As outlined in the last blog in our series “The Time is Now: Investing in Adolescent Health", there is a huge need to address poor mental health among adolescents. An estimated 80% of adolescents in need of mental health services do not receive care, although the true number is likely higher in low- and middle-income countries (LMICs).
The urgency of addressing this burden has been heightened by recent experiences with COVID-19, growing alarm about environmental issues, and new learnings about the impact of social media and technology use. As school-closures and lockdowns, due to COVID-19, have disrupted the lives of adolescents around the world, routines and relationships have been under strain. Some young people have also experienced hardship resulting from the economic impacts of COVID upon their families.
A survey conducted by UNICEF in Latin America and the Caribbean found 27% of young people reported anxiety and 15% reported depression. In the survey, 30% of young people reported that the biggest reason for their current emotions was their economic situation. More evidence is needed, particularly from LMICs, but there are strong indications that a higher than usual number of young people may be experiencing poor mental health as a result of the pandemic.
Additionally, concerns about environmental issues, particularly climate change, environmental degradation, and biodiversity loss, are increasingly at the forefront of the minds of young people, and have been indicated to contribute to stress, anxiety, and contributing to poor mental wellbeing.
Finally, emerging evidence has highlighted the negative impacts of social media on the mental health of young people, with more frequent social media use and high screen time linked to increased risk of anxiety and depression.
The Economic Case for School-based Mental Health Interventions
School-based health programs and services are an important approach that harness existing systems to reach a large population of young people. These inter-sectoral partnerships are particularly promising for programs targeting prevention and can be an effective way to reach adolescents who may not otherwise access health services due to stigma or other barriers such as cost, location, or age restrictions.
Sexual and reproductive health, nutrition, and de-worming programs have successfully been implemented through schools in many countries. Evidence from high-income countries suggests schools are also a promising setting for mental health promotion. While these programs exclude adolescents who do not attend school, they are a valuable platform for addressing mental disorders and scaling up access to services that are currently inaccessible for many adolescents in LMICs.
RTI has been working on adolescent mental health in partnership with the AstraZeneca Young Health Programme (YHP) since 2017. As part of this effort, we analyzed the return on investment (ROI) of a package of school-based mental disorder prevention interventions for the newly released UNICEF 2021 State of the World’s Children report.
The package of interventions we analyzed includes programs to prevent anxiety, depression, and suicide among adolescents, which were chosen because they have been demonstrated to be both effective in improving health outcomes and cost-effective to deliver. Participation in these programs is associated with decreased risk of developing anxiety and depression and of dying by suicide.