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.
– 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.
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/.