There is a widening mental health treatment gap for children and adolescents in sub-Saharan Africa. The region has few economic or human resources dedicated to the mental health of children and young people. The World Health Organization's Mental Health Gap Action Plan and the push for mental health to be included in the Millennium Development Goals have raised the profile of child mental health but comparatively few studies have estimated prevalence rates or assessed needs or tested interventions in African countries. In most countries there is no clear pathway to access treatment, especially in-patient facilities. This article considers these issues from clinical, educational and research perspectives.