No Psychiatrist, No Waiting List Spot, No Help: Why Follow-up Care Matters for Neurodivers Families.

"Sorry, We're Full": A Very Specific Kind of Annoyance

I get a particular feeling when I phone to refer a client and hear, "Unfortunately, she's not taking new patients at the moment." It isn't quite anger, and it isn't quite despair. It's somewhere between stubbing your toe on the same coffee table for the fourteenth time and discovering the load-shedding schedule changed without anyone telling you.

I hear it a lot. Psychiatrists, psychologists, occupational therapists and developmental paediatricians are full, booked out for months, or "not accepting referrals until further notice." In Cape Town, that roughly translates to "try again when your child is in matric."

This is what keeps me up at night. When I reply to a parent the same day, or the next morning, they are genuinely shocked. They're happy, yes, but shocked. A quick reply should be the bare minimum. Somewhere along the line, it became a luxury.

The Numbers Behind the Waiting Lists
This isn't just me being impatient (although, to be fair, I am a little bit impatient).

The South African figures are sobering:

Fewer than 40 child and adolescent psychiatrists.
In March 2026, the South African Society of Psychiatrists (SASOP) said South Africa has fewer than 40 registered child and adolescent psychiatrists across the public and private sectors combined, most of them in Gauteng and the Western Cape.

With a population of over 60 million, that is roughly one child psychiatrist for every 1.5 million South Africans.Only one in ten gets care. SASOP estimates that one in five South African children and teenagers lives with a mental health condition. Only about one in ten of them can access the care they need.

We're also losing the specialists we have. In just a few years, several South African child psychiatrists have emigrated to New Zealand and Australia.

Our best figure is still tiny. A UCT and SA Medical Research Council study found the Western Cape had the highest availability of public-sector psychiatrists in the country, at just 0.89 per 100,000 people. Nationally, the figure was 0.31.

Services are concentrated in the city. Research on Western Cape child and adolescent mental health services found most resources were in the City of Cape Town. There were no dedicated child-friendly mental health services at primary or secondary care level.So yes, Cape Town is technically the "well-resourced" option. Let that sink in while you sit on hold.

The Child With Nowhere to Go

Right now, I'm working with a young boy who has a PDA diagnosis but also shows Callous-Unemotional (CU) traits. He needs to see a psychiatrist. I have tried almost every avenue I know, and I know a lot of avenues.
I'm working with him because I can. Standard psychiatric units are generally designed for short-term, acute stabilisation, not long-term containment. Evidence-based treatment for high CU traits usually centres on intensive outpatient, multisystemic approaches. These include specialised family-based interventions and behavioural support that involve everyone around the child. That is what I'm trained to do, and it's what I do.But this family needs more than one person. Their son is escalating. Every time the phone rings, part of me braces for the call where someone has been seriously hurt and there is still nowhere to turn.
I do my best, and I keep showing up. But "my best" was never meant to replace a whole care team.

When the Helper Needs Help

This isn't only a professional frustration. It's personal too.
My sister passed away in August. Since then, I've been trying to see my own psychologist. She has rescheduled my appointments more times than I can count, even after I told her plainly that I needed support working through my sister's death. I've now spent more time looking at my calendar than talking about my grief.
I want to be clear: she is an excellent psychologist. She isn't careless. She's overcommitted and stretched across too many people who need her, in a system that simply doesn't have enough of her.

I work inside this world and know exactly whom to call, and I can't get a session. What chance does an exhausted mom in Mitchells Plain or Kraaifontein have at 9pm on a Tuesday?

"That Wasn't Bad. Thank You, Aunty Andrea."

💉 Last week, I went with a very stressed mom to take her son for his first blood test. He was petrified, and so was she.Honestly, the nurse looked a bit nervous too, and she does this all day.I coaxed him out of the passage. In the nursing room, I chatted to him about anything and everything that wasn't a needle.

Eventually I was holding him in a big, tight hug while he screamed directly into my ear. (My hearing is fine, thank you for asking. Mostly.)
When it was over, he pulled back and said, "Oh. That wasn't bad. Thank you, Aunty Andrea."
♥️ The gratitude on his mom's face will stay with me always. As a mom myself, I know those moments. You're holding your child together while quietly falling apart yourself, and you'd give anything for someone else to take the weight for five minutes.

🫖 I'm very happy to tap out a mom or dad and be their child's safe person for a while. Go and rest. Go and have a coffee while it's still hot. Go and scream into a pillow. That care is necessary, and needing it isn't a sign that you're failing.

Diagnosis Is the Beginning, Not the Finish Line

😵‍💫 We put enormous focus on diagnosis and medication, and both matter. But a diagnosis is a map, not the journey. A family walks out of an assessment with a report full of terminology. Then they go home to a Tuesday-night meltdown with nobody to call.

👥 What's so often missing is the in-between. It's the follow-up and the check-in. It's the message the next day that says, "I was thinking about what you said. Can I ask you something?"

🫂 Families need someone who notices things sliding before they reach crisis point. Even SASOP's leadership has said the answer isn't only training more psychiatrists. It's also upskilling others and spreading the work more widely, because child mental health has to be everybody's business.

🤗 That's where practitioners like me can help carry some of the load. We don't replace psychiatrists and psychologists. We work alongside them and fill the gaps between appointments. I truly love this work, but I'm one person. We need more of us. We also need our systems to value relationship-based follow-up care as much as they value a prescription pad.

Meanwhile, at Home: Hugs by the Minute

🏡 And then I come home. Two of my own children are going through a bit of a rough patch, and they need co-regulation hugs roughly every four minutes. I give them gladly, and I also get exhausted. So many other moms are running on the same fumes. We give everyone else their regulation while quietly wondering who is going to regulate us.

🌞 But there's always light in it. 

Yesterday my eldest gave me a lovely hug, then pointed over my shoulder and said, "That cat looks like Hitler."I said, "Whaaat?" and turned around. There on the garden wall sat a neighbourhood cat with a little patch of dark fur right under his nose, shaped exactly like a toothbrush moustache. He did, in fact, look like Hitler. He was also extremely unbothered about it.

🌈 That's the neurodiverse way of seeing the world. You notice the detail everyone else walks right past, and you name it with total, deadpan honesty. I laughed until my stomach hurt. Given the month I've had, it was probably the most therapeutic thing that has happened to me since August.

🙏 Please, Reach Out

If you're a parent who is tired, scared, or quietly coming apart at the seams, please reach out. Talk to a friend, a family member, a support group, a practitioner, anyone. Asking for help isn't weakness. It's how families survive the long stretches between appointments.

♥️ And to my fellow professionals: I know you're stretched thin, and I know the waiting lists aren't your fault. But if you can send that one follow-up message, make that one check-in call, or answer that email the next day, please do. To a family in crisis, it can mean everything.

I'll keep doing my best. I'll keep showing up for blood tests, school meetings and the 9pm WhatsApps. And I'll keep an eye out for that cat.

Sources: SASOP statements reported by Weekend Argus and OFM (March 2026); Daily Maverick/Spotlight (March 2024); UCT/SAMRC study reported by TimesLIVE (2019); Mokitimi et al., situational analysis of Western Cape child and adolescent mental health services (2022).