It is estimated that around 20 per cent of the world’s adolescents have a mental health or behavioural problem. Depression is the single largest contributor to the global burden of disease for people aged 15–19, and suicide is one of the three leading causes of mortality among people aged 15–35. Globally, an estimated 71,000 adolescents commit suicide annually, while up to 40 times as many make suicide attempts. About half of lifetime mental disorders begin before age 14, and 70 per cent by age 24. The prevalence of mental disorders among adolescents has increased in the past 20–30 years; the increase is attributed to disrupted family structures, growing youth unemployment and families’ unrealistic educational and vocational aspirations for their children.
Unassisted mental health problems among adolescents are associated with low educational achievement, unemployment, substance use, risk-taking behaviours, crime, poor sexual and reproductive health, self-harm and inadequate self-care – all of which increase the lifetime risk of morbidity and premature mortality. Mental health problems among adolescents carry high social and economic costs, as they often develop into more disabling conditions later in life. The risk factors for mental health problems are well established and include childhood abuse; family, school and neighbourhood violence; poverty; social exclusion and educational disadvantage. Psychiatric illness and substance abuse in parents, as well as marital violence, also place adolescents at increased risk, as does exposure to the social disruption and psychological distress that accompany armed conflict, natural disasters and other humanitarian crises. The stigma directed towards young people with mental disorders and the human rights violations to which they are subjected amplify the adverse consequences
Early recognition of emotional distress and the provision of psychosocial support by trained individuals – who need not be health workers – can mitigate the effects of mental health problems. Primary health-care workers can be trained to use structured interviews to detect problems early on and provide treatment and support. Psycho-educational programs in schools, supportive counselling and cognitive-behavioural therapy, ideally with the involvement of the family, are all effective in improving the mental health of adolescents, while the complex needs of young people with serious mental disorders can be addressed through stepped referrals to specialist services. At the international level, several instruments and agreements are in place to promote the health and development of adolescents, most notably the Convention on the Rights of the Child and the Convention on the Rights of Persons with Disabilities. The integration of mental health into primary health-care systems is a major endeavour to reduce the treatment gap for mental health problems.
Even though all children and adolescents can experience mental health problems, several factors predispose some children to greater risk for developing a mental disorder. These factors include:
- Low birth weight,
- Exposure to environmental toxins,
- Child abuse and neglect,
- Exposure to traumatic events or violence,
- The presence of a mental disorder in a parent, and
- Prenatal damage from exposure to alcohol, illegal drugs, and tobacco
Why is Children’s Mental Health Important?
Childhood is a critical time for promoting social and emotional development and preventing mental disorders. In fact, the precursors for many adult mental disorders can be found in childhood.2 Optimal mental health is marked by the achievement of key milestones—those critical points in children’s and adolescents’ lives when they attain expected developmental, cognitive, social and emotional markers—and by secure attachments, satisfying social relationships, and effective coping skills.3 Children’s mental health and wellness warrant unique considerations for several reasons, including the fact that children and youth are reliant on their parents and caregivers for nurture and support, and signs of mental health problems and disorders may be different in youth than in adults.
Mental-health conditions, which include behavioural and mental-health problems e.g. depression, anxiety disorders (including post-traumatic stress disorder), and disruptive behavioural disorders (such as attention deficit hyperactivity disorder, mood disturbances, substance use, suicidal behaviour, and aggressive/disruptive behaviour) are the leading causes of adjustment problems in adolescents and young people worldwide. Mental-health conditions have a significant impact on the development of over a billion youth and their social and economic integration, including employability. Yet, it is also critical that attention to global mental health moves beyond treatment-oriented programmes in health-care settings to include broader approaches inspired by public-health and social-inclusion considerations.