Интервью с проф. Margaret Barry, Охрана здоровья и общественное здравоохранение, Ирландский национальный университет в Голуэе

WHO

Putting mental health at the centre – focusing on adolescents in a changing world

Margaret Barry is Professor of Health Promotion and Public Health at the National University of Ireland Galway. She recently co-authored an evidence review of the effectiveness of mental health promotion interventions for young people, commissioned by WHO/Europe. In this interview, we discuss what really needs to be done to improve adolescent mental health.

The theme for World Mental Health Day 2018 is “Young people and mental health in a changing world”. Why is this theme both important and relevant now?

Being young today is very different from 20 to 30 years ago: there is now an unprecedented interconnectedness and a new sense of global perspective. This means that identity formation and social comparison isn’t just based on friends in your class anymore. Expectations are much broader, so young people need an equally broad range of cognitive, social and emotional skills to navigate this complex and highly competitive world. Learning skills for school, work and life, and enhancing resilience and well-being, is really key to this.

Adolescence is an important transition period from childhood to adulthood and a time when a sense of who we are is being formed. It is also a time when young people are making decisions regarding their future education, employment and relationships. Many young people may find this challenging, especially those who are disadvantaged and socially marginalized.

Most mental health problems originate before the age of 14, and so by working with young people there is an excellent opportunity to enhance their resilience and equip them with the social and emotional skills needed for life. This can make a real difference to their mental health and well-being, and reduce the risk for poor mental health and other health problems.

Schools have a crucial role to play and provide a really important setting for reaching most young people. In the review of the evidence, completed with my colleagues Dr Tuuli Kousmanen and Dr Aleisha Clarke, we found very clear and consistent evidence that social and emotional learning (SEL) programmes implemented in schools can have very positive and lasting benefits for young people’s development.

We found that SEL programmes implemented on a whole-school basis lead to lasting improvements in young people’s social and emotional well-being; their attitudes to self, others and school; and their academic performance. They reduce the risk of depression, anxiety, stress and problem behaviours.

The evidence supports adopting a universal approach that can be embedded within the school system to aid all young people, but there also needs to be more targeted approaches for those at higher risk. SEL needs to become part of the core business of schools as it supports learning and academic success.

There is also evidence emerging that youth development programmes can be effectively implemented in the out-of-school or community setting, especially for those disadvantaged young people who may drop out of school and are at higher risk. For this, there is evidence emerging concerning the use of online resources and digital interventions such as computerized anxiety and depression prevention programmes.

How can we ensure that evidence-based programmes are properly implemented?

There are plenty of new programmes being developed, mainly from outside of Europe, but implementation is often patchy and of poor quality, which weakens their impact. These evidence-based approaches need to be more accessible for young people living in very different contexts across the WHO European Region. SEL needs to become integrated and embedded into educational policies at the country level. The approach needs to be systemic, and not just focused solely on discreet, one-off programmes.

In addition, approaches need to be sensitive to the needs of young people in different cultural and social circumstances and across age groups – the needs of an 11 year old are very different to the needs of a 16 year old.

In Ireland, we have recently been working with the Health Service Executive and Ministry of Education in the development of a SEL programme for adolescents – MindOut – which was launched just last week. In developing this, we based the approach on the best international evidence of what works, but also included input from young people and teachers directly into the development of the programme materials. Young people were involved in writing elements of the programme. This ensures that the material and resources are age- and culture-appropriate and can easily be used by teachers and youth workers in their everyday interactions with young people. The perspective of the end-users needs to be incorporated into the design and implementation of evidence-based strategies.

There is a lot of pressure on schools at the moment, so practitioners and policy-makers particularly need to ensure that implementation is feasible. Teachers need to be supported, trained and provided with resources. Investments in adolescent mental health need to be placed high on the agenda. In this way, strategies to support and promote young people’s mental health and well-being can be built into the school curriculum and spiralled across school years.

Evidence shows that this also leads to better behaviour management in schools, reduced bullying and violence, and better academic and social outcomes for young people.

To conclude, if you had a magic wand, what would you change first about the world that adolescents live in?

If I had a magic wand, population mental health would be really valued: it would be central to policy and would not have to be pushed. The creation of a mentally healthy society would be a central policy goal. There would be real importance placed on understanding mental health and its determinants and how it influences everything we do, and, therefore, we would make sure resources are there to enable people to flourish and provide support for people when needed.

Mental health is on the margins of our health policy, so I would like to see it brought into the mainstream. Most people value mental health but this value is often not made explicit. We must really believe the slogan “no health without mental health”, and make “mental health in all policies” a reality.