WORLD CHILDREN: WHAT IS BEING DONE

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