Written by Amanda Nguyen
Society of Research on Adolescence
A few years ago, on sharing my goal to pursue research that would improve youth mental health and well-being in low-resource settings, I received a reply, “But isn’t mental health kind of a first world problem?”
At the time, I was caught a bit off guard, and struggled to find words to respond with much more than a feeble, “no, I think mental health matters for everyone.”
In fact, mental health and substance use problems are a leading contributor to poor health worldwide. This is particularly critical for young people, as adolescence is a time of major shifts in health problems to largely preventable causes and risk factors. Roughly 1 in 5 adolescents experience a mental health problem; a majority of mental disorders experienced throughout the life course begin during adolescence and emerging adulthood. And poor mental health is strongly related to other health and development concerns in young people, including lower educational attainment, substance abuse, violence, and poor reproductive and sexual health.
Even in well-resourced countries such as the US, many youth lack access to adequate mental health services. But nearly 90% of the world’s youth actually live in low- and middle-income countries, where these treatment gaps can be huge – up to 75% of those in need of mental health services lack access! A mapping exercise carried out by the World Health Organization (WHO) and UNICEF has shown that many of the existing adolescent mental health services tend to be poorly coordinated, implemented at a small scale, and lack evidence for effectiveness. There is also a challenge that youth mental health is often not considered (or evaluated) as a key outcome of health, social, and educational programming, while at the same time potentially relevant psychosocial programs do not specifically target youth. With these research limitations, it is hard to know what actually works, for whom, and in what circumstances. There is a need for greater awareness of youth mental health needs, technical and human resource capacity to implement evidence-based models, and an expanded focus of delivery beyond emergency contexts.
More than this, mental health is not just the absence of mental illness, but a state of well-being in which young people are able to thrive and contribute to society. This focus on positive aspects of well-being calls for moving beyond treatment to prevention of disorders and promotion of mental health, as well as social inclusion of all youth, including those with mental health conditions. Global mental health researchers have made substantial progress in building the evidence base for effective treatments in diverse cultures and contexts, but there is much more work to do. High priority activities include elevating mental health as a priority for policy makers, building capacity for implementation and sustainability of evidence-based services in multi-tiered support systems, and expanding rigorous research efforts toward large-scale prevention and promotion programs.
October 10 is World Mental Health Day. Recognizing the critical role of adolescent health and well-being in positive outcomes for both young people and societies, the 2018 WHO campaign focuses on “Young people and mental health in a changing world”. In addressing challenges and embracing opportunities, it is critical to build recognition of adolescence as a distinct developmental phase, separate from children and adults. It is critical to continue to partner across boundaries, cultures, and disciplines for prevention and intervention research. Most importantly, it is critical to place young people at the center of these efforts – to make space for them to advocate, partner in policy and program development, fully participate in the research process, and share their own stories.
It has been a while since I have had a conversation like that one from years ago. I am hopeful that there is growing recognition that promoting mental health and well-being is for everyone. But, just in case I do get a second chance at answering that question – I’m ready!
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