There are three main components necessary to promote, protect and care for the mental health of children, namely:

– Commitment to strengthen leadership and scale-up investment;
– Communication to tackle stigma and engage with young people;
– Action to minimize risk factors, maximize protective factors in families and schools, strengthen the capacity of social protection and improve research in the area.

Commitment, broadly speaking, implies the need for more vital global leadership, development of financing models to bridge the investment gap, and partnerships to share knowledge and build capacity, gather data and evidence, monitor, and evaluate progress. Additionally, it entails increased funding. In many countries, mental health is underfunded, as most of the budget is invested in psychiatric services, leaving a small amount to mental health prevention and promotion. Countries have focused on setting specific budget targets for mental health issues within the healthcare realm in recent years. These are typically at least 5% in low and middle-income countries (LMICs) and at least 10% in higher-income countries.

Countries must increase funding in both education and social protection. They should set more precise targets and develop new and innovative sources of funding and financing, involving international agencies and donors, in line with human-rights approaches based on people’s needs.

Improving communication can lead to better results. It tackles misconceptions about mental health issues that fuel stigma and prevent children and adolescents from seeking support and fully participating in their communities. Governments and media must work together to end the stigma around mental health and promote the view that it is essential to talk about mental health. This would increase people’s recognition of signs of distress and inform citizens on seeking help. Communication is critical since it provides young people with the means for active and meaningful engagement, namely through investing in community youth groups or co-creating peer-to-peer initiatives and training programs. Listening to young people’s needs will improve measures aiming to help children, young people, and caregivers throughout their lives.

Action should concern four main aspects. The first aspect is to support a child’s family as their fundamental figure. Stable relations at home can help protect children against toxic stress and promote resilience and overall wellbeing. Parenting programs need to be scaled up, focusing on Social and Emotional Learning (SEL) to support families and children in developing positive attachments and create a positive home environment. Children who live under grave home conditions, including violence or severe stress, should have specific targeted support. Their respective parents ought to be provided with knowledge (such as training programs, counseling on health, nutrition, and child development) and resources such as paid parental leave, breastfeeding support, available and accessible high-quality childcare, and child benefits. This will consequently enhance the caregiver’s engagement with their children throughout their childhood and adolescence as well as foster their social, emotional, physical, and cognitive development. Caregivers need skills training to improve the developmental, behavioral, and familial outcomes for children and adolescents’ health issues.
Secondly, schools are a big part of children’s lives, and as such, should be one of the leading institutions ensuring mental health support. Violence, bullying, stress, and pressure to perform are the main underminers of mental health. In this sense, schools must implement a holistic approach to enhancing children’s development and wellbeing. They should encourage a warm, positive climate that makes children feel safe and connected and empowers them to express their opinions, support other students in expressing theirs, and seek help when needed. It should provide regular mental health and psychosocial wellbeing training for teachers and other personnel as well as for children, adolescents, and families. Schools should further strengthen teachers’ knowledge and socioemotional competencies in order to help children and adolescents learn about mental health, develop healthy habits, and recognize students who might need additional support. They should, in addition, provide school staff with training aiming at identifying suicidal students and assist them accordingly. National suicide prevention programs should restrict access to means of suicide, encourage responsible media reporting, and identify and remove harmful content on social media.

Thirdly, multiple systems and workforces should be strengthened to address mental health challenges. Mental health services should be provided across different sectors and delivery platforms, including education, social protection, and community care. Community-based interventions such as child protection and gender-based violence case-management should be endorsed particularly to identify and support at-risk children who require specialized care. Local women’s organizations should be a crucial source of psychosocial support for women and girls, especially survivors of gender-based violence. MHPSS interventions should be upgraded so they provide children with the necessary means and resources to cope with anxiety and severe forms of distress. Child rights must be respected in the design and provision of mental health services, with service users treated not as patients but as individuals with rights. Care should be person-centered and recovery-oriented.

The fourth key factor for action is to improve data, research, and evidence. The lack of data on the mental health of children, adolescents, and caregivers, especially in the LMICs with most of the world’s adolescents, poses a challenge to policy development and planning. Countries must thus increase research budgets to apply to all ages and ethnicities, adapt to local realities, and capture diverse experiences. Qualitative research can help reduce gaps in evidence generation and provide a solid account of children’s and adolescents’ wellbeing.
It is crucial to monitor and assess mental health through a consensus-based set of core indicators around the child, adolescent, and caregiver’s mental health, covering the prevalence of mental health conditions, the provision of mental healthcare, and the extent of efforts to address issues protect at-risk children and adolescents. Research should aim to understand various needs and investigate the factors that halt or accelerate policy implementation and intervention. Increased research would provide governments with insight into the issue of mental health, turning ideas into action.

Summarize by Elizaveta Rusakova from A FRAMEWORK FOR ACTION of The State of the World’s Children 2021

A pressing issue

According to UNICEF’s report on today’s children, good mental health amounts to a positive state of wellbeing. Indeed, an individual’s mental state provides the lens through which an individual experiences the world and profoundly impacts lived experiences.(1)
In this sense, mental  health underlies activities such as thinking, feeling, learning, working, and connecting with fellow individuals. In the same vein, an individual with precaurious mental health and suffering from a mental illness may not experience life healthily and positively. Accordingly, mental health is a right that must be preserved.
This text points to the worrying amount of children and adolescents living with mental health conditions, such as depression, anxiety, and conduct and attention disorders in today’s world. These disorders will significantly hinder their life experience. Appropriate care and the right to a healthy life are fundamental rights.
However, the notion of mental health and the need for its protection is often ignored by policymakers as it is still stigma-ridden, and their nature is not properly understood by all members of society. By extension, policymakers tend to opt for silence rather than a comprehensive policy-drafting addressing mental illnesses.
Most notably, the life of those who suffer from mental illnesses can be counted in days, months, or years of missed opportunities and lost lives. This loss could be calculated in human capital, as these individuals would participate in their communities more fruitfully if they were cared for appropriately. Societies need to recognise their direct interests accordingly and improve access to mental health care.

What is mental health?

This section of the report aims to define and explain the concept of mental health. Interestingly, the notion of health has historically encapsulated physical understandings and still triggers images of physical capabilities such as exercise. The term ‘mental health’, on the other hand, often generates gross misconceptions akin to ‘crazy’ and ‘unstable’, reinforcing a binary notion of mental health. Thus, a person is viewed as either stable or ‘crazy’. In other cases, mental health care is often relegated as a luxury rather than a right. Indeed, as opposed to physical health that has become very salient with technology development, poor mental health is rarely assessed as such. Instead, diagnostics such as ‘thinking too much’ and ‘it is all in your head’ find their way into common generalisations. Despite this, ‘mental health’ refers to the actual state of health rather than the lack of disorder. The positive understanding of mental health has been defined as “a dynamic state of internal equilibrium” which involves the ability to use social, emotional, and cognitive skills to navigate efficiently through life, as well as the capacity to “enjoy life and deal with the challenges we face”.(2)
Mental disorder is defined as comprising a range of conditions with different symptoms.(3) The World Health Organisation has defined mental illness to include “anxiety, depression, schizophrenia, and alcohol and drug dependency”.(4)

In the case of children and adolescents, mental health and wellbeing stem directly from their caregivers’ intimate involvement in their life.

The spectrum of mental health
The State of the World’s Children 2021 Part II

The following section emphasizes the different shades and levels of mental health and mental illness. Indeed, a mental disorder and mental wellbeing can co-exist. On the other hand, an individual exhibiting no diagnosed disorder can have feeble mental health. For this reason, seeing mental health as a binary with mental disorders on one side and mental stability on the other is an inaccurate depiction of the continuum of human experience with mental health.

Firstly, the report looks at the myriad of possibilities in the absence of mental disorders. Scales have been invented in order to measure the level of positive or negative mental health. Some indicators are self-acceptance, optimism, resilience, positive relations with family and peers, a sense of purpose in life, and feelings of growth or achievement.(5) Other frameworks focus on how people see themselves in their public life, including their sense of social acceptance and integration into a community. Interestingly, mental health is not linear, such that a child will know different levels of mental health in their life.

Secondly, the article sheds light on the variety of mental health conditions. Disorders exist on a continuum, and, indeed, conditions may be manageable, progressive, or severe such that a child could exhibit any one of those. The most common disorders on this spectrum are anxiety, depression, psychosis, and alcohol and drug dependency disorders. We can also find bipolar, food, autism spectrum, conduct, substance abuse, idiopathic intellectual disability, attention-deficit/hyperactivity disorder (ADHD), and groups of personality disorders.(6) Terms such as ‘anxiety’ and ‘depression’ have found their way into everyday language in a way that does not always refer to the diagnosable and life-interfering disorders.

Lastly, this work emphasizes the importance of context in understanding the mental health continuum. Indeed, understanding a child’s mental state means understanding their particular cultural context. Societal and family values, age, and class shape expectations and influence both the individual’s mental health state as well as the broad understanding of the notion of it. Expectations regarding personal growth and fulfilment evolve throughout a child’s life and depend on the child’s environment, community, and peers. Accordingly, to appropriately assess mental health, the cultural, social, and political contexts need to be considered.

Concerning numbers on mental health and mental disorders in children
The State of the World’s Children 2021 Part III

This section uses numbers to illustrate the human cost of poor mental health and disabilities. Mental health conditions and its lack of appropriate care are the leading cause of death, disease, and disability in most countries, regardless of their development. This is especially the case for older adolescents.

Main takeaways:
– An estimated 86 million adolescents 15-19 years old and 80 million 10-14 years old (or 13% of adolescents in total) lived with a mental disorder as of 2019.
– Adolescent boys are more likely to experience disorders, regardless of the age group. However, girls were more likely to experience psychological distress, a lack of life satisfaction, or a sense of flourishing and happiness (40) in 2021.
– North America, the Middle East, and North Africa, followed by Western Europe, exhibit the highest percentages of mental disorders (18.6% for boys and 16.3% for girls; 17.3% for boys and 16.8% for girls; 17% for boys, and 16.1% for girls, respectively). The pattern is the same within the two adolescent age groups.
– Globally, anxiety and depression disorders are the most common disorders for adolescents aged 10-19 (56.3% for girls and 31.4% for boys). [Figure 1.3, p. 37]
– Around 45,800 adolescents a year take their own life. This equates to one every eleven minutes, and the risk increases with age.
– Suicide is the fifth most prevalent cause for adolescents aged 10-19 and the fourth for the ages 15-19. [Figure 1.4, p. 38]
– Suicide is responsible for the death of 5 out of 100,000 girls per year, and 6 in the case of boys. [Figure 1.4]
– In Eastern Europe and Central Asia, suicide is the number one cause of death for adolescents aged 15-19. It is the second most prevalent cause in North America, Western Europe, and South Asia.

Data-reading precautions

In this section, the report stresses the risks of interpreting data as the ultimate truth. Indeed, suicide has historically been underreported to the point that statistics are considered to be of poor quality. Additionally, the stigma around suicide, paired with its criminalisation in certain countries, majorly affects data availability. Often, the cause of death is registered as an ‘unknown cause’. This is particularly the case with child suicides, as families fail to report the death as a suicide to minimise social stigma.
Underreporting is, in addition, found in mental health issues as, in most places, data is not collected nor used to develop the appropriate policies. Moreover, in countries where information is collected, an array of methods is used, rendering comparison challenging.

Data accuracy is the first step in grasping the gravity of the problem and drafting the necessary response to it. In order to generate this data, the investment must increase. Nonetheless, investment in research remains stuck at around 3.7 billion USD per year, which equates to $0.50 (USD) per person per year. Only 33% of the budget is spent on research on mental health and young people. Notably, only 2.4% of this research funding is spent in low and medium-income countries, in which 84% of the world population lives. However, the cost of addressing mental health was predicted to reach $6 trillion by 2020, consequently maintaining the gap between what is needed and what is done.

Stigma as the main obstacle to mental health research and policies and the overwhelming costs it ensures
The State of the World’s Children 2021 Part IV

Whereas recent years have been marked with growing awareness of mental health and mental illness, the stigma surrounding it is still prevalent. Specifically, stigma prevents the implementation of better support systems for young people. In fact, young people have claimed that speaking out about mental conditions is often more disabling than the condition itself. Often, they do not seek help out of fear. This stigma is deeply embedded in the culture as, from the age of six, children already associate mental conditions with words such as ‘crazy’ and ‘mad’.(7) This phenomenon is emphasized for boys as societal masculine gender norms deem vulnerability as ‘unmanly’. Boys are in this respect more susceptible to stigmatization and to stigmatise in return.

The individual and structural risks of stigma

Stigma can have an influence both an individual and a collective level. On the individual scale, a child might internalise feelings of guilt, shame, or lower self-esteem. Stigma influences children’s actions, emotions, and coping strategies as well as the sense of identity. Mainly, the stigma will obstruct the individual from getting help and disclosing their conditions to relatives and friends. Stigma influences mental health at both ends; it can trigger a mental disorder and exacerbate an existing one. It is structural in nature, embedded in legislation through a lack of research, budget amounts, and medical coverage for treatments. An example of this can be seen in France, where psychologists do not receive reimbursements from Social Security. Furthermore, stigma may lead to a lack of institutional response to mental health issues.

The costs of inaction

The institutional ignorance of mental health issues has a human and financial cost, which has been calculated by estimating the value children and adolescents aged 0-19 would contribute to their economies if they did not suffer from mental health conditions. These calculations are based on years of life lost to disability and death. McDaid and Evans-Lacko calculated that the annual loss in human capital due to mental health conditions amounts to 340.2 billion USD. This number considers the financial burden these conditions bear on health education and criminal justice systems, meaning it is merely a small representation of the actual cost.(8)

Return on investment

Investing on mental health results in positive returns. For instance, companies that invest in their employees’ wellbeing will receive a $5 return for every $1 invested. This return does account for the financial improvement, but there is additionally a return in happiness and productivity. Similarly, school programs on mental wellbeing for children and adolescents provide a return of $21.5 for every $1 invested over a period of 80 years.(9) The most significant return on investment was in lower-middle-income countries, with an $88.7 return on every dollar invested. Lower-income countries exhibit a larger share of the population of children and adolescents.(10) This result provides further rationale for the investment in mental health in their case.

* Summarized by Maya Shaw from Mental Health section of  The State of the World’s Children 2021

1. ‘The State of the World’s Children 2021’ https://www.unicef.org/reports/state-worlds-children-2021
2. United Nations Children’s Fund Regional Office for Europe and Central Asia, All Children Returning to School and Learning: Considerations for monitoring access and learning participation during and beyond the COVID-19 pandemic, UNICEF Europe and Central Asia, Geneva, 2020; United Nations Children’s Fund Brazil, Cenário da exclusão escolar no Brasil: Um alerta sobre os impactos da pandemia da COVID-19 na Educação, UNICEF Brazil, Brasília, April 2021; United Nations Children’s Fund, COVID-19: A threat to progress against child marriage, UNICEF, New York, 2021; International Labour Organization and United Nations Children’s Fund, COVID-19 and Child Labour: A time of crisis, a time to act, ILO and UNICEF, New York, 2020; Azevedo, Joao Pedro, et al., ‘Learning Losses due to COVID19 Could Add Up to $10 Trillion’, World Bank Blogs, 10 September 2020, https://blogs.worldbank.org/education/learning- losses-due-covid19-could-add-10-trillion .
World Health Organization, updates for the 2020 World Mental Health Atlas, forthcoming.
3. World Health Organization, Mental Health Action Plan 2013–2020, WHO, Geneva, 2013, p. 38.
4. WHO, Social Determinants of Mental Health, p. 13.
5. Barry, ‘Addressing the Determinants of Positive Mental Health’.
6. World Health Organization, WHO Methods and Data Sources for Global Burden of Disease Estimates 2000–2019, WHO, Geneva, December 2020, p. 25.
7. Kaushik, Anya, et al., ‘The Stigma of Mental Illness in Children and Adolescents: A systematic review’, Psychiatry Research, vol. 243, 2016, pp. 469–294.
8. Ibid, 8.
9. RTI International, ‘The Return on Investment for School- Based Prevention of Mental Health Disorders’, background paper for The State of the World’s Children 2021, United Nations Children’s Fund, May 2021.
10. United Nations Department of Economic and Social Affairs Population Dynamics, ‘World Population Prospects 2019: Data query’, https://population.un.org/wpp/DataQuery/.

Part I*
Chapter 3 – Factors that help and harm

Researchers have identified various risk factors known as ‘risk markers’, namely their causes and potential effects on children’s mental health. The results of these risk factors vary significantly from child to child since their experiences, and social, economic, and environmental conditions differ. There is a proportional relationship between the risk factors and their causes. As the duration and intensity of these causes increase, so do the risk factors.
Since understandings of mental health vary culturally, researchers, despite gathering large amounts of data, are still limited in identifying common risks to mental health.

Environments can act as both a risk factor and a protective factor for a child, making it hard to generalize understandings of mental health. For example, a school can prove to be an empowering surrounding for a child where he is motivated by his teachers and teaches courses that broaden his personal and academic horizons. However, in the same settings, a child can experience severe bullying, criticism, and trauma, harming their mental health.

However, despite these complexities, this chapter of the ‘The State of the World’s Children 2021’ identifies three critical factors relevant to understanding children’s mental health. These factors are not biological and can easily be changed. Therefore, they must be understood prudently. These include:
• Nurturing care from parents/ caregivers
• External environment
• Relationships with peers (as they grow older)
This chapter navigates through thoughts presented by adolescents in mental health discussion groups directed by the John Hopkins University.

A life-course approach to prevalent mental health risks

Despite the difficulty in obtaining standardized information regarding mental health factors across regions, a team of experts from Universidade Federal do Rio Grande do Sul in Brazil examined standardized data from the Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), and the Global School-based Student Health Survey (GSHS), in order to find commonalities in the distribution of risk factors across regions. They did so with the aim to develop and implement better interventions and methods to address mental health risks in children. The experts found 23 factors in the perinatal, early childhood, childhood, and adolescent periods of a person’s first two decades. Some of the factors include bullying, child labor, subject to violence, and lack of proper nutrition.

Risk and protective factors: Parenting (the world of the child)

The role of parents is identified as the most critical and primary role in a child’s mental health development. This is the first point of contact of the child. Particularly with regard to how they go on to view themselves and the world around them. Parents can create a safe, protected, and stable environment for a child as well as provide them with opportunities and platforms to grow in the world. However, the limited world of a child expands greatly during adolescence where other external risks enter.

The world around the child

Some of these risks exist in the world, majorly stemming from poverty and conflicts. Most of the time, parents struggle to help adolescents navigate these external risks, making it difficult for children to cope with the world around them.

Part II – Big changes start small

Not spending on mental health costs England alone £16.13 billion a year. There is a lack of priority and initiative at the early stages of a child where violent behavior that later causes widespread damage and aggression can be curtailed at a significantly lower cost if addressed and prioritized from the beginning. The Royal Foundation gives six recommendations to curtail these £16.13 billion losses per year. These include:

1. Raising awareness on the impact of a child’s early years;
2. Building a more nurturing society;
3. Creating communities of support;
4. Creating a workforce that uplifts families of the affected;
5. Gathering and interpreting more data to improve care for children and their caregivers;
6. Promoting long-term changes that provide stable yearly childhood support.

At the start

Low birth weight and malnutrition can adversely affect a child’s mental health as they grow older. High levels of depression, anxiety, shyness, and low cognitive development often result from a mother’s use of drugs and alcohol or early child marriages. Paternal depression during the early years of a child’s development is an additional cause of emotional distress in a child.

Nutrition, physical activity, and body weight

Nutrition is the basic building block of lifelong mental health stability. Lack of proper nutrition acts as a risk factor to the cognitive development of a child, while adequate nutrition serves as a protective factor. To counter the risk factor of inadequate nutrition, nutrition interventions for mothers during their pregnancy such as Calcium, Vitamin A, and Zinc are provided to reduce the risk of low birth weight and malnutrition.

Lack of physical activity and increased screen time in adolescents is a global cause of impeded brain development. One study of adolescents in the United States of teenagers aged 14–18 showed that, for each hour of sleep lost, the changes of feeling sad and hopeless rose by 38 % to 42 %. Warmth, love and affection, adolescent development, respectful communication, positive discipline, safe environments, provision of basic needs, and caregivers’ and parents’ mental health are a few of the factors identified by UNICEF to bolster children’s cognitive abilities development.

Medication and children

Between 2005 and 2012, prescription rates for antidepressants for children younger than 19 are estimated to have increased as follows:

In Denmark: 60.5%
In Germany: 49.2%
In the Netherlands: 17.6%
In the United Kingdom: 54.4%
In the United States: 26.1%

These results indicate that mental health facilities are readily becoming available in many countries and that the youth are increasingly making use of them. However, the high prices of these drugs entail that many children do not often have access to them. Moreover, these drugs merely aid in countering mental health effects but do not address the root cause of the problems, so issues such as violence, poverty, and inequality that threaten children’s mental health ought to be addressed.

Case study: Ireland
MindOut: Social and emotional learning for adolescent well-being

When Ireland developed its National Youth Strategy in 2015, many young people identified mental health as one of the top three issues. MindOut is an evidence-based universal social and emotional learning (SEL) Programme and part of Ireland’s Health Service Executive. It offers an opportunity to target mental health and general well-being issues important to young people in Ireland. MindOut is provided to 15 to 18-year-olds in schools. It is included in the Social, Personal, and Health Education (SPHE) curriculum, a compulsory part of the school curriculum.
MindOut has helped children develop social and emotional skills, including self-awareness, self-management, social awareness, relationship management, and responsible decision-making.

Violence and mental health

Violence has been identified as one of the major causes of mental distress in children. Often, one or more forms of violence can co-exist in the same family, jeopardizing the child’s mental health. Over a billion children between the ages of 12 and 17 are estimated to be exposed to interpersonal violence with consequences including depression, anxiety, suicide, and behavioral and social problems. Preventing exposure to violence in childhood is crucial to promoting mental health. The World Health Organization (WHO) strongly suggests that healthcare providers must consider exposure to violence while examining children’s health, particularly when facing conditions that may be complicated by maltreatment.

* Summarized by Mahnoor Traiq from Risk and Protection section of  The State of the World’s Children 2021

Here you will get the summary of Chapter 4, “What is being done” Section

Unicef recently published a report with the title “The State of the World’s Children 2021”

“The COVID-19 pandemic has raised concerns about the mental health of a generation of children. But the pandemic may represent the tip of a mental health iceberg we’ve long overlooked. State of the World’s Children 2021 examines child, adolescent, and caregiver mental health. It focuses on risks and protective factors at critical moments in the life course and explores the social determinants that shape mental health and well-being.

It calls for commitment, communication, and action as part of a comprehensive approach to promoting good mental health for every child, protecting vulnerable children, and caring for the children facing their greatest challenges.” 1

In the past decade, global mental health advocates have come together to promote initiatives that raise awareness and address children and young people’s mental health. The World Health Organisation (WHO) has also been involved in such efforts.

WHO has made significant contributions in the past decades through the ‘WHO Comprehensive Mental Health Action Plan’, or MHAP. Established in 2013, the MHAP features four objectives that guide countries’ ineffective leadership and governance; comprehensive and integrated services in communities, implementation strategies for promotion and prevention; and strengthened information systems, evidence, and research. In 2019, the MHAP extended to 2030 to align the timeline for the Sustainable Development Goals. In addition, WHO has also issued guidance on interventions for preventing and managing precarious mental health, neurological, and substance use disorders such as depression, suicide, and behavioral disorders.

Beyond the realm of healthcare, there have been additional efforts to tackle mental health issues. Various international organizations, including the UNICEF, WHO, and the World Bank, have developed the Nurturing Care Framework to address early developmental challenges. In addition, UNICEF has provided parenting guidance to provide support to caregivers and adolescents’ parents.

The financial aspect of mental health initiatives remains one of the world’s significant issues, particularly in developing. A reason for it is the lack of money to afford such financing. WHO indicates that, in some of the world’s poorest countries, governments spend less than US$1 per person on treating mental health issues. Per capita income refers to the average income of individuals in the country. In upper-middle-income countries, expenditure is around US$3 per person. Likewise, in low-income countries, median government spending on mental health per capita was US$0.08; in lower-middle-income countries, it was US$0.37; in upper-middle-income countries, it was US$3.29; and in high-income countries, US$52.73. The stark difference in the expenditure on mental health per person between developing and developed countries illustrates an evident lack of capital investment by developing countries on mental health issues.

Across the developing world, various governments have tackled mental health problems across multiple sections of society, including young people. An example of this is the SEHER Strengthening Evidence Base on School-Based Interventions for Promoting Adolescent Health. SEHER, the Bihar-based Indian program is a whole-school, multicomponent mental health promotion program operating and testing on a large-scale basis. It features activities for all students while offering individualized counseling for students in need. It works in conjunction with a life-skills training program integrated into classrooms. Evaluations showed that the program succeeded by creating a positive school atmosphere that featured strong, nurturing relationships between teachers and students and fostered a sense of belonging among students, resulting in lower rates of depression, bullying, and violence. In contrast, when teachers delivered the intervention, there was little effect.

Furthermore, the ‘Ujana Salama’ program in Tanzania seeks to address mental health issues through its implementation in tandem with social services, combining a cash transfer program for adolescents aged 14-19 along with in-person training, mentoring, grants, and healthcare services. An evaluation of the program indicated that the program led to a reduction in depressive symptoms. After a year, male and female adolescents exhibited improved mental health and self-esteem and demonstrated greater knowledge about sexual and reproductive health and HIV. Studies of the program also indicated decreases in sexual violence and increases in school attendance among girls. These examples suggest that efforts to improve the mental health of the world’s population are being addressed beyond the World Health Organisation.

PART 2 – Dealing with data

How WHO and other institutions have contributed to the improvements in efforts to collect mental health-related data

Part of the data and research problem is the lack of funding. In 2019, investment in mental health research amounted to about 50 cents per person per year, based on a population of 7.7 billion, and stark inequalities mean that only 2.4% of this funding was spent in low and middle-income countries. Only 33% of the total spent on mental health research involves adolescents.

Collecting data requires definitions of mental health conditions that can be applied in different settings and cultural contexts. Indeed, context can determine how mental health conditions present and how symptoms are interpreted. In addition, it is essential to capture information on experiences that do not necessarily meet the definitions of diagnosable disorders.

UNICEF, WHO, and other key partners have embarked on the ‘Measurement of Mental Health Among Adolescents at the Population Level’, or MMAP, a robust and methodological approach to collecting and managing mental health data for adolescents.

Research efforts are also underway to make critical links between mental health and social determinants that put children and young people at risk. For instance, CHANCES-6, a project of the Care Policy and Evaluation Centre at the London School of Economics, has engaged in a large-scale research program investigating the link between poverty, mental health, and life chances for young people from low-income backgrounds. The program was underway from 2018 to 2021 in Brazil, Colombia, Liberia, Malawi, Mexico, and South Africa. Their methods focused on examining the impact of cash transfer programs on mental health and the impact of mental health programs on poverty.

Summarized by Aniruddh Rajendran