POLICY BRIEF         

 

Young People Will Transform Global Mental Health A call to prioritise global action on mental health for young people 

 Summary The world's population is young: up to 42 percent of all people are under the age of 25. Mental ill-health is the leading cause of disability in young people aged 10 to 24 years with half of all mental health conditions beginning by the age of 14, and three-quarters by mid-20s. Yet, young people are least likely to access mental health services due to underdetection, lack of awareness and help-seeking, and insufficient prioritization in policy frameworks.

With the global cost of mental health conditions in 2010 estimated at US$ 2.5 trillion, surging to US$ 6.0 trillion by 2030, the economic burden of mental health conditions is comparable to that of cardiovascular diseases, and higher than that of cancer, chronic respiratory diseases, and diabetes.

Globally, there is a significant lack of funding and accessibility of mental health services for children and young people. This translates into poorer mental health outcomes, higher rates of youth unemployment and dependency on welfare benefits and contact with the criminal justice system.

Immediate global action is needed to better prioritize the needs of young people by protecting their mental health with public policy frameworks and economic development.

Key messages and recommendations 

1. Ensure full and direct participation of young people as well as people with lived experience to ensure a rights-based approach is enshrined in the foundation of mental health policies.

2. Increase financial investment in early intervention and prevention programmes geared toward the mental health of young people.

3. Strengthen mental health education in schools and universities, to promote mental health literacy, address stigma and improve help-seeking.

 POLICY BRIEF

 A global problem  Mental health conditions are the leading cause of disability in young people in all world regions. If untreated, these conditions severely influence children’s cognitive, emotional and social development; their educational attainments and their potential to live healthy and productive lives. The effects can be long-lasting and may become more severe with age.

Social and environmental factors play a critical role in mental health during developmentally sensitive periods. Young people’s mental health is influenced by a range of social and economic factors. The UN Sustainable Development Goals (SDGs) specifically address these social determinants that increase mental health risk, including demographic, economic, neighbourhood, environmental and social domains. Supportive environments in the family, school and communities are essential to young people’s development during these formative years. While comprehensive action across the life course is needed, giving every child the best possible start will generate the greatest societal and mental health benefits.

Figure 1: The global burden of mental health problems, substance use, and suicide (self-harm) in DALYs across the life course (Global Burden of Disease 2016). One DALY represents 1 lost year of healthy life. The sum of DALYs* across the population, or the burden of disease, is a measurement of the gap between current health status and an ideal health situation in which the entire population lives to an advanced age, free of disability and disease. * DALY = disability-adjusted life-year. Reproduced with modification from Patel et al. (2018).

The lack of funding for accessible mental health services is alarming. Despite showing absolute increases in funding since 2007, development assistance for mental health has never exceeded 1% of all global development assistance for health. The allocations for child and adolescent mental health, arguably the most important developmental phase in the context of prevention, is just 0.1% of total development assistance for health. The consequences of under-investment are staggering. Between 2011 and 2030, the total lost economic output due to mental health conditions will reach US$ 16.3 trillion worldwide. This is driven in part by the early age of onset and loss of productivity across the life course. A rights-based approach to mental health is only way forward. Young people with mental health conditions face major challenges with stigma, isolation and discrimination. These challenges are further exacerbated by the lack of access to healthcare services and education facilities. Young people are also largely excluded from policy planning and leadership roles. Countries agree that “enjoyment of the highest attainable standard of physical and mental health” is a right of every person, as set out in the Sustainable Development Agenda for 2030, and that young people have the right to have a say and to be taken seriously, as stated in the UN Convention on the Rights of the Child.

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Conclusions and recommendations  Urgent action is needed. Engaging with young people during the early years of their lives and facilitating access to appropriate levels of care are critical for building sustainable and successful societies and economies. Ensuring good mental health and well-being requires a clear framework for action. This should encompass a balance between treatment, rehabilitation, care and recovery, with an equal emphasis on the promotion of mental health and prevention of mental ill health by intervening early in the life course. These actions and interventions positively affect youth employment and improve productivity, save costs for the health care sector, improve child welfare and reduce levels of crime. In order to promote the mental well-being of adolescents this policy brief recommends the following: Recommendation 1: Ensure active and direct participation of young people

● Ensure the full and direct participation of young people in the research, design, implementation and practice of mental health policies. “Nothing about us, without us”.

● Involve and engage young people in the co-production of multi-sectoral mental health policy frameworks that encompass an inclusive rights-based approach. These can cover a range of topics from prevention, early intervention, to mental health rehabilitation during early life stages.

● Work with youth-led advocacy groups to strengthen effective leadership and governance for adolescent mental health.

Recommendation 2: Invest in prevention and early intervention, adopting a holistic approach

● Actively increase financial investment and redistribution of department budgets to provide integrated and responsive mental health and social care services in community-based settings.

● Allocate funding towards integrated community, school and university-based mental health services, that focus on skills training, screening for at-risk young people and the education of teachers, primary care physicians and media. Integrated youth programmes or curricula can be packaged as life-skills education, mindfulness and physically active programmes.

● Alongside direct interventions, implement effective social policies that address social factors that influence mental health during developmentally sensitive periods, including poverty, gender discrimination and violence.

Recommendation 3: Improve and support mental health literacy

● Strengthen mental health education and training to young people in schools and universities to promote mental health awareness, reduce stigma and improve help-seeking.

● Implement strategies to strengthen information systems for promotion of psychosocial well-being, prevention of mental health problems and promotion of human rights of young people who face mental health challenges.

● Build capacity in caregivers at parental gatherings, schools and universities to promote mental health literacy to assist with motivation and self-efficacy.

Youth mental health support in practice The School Mental Health Program in Ethiopia enabled parents and teachers to promote prosocial behaviour to identify and support cases in need of referral. This innovation, initiated by the Ethiopian School Readiness Initiative (SRI), uses task shifting by enabling teachers and primary caregivers to identify and manage mental and/or behavioural problems, or refer such cases for professional care.

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Social Media Assets  @mymindourhumanity www.globalmentalhealthcommission.org www.facebook.com/LancetGMH 

    More information  Bloom, D. E. et al. (2011) The global economic burden of non-communicable diseases. Geneva: World Economic Forum. Chisholm, D., et al. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet

Psychiatry, 3, 415-424. Kieling C et al, (2011). Child and adolescent mental health worldwide: Evidence for action. Lancet, 378, 1515-25. Lu, C., Li, Z., Patel, V. (2018). Global child and adolescent mental health: The orphan of development assistance for health.

PLoS Med, 15, e1002524. https://doi.org/10.1371/journal.pmed.1002524. MHIN (2016). Introducing school mental health in Ethiopia. Retrieved from Mental Health Innovation Network:

https://www.mhinnovation.net/innovations/introducing-school-mental-health-ethiopia. MHIN (2016). School Readiness Initiative (SRI). Retrieved from Mental Health Innovation Network:

https://www.mhinnovation.net/organisations/school-readiness-initiative-sri Patel, V. et. al. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet, 392,

1553-1598. doi:10.1016/S0140-6736(18)31612-X WHO and the Calouste Gulbenkian Foundation. (2014). Social determinants of mental health. Geneva: World Health Org. World Economic Forum. (2019). Dialogue series on non-communicable diseases and mental health. Retrieved from

https://www.weforum.org/projects/dialogue-series-on-ncds World Health Organization. (2018). Adolescent mental health. Retrieved from

https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health World Health Organization (2019). Child and adolescent mental health. Retrieved from

https://www.who.int/mental_health/maternal-child/child_adolescent/en/

Acknowledgements / Contributors This policy brief was produced by members of the Young Leaders for the Lancet Commission on Global Mental Health and Sustainable Development with support from the Mental Health Innovation Network.

Suggested Citation: Booysen, C., Pavarini, G., Gatera, G., Jimenez, I., Muhia, J., Omar, D., Qureshi, O., Ryan, G., Eaton, J., & Singh, I. (2019). Young people will transform global mental health: A call to prioritise global action on mental health for young people. Young Leaders for the Lancet Commission on Global Mental Health. Retrieved from https://globalmentalhealthcommission.org/policy-briefs/.

Cover Illustration: © My Mind Our Humanity campaign, Young Leaders for the Lancet Commission on Global Mental Health and Sustainable Development.

Publication: © Young Leaders for the Lancet Commission on Global Mental Health and Sustainable Development, 2019.

Disclaimer: The views expressed in this publication are those of the author/s and should not be attributed to the Young Leaders for the Lancet Commission on Global Mental Health and Sustainable Development, the Mental Health Innovation Network, or their funders and affiliate.