A Global Framework for Youth Mental Health

An essential purpose of society should be to create an environment in which children can safely develop into healthy, fulfilled adults who can contribute fully.

Unfortunately, society often falls short of this aim. Whether it comes in the form of pressure from peers, social media or more dramatically war, disease and political and economic instability, the environment is not always conducive to developing stable, mental health.

In addition to this, barriers to accessing appropriate care and/or reluctance to engage with services that are developmentally inappropriate, result in many young people not accessing or receiving mental healthcare when it’s required.

It is a sad fact that mental illness is the leading cause of disability and poor life outcomes for young people today.

The impacts are manifold, affecting the individual, the economy and society more broadly. Of all non-communicable diseases, youth mental health problems present the most serious burden to GDP, reflecting the lack of the return on investment in the individual and the duration of the problem.

The onset of mental illness during adolescence and young adulthood typically disrupts normal developmental processes. It is fruit of these processes that results in a person’s ability to create their own individual identity, complete their education, find a job, and develop both friendships and intimate relationships. If disrupted, this undermines the individual’s ability to reach their potential – in social and economic terms.

The lack of an early response typically extends the length of the illness. Furthermore, the cost of later care is almost always higher than that associated with early intervention. This is not just in terms of medical costs, but factors like social welfare benefits, lost taxation, and in a minority of cases, detention or imprisonment.

Increasingly, return on investment analysis is being used to reveal the value of investment in mental health in high- and low-resource settings. This allows decision-makers to compare the investment into youth mental health with those such as education, housing or industrial development.

Prevention and early intervention include raising awareness of mental health issues and mental health literacy, reducing the stigma associated with seeking help, appropriate signposting of support and services, and the greater use of digital platforms.

Unfortunately, it remains the case that in general, investment into mental health is insufficient worldwide. Historically, it has been regarded as a luxury, all the more so in low- and middle-income countries. Typically, it is viewed as something that only those in high-income economies pursue.

In part, poor investment levels reflect the rather upturned situation that the benefits of good mental health are largely enjoyed outside the health sector. Higher levels of educational attainment and increased participation in the workforce do little, if anything, to directly support the sector.

In many high-resource settings, a youth mental health approach has emerged and, importantly, gained traction. This is necessary because a system is required that acknowledges and better understands the complex and evolving psychosocial issues, symptom patterns and morbidity that this age group displays. Among the key elements of this ‘fit for purpose’ system are: accessibility (there should be no barriers to entry), community based, non-judgemental and non-stigmatizing, and a place of trust that makes young people feel comfortable.

The model highlights that early detection and response are likely to result in a better prognosis as well as less disability and disengagement. Its characteristics include:

This model has been used successfully in high-resource settings, and as such, offers a blueprint for wider system reform. The majority of the world’s population – and with it, the majority of young people – do not live in countries where youth mental health is resourced, enjoy government support, the requisite infrastructure and the necessary workforce. To succeed in low- and middle-income environments, the principles for youth mental health found to work in high-income settings need to be reinterpreted and reoperationalized locally.

Following a wide-ranging consultation process, the importance of a local voice in implementing this type of model in other settings was heavily underlined. It is important not to subsume the local context but to use it as an element co-equal with the principles. Young people are not interested in a prescribed model imposed on them. They are keen to have guidance, but equally willing to contribute a local viewpoint about how the guidance should be interpreted and implemented.

Elements that play into this localization include a need to include a local view on language, a local contribution to framework interpretation and implementation, locally acceptable ways to provide services, and a detailed description of what is necessary to make that work.

It is clear that addressing the youth mental health situation will take the same vision, persistence and dedication that was employed for childhood mortality.