The global community is bringing mental health and psychosocial well-being of young people out of shadows, and starting to prioritize it as key determinants and indicators of their well-being, human rights, and future, as well as national development.
Building upon the Programme of Action of the International Conference on Population and Development (1994) and other global agreements, the 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs) (2015) have integrated promotion of mental health and well-being (Target 3.4), prevention & treatment of substance abuse (3.5), and protection of girls and women from psychological violence (5.2), as key global priorities from 2016 to 2030.
In addition, the United Nations Convention on the Rights of Persons with Disabilities (2006) has included persons with mental and intellectual impairments, and established a global human rights framework for persons with mental health conditions and psychosocial disabilities as well as persons with intellectual disabilities, which is legally binding among those countries that ratified it including Oman. Reflecting this, five SDGs Goals and seven Targets refer to the rights of persons with disabilities such as access to education, employment, public transport, public buildings and green spaces, positions in public institutions (national and local legislatures, public, service, and judiciary), governmental websites, mobile phones, and internet, and disability-disaggregated data collection. SDGs progress is monitored annually and internationally.
In the course of the COVID-19 pandemic which has brought a substantial global crisis unprecedented in our lifetime, the importance of including mental health and psychosocial measures in all social actions came to be widely recognized. Particularly, mental health and psychosocial consequences among young people, including in the context of loneliness, fear and anxiety in the quarantine and lock-down settings; domestic and gender-based violence; and information and communication in the cyber space including fake news and cyber bullying, got wider attention. The pandemic also offers an opportunity to build back better, and a historic chance to take concrete actions to promote, protect and care for mental health and psychosocial well-being of young people through mainstreaming those aspects in in policies, systems and programmes across sectors beyond health.
Globally, mental health conditions including depression are one of the leading causes of illness and disability among young people. Suicide is the second leading cause of death in young people: In some countries, suicide is the leading cause of death among young girls. The consequences of not addressing mental health conditions can extend to their future, affecting both physical and mental health: For example, people with severe mental health conditions die as much as 20 years early compared with people without such conditions. The consequences extend to non-health areas too, and possibly limiting opportunities to fulfill lives in various aspects, while experience of mental health conditions can also lead to resilience, deeper empathy, and other positive outcomes. Economic impact of mental health is also huge: OECD states direct and indirect cost of mental health is about 4% of GDP. An analysis indicates that lost contribution to economies due to mental health conditions among young people is nearly $390 billion a year. At the same time, investment of $1 in mental health leads to return of $4 according to WHO and the World Bank.
Half of all mental health conditions start by 14 years of age, and this also indicates importance of mainstreaming mental health and psychosocial support in policies and programmes for young people. Early detection and intervention can lead to better future outcomes for young people.
Factors that can affect mental health and well-being among young people include socio-economic status including poverty, discrimination, exclusion and other human rights violations; access to basic support, education and employment; physical and social health and well-being; relationship with parents, caregivers, friends and others which can include support, pressures, abuse, and bullying; exploration of sexual and gender identity; sexual and reproductive health and rights including pregnancy and sexual and gender-based violence; increased use of technology; and humanitarian crises. Young people with mental health conditions, psychosocial or intellectual disabilities are, in turn, vulnerable to stigma, social marginalization, discriminations, including exclusion from communities, education or employment due to social barriers such as institutional, environmental and attitudinal barriers; thus, there exists a possible vicious cycle of marginalization and compromised mental health and psychosocial well-being.
In order to respond to these, global community has developed various policy and programme frameworks. For example, the Convention on the Rights of Persons with Disabilities has set up legal frameworks for promoting and protecting the rights of persons with mental health conditions, psychosocial disabilities, and intellectual disabilities, in autonomy, community life, education, employment, cultural life and beyond, based on its social model. WHO’s Comprehensive Mental Health Action Plan (2013) has set out a policy and system framework on mental health, and mhGAP Intervention Guide (2010) has indicated clinical guidance to enable mental health assessment and support at the non-specialist primary health care settings. UNFPA has developed various tools to integrate mental health and psychosocial support in sexual and reproductive health and rights services including those related to the gender sector such as response to sexual and gender-based violence, on the ground. IASC has established guidelines (2007) to promote mental health and psychosocial well-being in various sectors in emergency settings, together with the Sendai Framework for Disaster Risk Reduction and other frameworks. The United Nations has issued the Policy Brief: COVID-19 and the Need for Action on Mental Health (2020). WHO and UNICEF has launched the Helping Adolescents Thrive (HAT) initiative and published guidelines (2020) and toolkits (2021). Recently, UNICEF has published The State of the World’s Children 2021: On My Mind: Promoting, protecting and caring for children’s mental health.
Oman has been spearheading scaling up of its mental health policies and programmes. In 2020, Ministry of Health has issued Guideline for Management of Mental Disorders in Primary Health Care (2020) for primary health care providers to be empowered with the necessary knowledge, skills, competence and attitude to recognize as well as manage mental health conditions. In addition, the Guidelines on School Mental Health Services (2020) was published to promote mental health and psychosocial well-being of children and young people through the education sector in close collaboration with the health sector. In Oman, the cultural sector including traditional healers as well as arts and entertainment community have been playing key roles in promotion of mental health and psychosocial well-being, too.
Building upon these, the guidance note sets out key action points and recommendations based on multi-sector, human rights-based approach with reaffirming mental health as a positive state of well-being and essential part of everyone’s life. Mental health exists on a continuum that includes periods of well-being and periods of distress, most of which will not evolve into diagnosable disorders. As opposed to common misunderstandings that mental health is only in the realm of biological and medical problem or psychiatry, as the IASC mental health and psychosocial support pyramid indicates, multi-sector approach is inevitable for mental health and psychosocial well-being of young people. This includes 1) basic services and security, 2) community and family support, 3) focused supports by non-mental health professionals in various sectors, and 4) specialized services by mental health professionals. All people including young people themselves have a role to play. This includes obtaining evidence-based correct information and raise understandings and literacy on mental health and psychosocial well-being, tackling social barriers for mental health conditions or psychosocial disabilities including institutional, environmental and attitudinal barriers, and providing and receiving social support mutually.
All these must be built upon the human rights-based approach, with special attention to “do no harm” and “nothing about us without us” principles, as well as gender, age and culture-sensitive approaches, envisioned by various human rights instruments including the Convention on the Rights of Persons with Disabilities and the Convention the Rights of the Child.