings show that opportunity costs is another health determinant that hinder girls
in Chitungwiza from accessing mental health services. Girls prioritize school, family
obligations, and other duties over seeking mental health services. Patel et al. (2015) found
that some girls rarely have time for self-care, particularly in Africa. Girl's busy schedules,
including school, household chores and caring for siblings, leave little time for seeking
mental health support. Cavanaugh & Peterman (2019) further noted that in patriarchal
societies, girls are often socialized to suppress emotional expression and are less likely to be
prioritized in receiving health care, including mental health services. Thus girls feel forced to
choose between seeking assistance and fulfilling other responsibilities, fearing negative
outcomes. Barros & Silva (2020) also found that cultural norms often position the mental
well-being of girls as less important compared to their roles as caregivers or family
supporters, leading to a neglect of their psychological needs. As a result, mental health needs
are sacrificed for other responsibilities, potentially exacerbating mental health issues. The
SDH also posits that gender roles creates a form of social hierarchy that deters women and
girls from actively seeking health services.

4.5 STRATEGIES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AMONG

GIRLS IN CHITUNGWIZA
Participants and key informants proffered various solutions to improve access to mental
health services in Chitungwiza. These strategies include, community engagement,
collaborations and increasing online presence of support services. These are presented,
analyzed and discussed in detail in the following section.

55
4.5.1 Community engagement
Finding suggest that community engagement efforts can improve access to mental health
services among the girl child in Chitungwiza. A participant said that;

Ndinofunga kuti vakaita maroadshows sezvinoita ana Econet, vachiuya kuzotidzidzisa

nezvemental health munzvimbo dzatinge tiri zvingatibatsire. Mamwe akaitirwa
muzvikoro, mamwe munharaunda kuitira vasingaendi kuzvikoro. (FGDP4)

(I think they should do roadshows like what Econet does, they must educate us about
mental health in our respective places, and it would help a lot. Some should be done at
schools and some within residential areas for the benefit of those out of school)

A key informant had this to say;

Community engagement helps promote mental health awareness, reduces stigma, and
builds trust between girls and service providers, making them more likely to seek help.
It also ensures that mental health services are culturally sensitive and tailored to girls'
specific needs. (KI1)

The findings show that community engagement can educate girls and communities about
mental health, reducing misconceptions. WHO (2021) established that when participatory
mental health promotion initiatives are tailored to local contexts they reduce stigma and
increase service uptake. Thus, outreach efforts can help normalize mental health discussions
and reduce stigma. Community engagement ensures that services are tailored to girls' specific
needs and of the community. Barry et al. (2019) noted that mental health education is most
effective when it is culturally sensitive, gender-responsive, and delivered through trusted
local actors such as community health workers, faith leaders, and teachers. This shows that
community engagement fosters trust between girls and service providers, encouraging help-
seeking behavior. Tomlinson et al. (2016) established that community dialogue forums and
participatory theatre have been employed to raise awareness about mental health in South
Africa. These engagements encourage young people especially girls to be aware of mental
health issues and how to get services. These findings are in line with the SDH, as the theory
advocates for addressing underlying issues that contributes to mental health challenges such
as stigma and discrimination. Community engagements aims at addressing inequalities, dispel
misconceptions and strengthen health seeking behaviors among girls.

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4.5.2 Strengthening collaborations and partnership
Findings reveal the importance of strengthening collaborations and partnerships among
organizations to improve access to mental health services for girls in Chitungwiza. One of the
participants narrated that;

Vakaramba vachiita zvavakaita pacase yangu zvinoita kuti vakawanda vawanewo

maservices. Inini ndakanobatsirwa kuMusasa kuwana counselling yandaida. Social
welfare yakazondipa rumwe rubatsiro rwekuenda kumaCourts. Zvikaita kuti
ndibetserekane pazvose zvainetsa. (FGDP4)

(If they keep doing what they did on my case, it will make many receive services. I
received counseling services I needed from Musasa. The DSD helped me approach the
courts. This helped me to get the assistance I required.)

A key informant highlighyed that;

Partnerships can increase mental health support to more girls, especially in

underserved areas, by bringing together healthcare providers, schools, and
community organizations to offer comprehensive care. (KI1)

Another key informant shared the following;

Working together can enhance coordination, fill gaps, and make services more
effective. Partnering with community groups also helps customize support to girls'
specific cultural and individual needs. (KI5)

The findings reveal that partnerships can provide holistic support by bringing together
healthcare providers, schools and community organizations. Similarly, Patel et al. (2018)
advocates for partnerships between education systems, community-based organizations, and
social services enhance the reach and impact of mental health interventions by ensuring
continuity of care and addressing the socio-structural drivers of mental illness. Thus,
collaborations can extend mental health services to more girls, particularly those with
undeserved needs. Studies by Fazel et al. (2014) and Weist et al. (2017) agree that multi-
agency collaboration models improve early identification and response for girls exposed to
trauma and abuse. Partnerships can fill gaps in services, reduce duplication, and improve
overall effectiveness. Barry et al. (2019) argue that multi-sectoral coordination is essential to
create girl-centred interventions that are sensitive to gender, culture, and age. As such,
partnering with community groups helps tailor support to girls' specific cultural and

57
individual needs. Therefore, strengthening collaborations and partnerships is crucial in
ensuring that girls have equitable access to services and addressing barriers that hinder
access.

4.5.3 Increasing online presence of support services

Findings suggest that increasing the online presence of support services can increase girls'
access to mental health services in several ways. A participant said;

Panoda kuti kuve nemaservices anowanikwa online akawanda sezvinoita efriendship

bench. Akawanda uye akawanikwa pamaWhatsApp channels zvinotibetsera chaizvo
nekuti vamwe general data rotidhurira. Tikakwanisa kuwana services tiri chero
kwatiri zvinotinakira kusaver matransport. (P4)

(There need to more online services like those of Friendship Bench. If they increase
and they can be accessed on WhatsApp channels, this would help a lot because general
data is expensive. If we can get such services anywhere, it’s good for us because we
get saved from transport costs.

A key informant added that;

Online platforms can expand support reach, offering anonymity and flexibility,
helping girls access mental health services more comfortably and conveniently. (KI1)

The findings above highlight that online services can reach girls in remote or underserved
areas. Online platforms provide a private and comfortable space for girls to seek help. Girls
can access support at their convenience, reducing barriers like transportation costs and time
constraints. Similarly, Pillay & Dube (2018) noted that for services that provide 24/7 national
helpline for children in crisis ensure that young people can access help whenever necessary.
Thus, online services can reduce costs associated with in-person visits, such as transportation.
Marimba and Gondo (2020) also established that mental health services must be designed to
provide immediate assistance. Therefore, increasing online presence of support services can
help bridge the gap in mental health access for girls, providing them with convenient, private
and cost-effective support options.

4.6 CHAPTER SUMMARY

In this chapter, data was presented, analyzed and discussed. This was done in accordance to
the study’s aim and objectives. The findings have shown that there are socio-economic
factors that hinder the girl child from accessing mental health services in Chitungwiza. The

58
following chapter however, will provide this study’s summary, conclusion, areas for further
research, implications for social work practice and general recommendations.

59
CHAPTER 5

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

5.1 INTRODUCTION
Through data analysis and discussion, the preceding chapter has managed to establish mental
health services available at Chitungwiza Department of Social Development while
highlighting socio-economic factors hindering the girl child’s access to mental health
services. Again, the suggested strategies towards improving the girl child’s access to mental
health services from both the participants and key informants has also been established. This
chapter however, seeks to provide a summary of the findings, conclusions and
recommendations. This chapter will also establish this study’s implication to social work
practice coupled with highlighting areas for future research. Finally, the chapter summary
shall also be provided.

5.2 SUMMARY OF STUDY FINDINGS

The findings from the study reveal a comprehensive range of mental health services offered
to girls at the Department of Social Development (DSD) in Chitungwiza, addressing various
challenges they face. Central to these services are mental health assessments, which serve as
the initial step in identifying individual needs and planning tailored interventions. Participants
reported that these assessments help in recognizing symptoms such as depression, facilitating
access to necessary therapeutic support and aligning with the Social Determinants of Health
(SDH) theory that emphasizes addressing root causes of ill health. Complementing this,
awareness campaigns play a critical role in promoting understanding of mental health issues
within the community; participants noted that such initiatives significantly reduce stigma and
empower girls to seek help, highlighting the importance of early intervention. The provision
of counseling services was also emphasized, as girls shared experiences of finding a safe
space to express their feelings and receive guidance, which proved essential in coping with
traumatic events. Additionally, case management emerged as a vital mechanism for ensuring
continuity of care, enabling the DSD to create personalized plans that address each girl’s
unique mental health needs while facilitating access to relevant resources. Finally, the study
highlighted the importance of psychosocial support, where connections with peers who have
faced similar challenges foster a sense of community and reduce feelings of isolation. This
support is further enhanced by involving family members, thereby creating a robust network
that promotes emotional and mental well-being.

60
The study also identified several socio-economic factors that significantly hinder girls in
Chitungwiza from accessing mental health services provided by the Department of Social
Development. Lack of awareness emerged as a primary barrier, with many girls unaware of
mental health conditions, symptoms, and available services. Participants expressed confusion
about mental health issues, leading to delays in seeking treatment, as they often associated
mental health with negative stereotypes and stigma. This lack of knowledge resonates with
findings from other studies indicating that cultural stigma and misconceptions about mental
health contribute to low service utilization among adolescents. Social stigma and
discrimination further exacerbate the issue, as girls fear being labeled as "mad" and face
shame for discussing their mental health challenges. This societal pressure discourages them
from seeking help, perpetuating negative health-seeking behaviors and internalized stigma.
Additionally, limited financial resources were highlighted as a critical barrier, with many
girls from low-income backgrounds struggling to afford transportation and other costs
associated with accessing mental health services. This financial strain forces families to
prioritize basic needs over mental health care, leading to worsening conditions for those in
need. The findings also revealed the influence of opportunity costs, as girls often prioritize
school, household duties, and family responsibilities over their mental health needs. Their
busy schedules leave little to no time for seeking assistance, which is further compounded by
cultural norms that position their well-being as less important than their roles as caregivers.

The study identified several strategies to improve access to mental health services among
girls in Chitungwiza, emphasizing the importance of community engagement, strengthening
collaborations, and increasing the online presence of support services. Community
engagement was highlighted as a key approach that can enhance awareness and reduce
stigma around mental health issues. Participants suggested that initiatives such as roadshows
and educational campaigns would help inform girls about available services and normalize
discussions about mental health. This aligns with the findings that community-based mental
health education can effectively dispel misconceptions and foster trust between service
providers and girls. Additionally, the significance of strengthening collaborations and
partnerships among various organizations was evident, as these alliances can provide
comprehensive support by integrating healthcare providers, schools, and community groups.
Participants noted that effective partnerships could enhance service delivery, address gaps,
and ensure that mental health interventions are culturally sensitive and tailored to the unique
needs of the girls. Finally, the findings underscored the potential of increasing the online

61
presence of support services to facilitate access for girls, especially those in remote areas. The
availability of mental health resources through online platforms can offer anonymity and
convenience, allowing girls to seek help without the barriers associated with transportation
and time constraints.

5.3 CONCLUSIONS
From all the provided discussions above, the following conclusions were established:

The research illuminated the complex landscape of barriers faced by girls in St Mary's,
Chitungwiza when attempting to access mental health services. Central to these findings is
the recognition that a significant lack of awareness regarding mental health issues profoundly
affects help-seeking behavior. Many participants expressed confusion about mental health
conditions, often not recognizing the symptoms of their struggles until they reached a crisis
point. This lack of knowledge is compounded by societal misconceptions that equate mental
health challenges with madness, leading to stigma and fear of being judged. Consequently,
many girls hesitate to seek assistance, which delays their access to necessary services and
exacerbates their mental health difficulties. This underscores the urgent need for targeted
awareness campaigns that educate both girls and the broader community about mental health,
normalizing conversations and reducing stigma.

Furthermore, social stigma and discrimination emerged as formidable barriers that discourage
girls from pursuing mental health care. The fear of being labeled or judged by peers inhibits
open discussions about mental health issues, contributing to feelings of shame and isolation.
Participants indicated that societal attitudes often perpetuate self-stigmatization, where
individuals internalize negative perceptions about mental health, further complicating their
willingness to seek help. These findings mirror broader trends observed in various cultural
contexts, where mental health is often shrouded in silence and misunderstanding. To combat
these pervasive attitudes, community engagement initiatives are essential. By fostering
environments where mental health is openly discussed and supported, we can encourage
more girls to seek help without fear of repercussion.

The study also highlighted the significant impact of socio-economic factors, particularly
financial constraints, on access to mental health services. Many girls come from low-income
households, where basic necessities often take precedence over mental health care. The
struggle to afford transportation to clinics or the costs associated with treatment can deter
them from seeking help altogether. This reality is compounded by the opportunity costs

62
associated with accessing services, girls often prioritize family obligations and school
responsibilities, leaving little time for self-care. The implications of these findings are
profound, suggesting that any effective intervention must address not only the psychological
aspects of mental health but also the socio-economic realities that hinder access.

Finally, the research emphasized the importance of strengthening collaborations and

increasing the online presence of support services. Thus by fostering partnerships between
various stakeholders such as schools, healthcare providers, and community organizations, we
can create a more integrated approach to mental health care that is responsive to the needs of
girls. Additionally, enhancing the availability of online mental health resources can provide a
more accessible platform for girls to seek help, particularly in underserved areas. The
conclusions drawn from this study highlight the interrelated nature of awareness, stigma,
socio-economic factors, and the need for community-based solutions in improving access to
mental health services for girls in Chitungwiza. Addressing these challenges holistically is
essential for fostering a supportive environment where girls can thrive and receive the mental
health care they need.

5.4 IMPLICATIONS ON SOCIAL WORK

The findings of this study carry significant implications for the practice of social work,
particularly in the context of improving mental health service access for girls in Chitungwiza.
First and foremost, the identified barriers such as lack of awareness, social stigma, financial
constraints, and opportunity costs highlight the necessity for social workers to adopt a holistic
and multifaceted approach in their practice. Social workers must prioritize raising awareness
about mental health issues within the communities they serve. This involves not only
educating girls about the symptoms and treatment options available but also engaging with
families and community leaders to dispel misconceptions surrounding mental health. Social
workers can help reduce the stigma associated with mental health challenges, encouraging
more girls to seek the help they need without fear of judgment.

Moreover, the implications extend to the training and professional development of social
workers. It is crucial that social work education programs incorporate comprehensive training
on mental health literacy, stigma reduction strategies, and culturally sensitive practices.
Social workers should be equipped with the skills to identify mental health issues early and to
provide appropriate interventions. This training should emphasize the importance of building
trust with clients and communities, as trust is a critical factor in encouraging help-seeking

63
behavior. Additionally, social workers should be trained in navigating the socio-economic
factors that impact their clients' access to services, ensuring they are well-prepared to
advocate for resources and support systems that address these challenges.

The study also highlights the importance of interagency collaboration and partnerships in
enhancing service delivery. Social workers should actively seek to strengthen relationships
with other organizations, such as healthcare providers, educational institutions, and
community-based organizations. Thus by fostering a collaborative approach, social workers
can create comprehensive support networks that address the diverse needs of girls. This can
include sharing resources, coordinating services, and developing integrated programs that
provide holistic care. Such partnerships not only enhance the effectiveness of interventions
but also ensure that services are tailored to the specific cultural and individual needs of the
girls they serve.

Furthermore, the findings underscore the potential of using technology to improve access to
mental health services. Social workers should advocate for the development of online
platforms that provide mental health resources, counseling, and support. This approach can
be particularly beneficial for girls in underserved areas who may face transportation barriers
or time constraints. Thus by leveraging technology, social workers can increase the reach and
accessibility of mental health services, making it easier for girls to seek help in a confidential
and convenient manner.

Finally, the ethical implications of this study are profound. Social workers have a
responsibility to advocate for equitable access to mental health services and to ensure that the
voices of marginalized populations, particularly girls, are heard. Therefore by addressing the
systemic barriers that hinder access to care, social workers can contribute to a more just and
equitable society. This advocacy work is essential in promoting the well-being of girls and
ensuring they receive the support they need to thrive. The implications of this study call for a
proactive, collaborative, and culturally sensitive approach to social work practice in the realm
of mental health, ultimately aiming to empower girls in Chitungwiza to access the services
they require for their mental well-being.

5.5 RECOMMENDATIONS
Owing to the challenges encountered in accessing mental health services as highlighted in
this study, the following recommendations have been drawn from insights provided by
participants and key informants. To establish a holistic and sustainable framework for

64
improving mental health service access for girls in Chitungwiza, these recommendations are
categorized into four sections: the Government, Civil Society Organizations, the Community,
and Tertiary Education Institutions.

5.5.1 The role of government

Given the government's responsibility in promoting the rights and mental health of children,
the following recommendations are made:

 The government should expedite the harmonization and ratification of relevant mental
health policies and guidelines to facilitate effective implementation of mental health
services.

 There is a need for collaborative training among key stakeholders involved in mental
health service delivery, including social workers, healthcare providers, and
community organizations.

 The government should allocate a dedicated budget for mental health services to
reduce reliance on inconsistent donor funding.

 The government should look to successful models from other countries that have
implemented effective mental health interventions tailored to the needs of
adolescents. This could include adapting programs that address specific challenges
faced by girls, such as trauma-informed care.

 It is crucial to employ sufficient mental health professionals, including counselors and

social workers, to manage caseloads effectively. Adequate staffing will ensure timely
access to services and improve the quality of care provided to girls.

5.5.2 The role of Civil Society Organizations

Civil Society Organizations (CSOs) play a vital role in advocacy and community
engagement. The following recommendations are suggested:

 CSOs should continue to advocate for the rapid development and implementation of
policies that support mental health services for girls. This includes pushing for the
alignment of existing laws with current mental health needs.

65
  Collaborations among organizations focusing on mental health, children's rights, and
education should be enhanced. This will ensure a comprehensive approach to mental
health service delivery, addressing the various dimensions of girls' needs.

 CSOs should implement community-based programs that educate the public about
mental health issues, rights, and available services.

5.5.3 The role of the community

Community engagement is crucial in shaping attitudes towards mental health.
Recommendations include:

 Active, child-centered community groups should be formed to represent girls' mental

health needs. These groups can provide peer support and empower girls to advocate
for their rights and well-being.

 Community leaders and Child Care Workers should take the initiative to educate
families about mental health services, ensuring that community members understand
the importance of seeking help and how to access available resources.

 Involve families in mental health education to help reduce stigma and encourage
support for girls seeking help.

5.5.4 The role of education institutions

Educational institutions are essential in training future professionals in mental health.
Recommendations for these institutions include:

 Tertiary institutions should revise their curricula to align with contemporary mental
health dynamics, incorporating legal theory, child development, and mental health
education to better prepare students for practice.

 Institutions should emphasize experiential learning by providing students with

opportunities to engage in real-world mental health settings. This can include
internships or placements in mental health facilities, allowing students to apply
theoretical knowledge in practice.

 Schools should implement mental health programs and provide training for teachers
to recognize mental health issues and support students effectively.

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5.6 AREAS FOR FUTURE STUDIES
Given the issues established in this study, several areas warrant further research:

1. The study revealed a significant lack of knowledge among girls and stakeholders regarding
their rights related to mental health services. Future research should focus on mental health
rights and the eligibility criteria for accessing these services, which can empower individuals
and facilitate easier access.

2. There is a need for studies that specifically examine the impact of mental health services
on female adolescents, as much of the existing research tends to focus on male counterparts.
Understanding their unique experiences can inform more tailored interventions.

3. The study emphasized the lack of support from parents or guardians due to financial
struggles as a barrier to accessing mental health services. Future research should examine the
effects of parental participation and economic constraints on mental health outcomes, using
correlational designs to establish the relationship between poverty and access to services.

4. Given the reluctance of some individuals to seek mental health services, studies should
explore the factors that determine the likelihood of accessing available mental health
resources. Understanding these factors can help improve engagement strategies and promote
restorative approaches in mental health care.

5.7 CHAPTER SUMMARY

This chapter provided a comprehensive summary of the study's findings, highlighting the
significant barriers that girls in St Mary's,Chitungwiza face in accessing mental health
services. Key conclusions emphasized that while various mental health resources exist, socio-
economic factors, stigma, and limited awareness deter many from seeking help. The study
underscored the importance of addressing these challenges to align with social work values
such as social justice, human dignity, and the need for equitable access to care.
Recommendations were outlined to enhance service delivery, and areas for future research
were identified to further explore the implications of these barriers on mental health
outcomes for girls.

67
68
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Journal of Adolescent Health, 60(3), pp. 238-244.

APPENDICES

APPENDIX 1: CONSENT FORM FOR PARTICIPATION IN RESEARCH STUDY

RESEARCH TOPIC:

Socio-Economic Factors Affecting the Girl Child’s Access to Mental Health Services at
Chitungwiza Department of Social Development: A Case Study of St Mary’s, Chitungwiza

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Researcher: Melissa Milan Mdoka,

Women’s University in Africa

Purpose of the Study:

The aim of this study is to examine how socio-economic factors influence the girl child’s
access to mental health services at the Chitungwiza Department of Social Development, with
a focus on the St Mary’s area. The findings will help to identify key barriers and suggest
ways to improve access to mental health care for girls in this context.

What Participation Involves:

You will be asked to participate in an interview lasting approximately 30 minutes.

The interview will involve questions about your experiences, views, or observations
regarding socio-economic conditions and how they affect girl’s access to mental health
services in St Mary’s.

The interview may be audio-recorded with your permission.

You are free to skip any question or stop the interview at any time without any negative
consequences.

All the information you provide will be treated with strict confidentiality. Your name and any
identifying details will not appear in any reports or publications. Responses will be
anonymised using pseudonyms.

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Risks and Benefits:

There are no direct risks or financial rewards for participating. However, your views will
contribute to understanding and improving access to mental health services for vulnerable
girls in St Mary’s, Chitungwiza.

Consent Statement:

I have read and understood the purpose and nature of this study. I understand that my
participation is voluntary and that I may withdraw at any time without giving a reason. I
freely agree to participate in this study.

Participant Pseudonym …………………………..

Signature ……………………………..

Date ……………………….

Researcher…………………………

Signature…………………………

Date……………………………

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APPENDIX 2: SEMI-STRUCTURED INTERVIEW GUIDE FOR GIRL CHILD
PARTICIPANTS

Introduction:

Hello, my name is Melissa Milan Mdoka, and I am a student at the Women’s University in
Africa. I am doing a study to understand how easy or difficult it is for girls like you to get
help with your mental health, especially at the Chitungwiza Department of Social
Development. This means learning about the kinds of support available, what challenges you
face in accessing help, and how we can make things better for you. What you share will stay
private and will help improve services for girls in your community. If you're ready, may we
begin?

Section 1: Mental Health Services Available for Girls

1. Have you ever heard of places where girls can go to talk to someone when they are feeling
sad, stressed, or worried?

2. Do you know about any mental health services or support offered by the Department of
Social Development here in St Mary’s?

3. Have you ever used any of these services or do you know someone who has? What kind of
help did they give?

4. Are there enough people or services to help girls with mental health issues in your area?

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Section 2: Socio-Economic Challenges to Accessing Mental Health Services

5. What do you think stops girls from getting help when they are going through mental or
emotional problems?

6. Do you think things like money, family problems, or where someone lives make it harder
for girls to get mental health help? How?

7. Are there any beliefs in your home, school, or community that make it hard for girls to ask
for help?

8. How do you or your friends feel when you think about going to get help for mental health?
Is it easy or hard to talk about these things?

Section 3: Ways to Improve Access to Mental Health Services

9. What do you think should be done to help girls get the mental health support they need?

10. What kind of support would you like to see in your school or community to help girls
who are struggling emotionally?

11. If you could talk to leaders or social workers at the Department of Social Development,
what would you tell them to do differently?

12. What kind of programs or people do you wish were available to help you when you’re
feeling mentally or emotionally unwell?

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APPENDIX 3: KEY INFORMANT INTERVIEW GUIDE

Researcher: Melissa Milan Mdoka

Institution: Women’s University in Africa

Research Topic: Socio-Economic Factors Affecting the Girl Child's Access to Mental
Health Services at Chitungwiza Department of Social Development: A Case Study of St
Mary’s Chitungwiza

Introduction:

Good day. My name is Melissa Milan Mdoka, a student at the Women’s University in Africa.
I am conducting a study to explore the socio-economic factors affecting the girl child’s access
to mental health services in St Mary’s, Chitungwiza, with a focus on the Department of
Social Development. As someone with expert knowledge in this area, your insights will
greatly enrich this research. Your responses will remain confidential and used only for
academic purposes. With your permission, may we begin?

Section 1: Availability and Scope of Mental Health Services

1. What mental health services are currently available at the Department of Social
Development in Chitungwiza, specifically for girls?

2. Are there any targeted programs or interventions aimed at addressing the mental health
needs of the girl child in this area?

3. How effective have these services been in reaching adolescent girls in St Mary’s?

4. In your view, is there adequate staffing, infrastructure, and resources to support girls
mental health needs?

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Section 2: Socio-Economic Barriers to Access

5. From your professional experience, what are the major socio-economic factors hindering
the girl child’s access to mental health services in this community?

6. How do factors such as poverty, unemployment, household income, and housing affect
access to these services?

7. Are there any cultural, religious, or gender norms in St Mary’s that affect how families or
girls themselves view mental health care?

8. What role do schools and families play in either facilitating or hindering access to mental
health support?

Section 3: Strategies for Improvement

9. What has been done so far to address these access challenges within the Department of
Social Development or in collaboration with other stakeholders?

10. In your view, what strategies or policies could be introduced or strengthened to improve
access to mental health services for girls in St Mary’s?

11. What kind of community-based interventions or outreach programs do you think would
be most effective?

12. What recommendations would you make for strengthening institutional support for
adolescent girls' mental health in low-income urban areas like St Mary’s?

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APPENDIX 4: FOCUS GROUP DISCUSSION GUIDE

Researcher: Melissa Milan Mdoka

Institution: Women’s University in Africa

Research Topic: Socio-Economic Factors Affecting the Girl Child’s Access to Mental
Health Services at Chitungwiza Department of Social Development: A Case Study of St
Mary’s Chitungwiza

Introduction

Good day. My name is Melissa Milan Mdoka, a student at the Women’s University in Africa.
I am carrying out a study on the challenges that affect the girl child’s ability to access mental
health services at the Department of Social Development in St Mary’s, Chitungwiza.

This discussion is meant to hear your views and experiences so we can better understand the
problems girls face and explore ways to improve access to mental health care. Everything
you say will be kept confidential, and no names will be used in the final report. You do not
have to answer any question you are uncomfortable with. Feel free to speak openly and
respectfully. May we begin?

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Section 1: Awareness and Use of Mental Health Services

1. What do you understand by“mental health”or“mental health services”?

2. Are you aware of any mental health services available for girls in St Mary’s or at the
Department of Social Development?

3. Have you or anyone you know ever used mental health services? What was the experience
like?

4. What kinds of mental health challenges do girls your age commonly face in this
community?

Section 2: Socio-Economic Barriers to Access

5. What makes it difficult for girls in your community to access mental health services when
they need them?

6. How do issues such as lack of money, transport, school dropouts, or family problems affect
girl’s ability to get help?

7. Do you think families and the community support girls in seeking help for mental health
issues? Why or why not?

8. Are there any beliefs, attitudes, or customs that discourage girls from using mental health
services?

Section 3: Coping Strategies and Support Systems

9. When girls in this area face emotional or mental challenges, where do they usually go for
help?

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10. What role do schools, churches, youth groups, or peers play in helping girls deal with
these problems?

Section 4: Solutions and Recommendations

11. What changes would make it easier for girls in your community to access mental health
care?

12. What types of programs, services, or people would you like to see available to support
girls with mental health needs?

13. If you had the chance to advise government or social workers, what would you suggest
they do differently?

82