Understanding and addressing the mental health needs of adolescents
To truly understand the needs of adolescents, it is vital to listen to adolescents themselves. This was a central feature on the agenda of the first ever inter-country meeting and international conference addressing the mental health and well-being of adolescents living in central Asia, which took place on 17–20 January in Almaty, Kazakhstan. The meeting was hosted by the Government of Kazakhstan and organized by the United Nations Children’s Fund (UNICEF), in collaboration with WHO. Country delegations from Belarus, Kyrgyzstan, Tajikistan, Ukraine and Uzbekistan, as well as Kazakhstan, participated in the exchange of knowledge, experiences and plans to better understand and address the mental health needs of adolescents.
Meeting participants were privileged to hear the heartfelt and very personal testimonies of a number of adolescents who have recently experienced mental health issues including anxiety, depression, suicidal thoughts and self-harm. These issues have typically been triggered by adverse experiences such as being bullied at school, losing a grandparent or moving country. The collective plea from these young people was that they want to be listened to, and given better protection and access to help when facing adversity in their lives. Their plea went straight to the heart of the agenda, which emphasized the need for a multistakeholder, intersectoral approach towards mental health promotion and protection.
Mental health of adolescents a growing concern
Childhood and adolescence is a critically important stage of life for the mental health and well-being of individuals, as this is when young people develop their skills in self-control, social interaction and learning. Negative experiences – such as family conflict at home or bullying at school – can have a damaging effect on the development of these core cognitive and emotional skills. The broader socioeconomic conditions in which children grow up can also have a telling impact on subsequent choices and opportunities in adolescence and adulthood. Poor housing or living conditions, for example, may be seen by young people as shameful or degrading, may reduce opportunities for productive learning and social interaction, or may increase their exposure to substance abuse, disease and injury.
The manifestation of these negative risk exposures can be seen in high and increasing rates of mental and behavioural health problems at the population level in the WHO European Region. Depression and anxiety disorders fall within the top 5 causes of overall disease burden in this age group (as measured by lost years of healthy life), and suicide is the single leading cause of death among adolescents in the low- and middle-income countries of the Region. Half of all mental health problems in adulthood have their onset during or before adolescence.
Cross-sectoral efforts to improve mental health programmes and interventions
The meeting in Kazakhstan focused on mounting an effective response across sectors, with particular emphasis given to the role of school-based programmes in promoting mental health and preventing suicide. For example, building on an earlier assessment of the prevalence and underlying risk factors in relation to suicide in Kazakhstan, a new UNICEF-supported initiative has seen the introduction of a structured, multi-tiered programme involving nearly 300 schools and 50 000 school pupils. The programme combines early identification of school pupils at risk for suicide and mental health problems with gatekeeper training for school staff and awareness-raising among adolescents. Evaluation of the programme has shown marked decreases in psychopathology (depressive and anxiety symptoms) as well as suicidal thoughts and attempts. Importantly, presenters at the meeting stressed that asking school pupils about self-harm or suicidal thoughts and behaviours does not lead to heightened incidence of such outcomes.
From the health sector side, WHO has already developed guidelines through the Mental Health Gap Action Programme (mhGAP) to assist non-specialists in assessing and managing mental and behavioural disorders among children and adolescents. WHO has also embarked upon a new initiative – Helping Adolescents Thrive – that will culminate in the generation of an evidence-based intervention package focused on promotion and prevention. The meeting in Almaty helped to identify ways in which collaboration can be strengthened between WHO, UNICEF and other international and national partners so as to facilitate further work in the area of adolescent mental health and well-being.