"This is not our priority" is what we used to hear from programme officers in many countries when we would speak to them about improving child development and mental health.
As part of the Millennium Development Goals, many countries have succeeded in reducing deaths in children under five and have improved services for the treatment of potentially fatal illnesses, such as diarrhoea. But the mental health needs of young people have been largely ignored and unmet.
What is often a surprise for policy makers (and maybe for many readers here) is that mental and neurological disorders are the leading cause of disability in young people in all global regions, with depression the predominant cause of illness and disability for adolescents aged 10 to 19 years, and suicide the number one cause of death in girls aged 15-19. Impacts are not just related to emotional wellbeing, as research shows an association between poor mental health and poor educational achievements, higher risk of non-communicable diseases and premature deaths. Unfortunately, few of these young people -- less then one in four children even in some high-income countries -- will be identified and even fewer will have access to the help they need.
There are, however, reasons to be positive, as things are changing with new global commitments providing opportunities to improve the mental health of children globally. For example, a global strategy launched by the UN Secretary General in September 2015 lays out an ambitious vision for a world where all women, children and adolescents realize their rights to good physical and mental health and participate fully in society. But in order to realise this vision we need to find innovative models for the provision of mental health care that are sustainable and can be rolled out across whole countries.
The role of non- professionals -- parents, teachers, peers, and other health providers is crucial. Often though, parents, nurses and doctors feel ill-equipped to identify and provide care for children and adolescents with mental disorders.
The WHO is working closely with different partners (e.g. governments, academics, international, non-governmental, civil society organizations) to develop new models which may address some of these problems. For example, the WHO mhGAP Program aims to equip those care providers in communities who are best-placed to support young people with skills for early recognition and treatment of mental disorders. More than 10 countries have implemented the mhGAP modules for children and adolescents. We have learnt that the program is generally well-accepted and parents are happier with treatment received. We also learnt that in order to improve access to psychological interventions for both parents and children, we need effective interventions that can be used by non-specialist community workers and be brief enough to be feasible in low resource settings
In recent years, WHO has been working to develop a range of such interventions. We have developed a parenting program for caregivers of children with autism and intellectual disability that is being pilot tested in more than 10 countries over the next two years. We are also developing brief psychological interventions for adults (many of whom will be parents), that can be provided by non-specialists that are being tested in randomised controlled trials in various locations globally. More recently, WHO has begun work on a psychological intervention for young adolescents with impairing levels of psychological distress.
These "brief" psychological interventions will become available for use in the coming years following rigorous testing. There will then be a set of effective tools available for various actors to begin meeting the mental health needs of children and adolescents. These efforts will help to ensure that child and adolescent mental health becomes the priority it needs to be.