Families seeking help for traumatised children often face a problem that therapy alone cannot solve. Hunger, lack of school fees, and unstable living conditions can quietly block access to care, even when services are available. New research highlights how these everyday hardships directly shape whether children engage with mental health treatment.
The study, published in PLOS Mental Health, examined how social risk factors affect participation in trauma focused cognitive behavioural therapy among children in western Kenya. Researchers spoke with children, guardians, and lay counsellors delivering care in schools, focusing on real experiences rather than controlled clinical conditions.
Social risk factors refer to the conditions in which people are born and live, including poverty, food insecurity, and limited access to education. These factors are especially common in low and middle income countries, where mental health services are already limited. The study notes that although over 13% of the global population lives with a mental disorder, access to adequate care in these regions can be as low as 5–21%.
In this context, the research focused on children who had lost one or both parents, a group known to face higher risks of depression, anxiety, and trauma related symptoms. Many also deal with overlapping challenges such as stigma, poor nutrition, and disrupted schooling. These pressures do not exist in isolation and often make it harder for children to attend or fully engage in therapy.
Findings showed that basic needs had a direct impact on treatment participation. Children who lacked food or travelled long distances to school often arrived too tired to take part in sessions. Others felt embarrassed by torn clothing or poverty, which reduced confidence and willingness to engage. Guardians, meanwhile, sometimes missed sessions because they needed to prioritise finding food or income for their families.
Counsellors reported that these barriers affected not only attendance but also the quality of engagement. Even when children were present, their ability to focus and benefit from therapy was reduced. This highlights a key issue in global mental health, where access alone does not guarantee effective care.
The study also found that many counsellors were already trying to address these challenges, often using their own limited resources. Some provided school supplies, clothing, or food, while others worked with schools to prevent children being excluded for unpaid fees. However, this informal support raises ethical concerns and risks placing additional strain on already under resourced workers.
Importantly, participants identified practical strategies that could improve engagement without requiring large financial investment. These included closer collaboration with schools, stronger communication with families, and teaching life skills or income generating activities. Such approaches aim to reduce barriers while preserving the core structure of therapy.
Where social risk factors were addressed, the impact was clear. Children showed improved mental health, higher self esteem, and better school attendance. Engagement in therapy also increased, suggesting that small, context specific adjustments can significantly improve outcomes.
The findings point towards a broader shift in how mental health care is delivered in low resource settings. Rather than treating therapy and social conditions as separate issues, the research suggests they must be addressed together to be effective.