MentalHealthIssuesinAdolescence

World wide as measured by DALYs (Disability Adjusted Life Years) in adolescence, unipolar depression ranks first, self harm fifth and anxiety eighth.

An electronic publication for mental health in developing

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AdolescentMentalHealth

Edition 6

Developing Mental Health

• 1 in 6 people in the world today are adolescents (10-19 years old). • 90% Adolescents live in Low and Middle Income Countries (LIMC)• In LMIC 50% are children and adolescents

An Emerging Agenda for Change

As many as half of mental health problems start by the age of 14 across LIMC and wealthy country contexts and if not treated can have consequences throughout a life time.

These are shocking figures, and perhaps for years have been obscured by inadequate data internationally and by aggregation with other age cohorts. It is likely too that some of the successes in global health over the era of the Millennium Development Goals (MDG) have reduced the impact on these statistics of infant/maternal mortality, diarrhoeal disease and other infective disorders.

The Reality of these statistics provoke both an ethical response to relieve or prevent suffering as well as one based on the economic and societal impact.

What are DALYs? Disability Adjusted Life Years, a measure of the years of healthy life lost due to ill health, disability or premature death. They estimate the gap between current health status and an ideal health status, with the entire population living to an advanced age free of disease and disability. For a specific health condition, DALYs are calculated as the sum of the years of life lost (YLL) due to premature death plus disability (YLD) for people living with the health condition

Causes of DeathLooking at causes of death in this age group, self harm ranks as 3rd.

Any successful intervention in prevention or improved health can have a positive impact now in health terms but also if reducing recurrence in the long term, Similarly the impacts economically of positive intervention can play out again and again over time.

Superseding MDG are the World Health Organisations (WHO) Sustainable Development Goals (SDG) and in this domain mental health issues and adolescent health issues finally find a place and voice.

The WHO Publication HEALTH FOR THE WORLD’S ADOLESCENTS - A second chance in the second decade summarises broadly the problems and principles required in response and provides some of the background statistical analysis that underpins this.

Morris et al showed that in high income countries such as the United States of America and Canada, fewer than half of adolescents with mental health problems receive needed care. In low and middle income countries access to treatment is scarce.

Arenas of Action

Health for the World’s Adolescents whilst having a broader remit than mental health looks at several approaches to further the response to mental health problems. There is acknowledgement in this too that professionalized care is scare in LIMC.

Many sectors must participate – Given the multifactorial etiology bearing on these issues, it is also important to consider a multi sector approach, which will include other health provision, environmental, and legal to name a few. Bringing the mental health agenda into the education setting is key in this age group.

Research and strategic information – informs policy and programmes. Information is often poor, and attempts to improve this will help inform and drive programmes of improvement. Context specific evaluations and research will help decisions about where best to utilise scarce resource and to lobby for new funding. Least research evaluation taking place in LMIC is estimated 10% of the total (where 90% of this group live).

Human rights approach – international conventions recognise adolescents’ rights to the highest attainable standard of health and these are recognised by most countries but the influence of this on the shape and interface of services often remains a challenge.

Policy – among national health policy documents from 109 countries 84% give some attention to adolescents but only one quarter address adolescent mental health. Influencing policies at every level is important in tackling this agenda.

New technologies – e-health(using electronic communication) and m-health(using mobile phone) whilst no replacement for contact with competent health providers can offer wider reach, ways of engaging clients into services and supporting to face to face care. Development and evaluation is needed.

Adolescent involvement – Adolescents are a force for their own and others health, they are actors for social change, and their participation need to be activated and facilitated. When adolescents were asked their perceptions of the most important health issues, mental health came top. They are aware as a group and engaging with them in terms of both shape of services but perhaps too in elements of service delivery seems important.

Not all readers will feel that they are in a position to influence the broad arenas mentioned above, so what can we all do?

Here are some questions that we can all consider whatever our context or perceived influence.

• Where you are working with adolescents – what do they need from you/your practice/service?

• What are the resources I have, what is the best use of them?• If we had a little more resource, how might that be most effectively used?• How can I influence policy most effectively?• How can we most effectively work with adolescents to honour their views and

contributions as individuals and a group?• What can I do differently next week?

References

1. WHO Publication HEALTH FOR THE WORLD’S ADOLESCENTS - A second chance in the second decade http://apps.who.int/adolescent/second-decade/

2. Morris J et al. Treated prevalence of and mental health services received by children and adolescents in 42 low- and-middle-income countries. Journal of Child Psychology and Psychiatry, 2011, 52:1239–1244

3. Unicef. Statistics and monitoring. 2008. http://www.unicef.org/ 4. Belfer M.L. Child and Adolescent Mental Health Around The World: Challenges for Progress JIACAM Vol. 1, No. 1, Article 35. Kieling C et al. Child and adolescent mental health worldwide: evidence for action Lancet 2011; 378: 1515–25

… and what can the reader do?

Closing the Depression Treatment Gap in India, on Motorbikes

This short film (approx. 8minutes) produced by Thomson Reuters Foundation of some of the work of Sangath. India has approximately 3500 trained psychiatrists so that is about on for every 200,000 to 300000 people. This film showcases an approach of training lay people and implementing a programme to treat people with depression.

Watch the film here

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Vikram Seth, TED talk - Mental Health For All By Involving All

Nearly 450 million people are affected by mental illness worldwide. In wealthy nations, just half receive appropriate care, but in developing countries, close to 90 percent go untreated because psychiatrists are in such short supply. Vikram Patel outlines a highly promising approach - training members of communities to give mental health interventions, empowering ordinary people to care for others.

Watch Vikram Seth here