The mental health impact of intergenerational violence on children

(Photo: By James Fowler)

Taking a drive down Klipfontein Road in Cape Town can be a herculean task depending on the time of the day. Pedestrians, taxis, Golden Arrow buses and cars all compete for pole position on the road. Hawkers dipping and diving through the busy race, trying to sell fruits, vegetables or other wares. After passing through Athlone, and crossing Jakes Gerwel Drive, you eventually arrive at the gates of the Saartjie Baartman Centre for Women and Children (SBC). The gates sit just on the edge of Manenberg, a large community in the Cape flats.

The facility is a labyrinth. “Kind of like navigating service providers as a survivor of gender-based violence (GBV),” quips Advocate Bernadine Bachar, the centre’s fiercely passionate Director, while taking Health-e for a tour. The eggshell-coloured concrete walls have an institutional feel like an old hospital or clinic. “It used to be a substance abuse facility,” says Bachar. 

Despite the coldness of the walls, the warmth of the centre seeps from every corner. Children’s laughter fills the halls alongside motivational posters, artwork and beautiful murals. It is clear the SBC is a much-loved safe haven for women and children.

“I always say it takes the greatest amount of courage to get to those gates,” says Bachar.

(Photo: Jame Fowler)

The SBC has been around for 23 years and was the very first one-stop centre for women and children survivors nationally, providing a holistic package of services. Today, the centre has helped over 250 000 women and children. Why Manenberg? The Cape flats is an area characterised by high levels of unemployment, poverty, abuse against women and children, substance abuse, gangsterism, and many social challenges, explains Bachar. The centre’s creation was in response to a clear-cut need in the community. 

Advocate Bernadine Bachar, Director of the Saartjie Baartman Centre for Women and Children. (Photo: James Fowler)

“The idea behind the centre is that women can come through and receive all services they would need as survivors of GBV,” says Bachar. This includes linking survivors to the appropriate health and forensic services. The SBC operates over nine programmes that directly address the needs of survivors and children at a grassroots level. “That’s what makes SBC so novel, the needs of survivors are always changing, so SBC evolves to meet those needs.”

The 120-bed facility’s wide array of programmes includes an initial four-month in-residence programme, as well as a six-month second-stage housing programme which is on the premises. There is also a substance abuse unit on site, one of the first in the world for GBV shelters. Plus, an Early Childhood Development (ECD) centre and a homeschooling programme to prevent the shuffling of children from school to school as a result of family challenges or as a means of escaping the perpetrator. 

The centre also offers an economic empowerment programme to assist residents with vocational training skills for future employment. 

But, the SBC’s work does not end at its gates. Their services extend into the greater community, including a nine-week child protection programme, legal assistance and support, and outreach and advocacy work. 

Children’s mental health responses to violence

The staff complement at the SBC is filled to the brim with women (some of who are former residents) who share a passion for children. 

“There is a lot of work that needs to be done with children who have been victims of or exposed to GBV in the home, so we have programmes for them as a means to break that intergenerational cycle of abuse and to ensure that children have the best possible launching pad once they’ve left,” says Bachar. 

The root drivers of GBV against children are largely the same as adults, she says. Between the levels of adherence to patriarchal values, the huge gender gap, poverty and substance abuse, “it really does require a very nuanced and complex response,” she says. 

Dilshaad Esau, the Centre’s ECD teacher, along with two women from the Centre’s Child Protection Unit (CPU), spoke to Health-e about the impacts of violence against children and what they see in the children and adolescents that they work with. 

(Photo: James Fowler)

“A lot of the children that we see have witnessed abuse or trauma [and] come in with behaviour problems, low self-esteem, suicidal thoughts, and inability to cope at school. It’s a lot of continuous trauma that they experience throughout their lives,” says Shameema Van Dyk, a social worker with the CPU.”

Fellow CPU social worker Kayla Williams adds to this: “The children are not necessarily direct victims, but the parents are, so they are in-direct victims. They get to see mommy broken, they get to see mommy cry, [and] they don’t necessarily know what to do. They suppress what they are feeling [and] they lash out. Normally we find this in the school setting, then the school will refer the child to us.”

“By the time they get to us, we have to address the behaviour, but it should have been done a long time ago,” adds Van Dyk.

“For the kids in the shelter, you see the lashing out because that’s what was made a role model for them,” says Esau. “You see them get physical, [and] you see the swearing. Once they realise this is a comfortable space, you have a lot of meltdowns, a lot of blowouts, and lots and lots of crying. This is what we generally see.”

Esau details that often the children that come into the centre are part of the abuse cycle in the home environment, particularly very young children. She says that if the young children are in the way or trying to get to mommy to shield or protect her, they will also be abused. 

Mental health insights from the classroom

In Esau’s ECD classroom, colourful crafts of birds, bees and butterflies dress the walls of the room. It is nap time during Health-e’s visit so all is calm and quiet in the room as about a dozen young children lie fast asleep on small mattresses with soft blankets. 

At the end of each school day, Esau does what she calls a ‘review of the day’ with each young learner. This is a space for them to tell me what they liked or didn’t like, and I do the same, she says. “[During this time] they start opening up to me more and more about things that have happened in their past so I can move it over to the child counsellor or the social worker to tackle the deeper issues.”

She says that these conversations often reveal that the children have had constant exposure to different forms of violence, often from a very young age. 

“They will start detailing for you what was used to beat the mother, how she used to cry, what the injury looked like.”

“I had a little boy who was really not having a good day and was physically going at me, and [another] little boy actually told him ‘must I bring you something? I used to bring my daddy the hammer to hit my mommy,’ so he wanted to give something to the boy to hit me with. Those are the type of things we see, and with the help of the social workers, we try to teach them that that’s not the way to go about it.” 

Breaking the intergenerational cycle of violence

Bachar, Esau, Van Dyk and Williams are all playing a part in breaking the intergenerational cycle of violence that can impact children from the prenatal phase long into adulthood. Professor Shanaaz Mathews, Director of the University of Cape Town Children’s Institute, spoke to Health-e about this cycle. 

During Mathews’ PhD work, she investigated the pathways that led to men taking on violent masculinities, or in other words, aggressive, dominant and violent behaviours, particularly towards women and children.

“I interviewed men in prison who killed their partners, very violent men, but what that piece of work had shown is that childhood adversities shape who men become. The emotional vulnerabilities that form in the early years for these men play out in their intimate relationships. We should not disconnect what’s happening in childhood from violence later on in life,” she says. 

These patterns of violence are cyclical, she adds, with women often being the ones trapped in these violent relationships. 

The SBC takes in women and children as old as 17, while other shelters may only take boys up to the age of 10. Mathews says this is a huge constraint and forces mothers to leave children behind, sometimes on their own or with the perpetrator, or women choose to stay in violent relationships – it is a “catch-22” for them. 

“We need to be rethinking how services are designed. Our system thinks of young boys themselves as being perpetrators, and we’re creating those perpetrators if we’re not providing safe spaces for them,” she emphasises.

“It’s very critical that we have a life course understanding of violence.”

Shooting in the dark

Looking for data on the prevalence of GBV cases against children, and corresponding data on mental health outcomes is a thankless task. The only data available is from small localised populations in parts of the Western Cape or other countries around the world, explains Mathews. 

“We don’t have any data on mental health for children in South Africa. South Africa has not invested in a survey looking at the mental health of children, and I think it’s a crucial gap. If we don’t understand the problem we are dealing with, how are we going to be able to design interventions? From an epidemiological point of view, we actually are shooting in the dark,” she says. 

In terms of the prevalence of sexual violence, Mathews highlights the 2015 Optimus Study, which provided the first national prevalence data on child abuse, violence and neglect.  In the latest edition of the Child Gauge, published by the Children’s Institute, it states that the study “found that 42% of children have experienced some form of violence – including sexual abuse (35%), physical violence (35%), emotional abuse (26%) and neglect (15%).”

Our current models of mental healthcare are not appropriate, or designed, taking into consideration the chronic and cumulative nature of trauma that our children are experiencing here, says Matthews.

Currently, mental healthcare services for children and adolescents are integrated into primary healthcare structures, but human resources for child and adolescent mental health are extremely limited. The Gauge reports that the country currently has 60 child and adolescent psychiatrists; of those, 20 work in the public sector. 

Last year, Spotlight reported that the National Mental Health Policy Framework and Strategic Plan 2013-2020 had lapsed, and that the new plan was underway. Health-e asked how the new plan will seek to raise the bar on mental health care services and support for children and adolescents who witness and experience GBV.

In response, Foster Mohale, Spokesperson for the National Department of Health, says that the literature review and feedback from stakeholders indicated that most of the content of the lapsed plan is still relevant. “The process that is underway is to review and update the policy which includes areas that need to be strengthened. Issues of child and adolescent mental health will be strengthened in the new policy, which adopts a public health approach to mental health,” he says. 

“In the old plan, children were quite invisible,” says Mathews, “it will be interesting to see how they feature in the new plan.” 

Lori Lake, Communication and Education Specialist at the Children’s Institute, adds to Mathews concerns. “One of the things we would like to see is the strengthening of support for children with parents with mental health disorders. We know these children are more vulnerable, yet mental health services tend to be focused on the adult index patient. So we need to adopt a child- and family-centred approach sensitive to the intergenerational cycles of poverty, violence and poor mental health,” she says.

To further increase access to mental health services, Mohale states that a mental health conditional grant has been made available for provinces to contract private psychiatrists, psychologists, social workers and registered counsellors to complement the already available professionals and render mental health services in primary health care. 

“Inservice training of staff on management of mental health issues, including those that affect children and adolescents, is regularly conducted to ensure that staff are skilled to deal with the issues. These and other interventions are aimed at strengthening the access to and quality of mental health services for all age groups, including children and adolescents,” he adds.

Hopeful mental health policies and community-based solutions

Turning to solutions to the growing pandemic of GBV, the SBC offers a beacon of hope to women and children from communities in the Cape flats and beyond as they work to break the intergenerational cycle of violence. 

Moving forward, Mathews states that when we’re thinking about the depth of the problem of violence against women and children, we need to think about multi-component approaches.

“For many years our response has largely been a criminal justice response, which has shown us that we’re not making significant differences in the lives of women and children. In terms of our policy responses and our emphasis on building a criminal justice system that can address the problem, I think it is not sufficient to prevent violence.”

Earlier this year, three new amendment bills aimed at reducing gender-based and domestic violence were signed into law. In 2021, the long-awaited National Strategic Plan on Gender-based Violence and Femicide (NSP GBVF) was also passed. However, Bachar comments that the plan is not fully operational due to a lack of budget. 

The National Treasury was approached for comment on this matter but did not provide a response. 

Mathews holds some concerns about the NSP GBVF, stating that children remain at the margins. “You’ve got a plan that emphasises women and not thinking critically about how we take children along this journey. If we use the language ‘GBV’, we also miss out on other types of violence children experience. For example, violence in the home, because that’s not always seen as gender-based violence.”

(Photo: James Fowler)

Mommies and daddies mustn’t fight

“Girls and boys, tell me when you are feeling safe, what does feeling safe mean?” asks Esau, affectionately known as Teacher D.

“Your tummy feels warm,” says one child.  “Happy!” shouts another. “Loved!” another adds. 

“What do you think will make the world a safe place for big friends and small friends?” Esau asks. “Be kind,” says one child. “You must be kind; that’s a very nice one!” She waits for more replies from the group of learners, who are no more than five-years-old. 

“Mommys and daddies mustn’t fight,” a child adds a few moments later.

“So you’re saying people must be kind, and mommies and daddies mustn’t fight, and that will make the world a better place?” 

The children answer with a resounding, “yes!” – Health-e News

Kathryn Cleary is a volunteer journalist and was approached by Health-e News for this story. Cleary currently works as the Member Engagement Coordinator of the Internews Health Journalism Network, and was previously named the overall winner of the 2020 Isu Elihle Awards for child-centred journalism in Africa. 


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