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Mitigating the Direct and Indirect Consequences of COVID-19 on the Health and Well-Being of Young People in the Americas��Young people’s mental health

Dr. Claudina Cayetano

Mental Health and Substance Use Unit PAHO/WHO Washington DC

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©UNICEF 2020

Multiple studies have reported on the deterioration of the mental health of children and young people during the pandemic

A recent poll conducted by UNICEF shows that the COVID-19 crisis is having a significant impact on the mental health of adolescents and young people in Latin America and the Caribbean

Among the participants, 27% reported feeling anxiety and 15% depression in the last seven days. For 30%, the main reason influencing their current emotions is the economic situation.

A situation that generates deep concern and is a call to national health authorities is that 73% have felt the need to ask for help concerning their physical and mental well-being. Despite this, 40% did not ask for help.

This figure rises to 43% in the case of women. Health centers and specialized hospitals (50%) followed by worship centers (26%) and online services (23%) are the main mechanisms where they would seek help if needed.

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Percentage of substance using adolescents and mean number of substance-using days

in the 3 weeks before versus 3 weeks into the COVID-19 pandemic

Journal of Adolescent Health, 67(3), 354-361.

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Address young people’s mental health

The response must include timely diagnosis and treatment, as well as promotive and preventive measures.
Psychological, behavioral, or social approaches contribute to positive mental health, reduction of mental disorders, self-harm, suicide, and risky behaviors.
It is possible to implement these interventions through digital platforms, in schools, communities and health centers.

A comprehensive response to the mental health of young people must include timely diagnosis and treatment, as well as promotive and preventive measures. Recent WHO guidelines on mental health promotive and preventive interventions for adolescents recommend universally delivered interventions that use a psychological, behavioral, or social approach based on the evidence that such interventions contribute to positive mental health (mental well-being and mental functioning), reduction of mental disorders, self-harm, suicide, and risky behaviors (substance use and aggressive, disruptive, and oppositional behaviors). The guidelines further state that such universal interventions offer the opportunity to target a wide range of risk factors simultaneously, which is particularly pertinent in low-income settings.

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School Mental Health Literacy Training to Address Rise in COVID-19 Related Mental Health Issues

Enhance the understanding about mental health and mental disorders and to reduce stigma against mental illness
Helping to build the capacity to obtain and maintain good mental health; including linking adolescents with appropriate referral services

The Pan American Health Organization (PAHO) has collaborated with countries of the Region to train a cohort of trainers in mental health literacy (MHL) to address the expected increase in metal health needs of secondary aged school children due to the current COVID-19 pandemic.

The MHL approach was designed to enhance the understanding about mental health and mental disorders and to reduce stigma against mental illness, while helping to build the capacity to obtain and maintain good mental health; including linking adolescents with appropriate referral services

In collaboration with other experts, a team at Dalhousie University—a PAHO Collaborating Center—developed a school-based mental health literacy program. The intervention consists of six modules that are delivered in 10–12 hours of class time through a mix of didactic instructions, group discussions and activities, self-directed learning, and video presentations. The intervention is delivered by trained classroom teachers and is embedded in the school curriculum. Evaluations measured significant and sustainable improvements in student knowledge and attitudes regarding mental disorders, as well as potentially among the teachers.

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AIM: Improve evidence-based programming for psychosocial interventions for promotion of mental health and prevention of mental disorders, self-harm and other risk behaviors in adolescents.

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Strategies:

1. Implementation and enforcement of policies and laws: provides guidance on and examples of laws and policy provisions to improve adolescent mental health outcomes, embracing a whole-of-government and whole-of-society approach.

2. Environments to promote and protect adolescent mental health: focuses on actions to improve the quality of environments in schools, communities, and digital spaces through evidence-based activities such as school climate interventions, adolescent

safe spaces in communities, and teacher training.

3. Caregiver support: refers to interventions to build caregivers’ knowledge and skills for promoting adolescents’ mental health; strengthen caregivers’ and adolescents’ relationships; and support caregivers’ own mental health and well-being.

4. Adolescent psychosocial interventions: focuses on evidence-based psychosocial interventions for universal, targeted, and indicated mental health promotion and prevention.

Approaches:

• Multisectoral collaboration: collaboration between public, private, and civil society sectors and stakeholders at national and local levels to support the development and implementation of preventive and promotive mental health programming for adolescents.

• Monitoring and evaluation: systems which can provide policymakers and program managers with critical information on whether programs and policies are being implemented as intended and are having their intended impact.

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• Can be more damaging than the illness itself

• Examples how stigma manifests itself:

being dismissed or disregarded(the social & support network)
low self-worth, self-stigma
decreased employment, housing & educational opportunities

A major barrier or avoidance of treatment, poorer quality of care

Why Address Mental Health Stigma

Several factors stop people from seeking help for mental health conditions, including poor quality of services, low levels of health literacy in mental health, and stigma and discrimination. In many places, formal mental health services do not exist. Even when they are available, they are often inaccessible, unaffordable or of poor quality.

Lack of knowledge about mental health, or prevailing attitudes that undermine the value of mental health, can drive down demand.

One of the biggest barriers to demand is stigma. People living with mental health conditions can experience stigma from families, neighbors, and from health professionals themselves. People will often choose to suffer mental distress without relief rather than risk the discrimination and ostracization that comes with accessing mental health services

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Key principles

Mental health is critically important for everyone, everywhere.

Mental health is integral to our general well-being.

Everyone has a right to mental health.

Mental health is relevant to many sectors and stakeholders.

CONNECT

FUNCTION

THRIVE

COPE

Mental health is important to:

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Summary of tips for Youth during COVID

Recognize that your anxiety is completely normal.

Create distractions.

Find new ways to connect with your friends.

Focus on you.

Feel your feelings.

Be kind to yourself and others.

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Unavailable
Inaccessible
Unaffordable
Low quality

POOR SUPPLY

60%

Treatment Gap for depression

Lack of knowledge and understanding
Prevailing beliefs and attitudes

LOW MENTAL HEALTH LITERACY

Stereotyped views
Fear, shame and contempt
Human rights violations
Discrimination and exclusion

STIGMA

All too often people are reluctant or unable to seek help.

Stigma stifled my recovery

Odireleng’s experience

My healing only began when I overcame the stigma and realized there is no shame in asking for help.

NARRATIVE

Barriers to demand

Several factors stop people from seeking help for mental health conditions, including poor quality of services, low levels of health literacy in mental health, and stigma and discrimination. In many places, formal mental health services do not exist. Even when they are available, they are often inaccessible, unaffordable or of poor quality.

Lack of knowledge about mental health, or prevailing attitudes that undermine the value of mental health, can drive down demand.

One of the biggest barriers to demand is stigma. People living with mental health conditions can experience stigma from families, neighbors, and from health professionals themselves. People will often choose to suffer mental distress without relief rather than risk the discrimination and ostracization that comes with accessing mental health services

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Consequences of Stigma and Discrimination

Downplaying of symptoms
Delayed diagnosis and treatment
Poor adherence to treatment
Increased levels of anxiety
Increased risk of illness and death

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How to Support Someone with a �Mental Health Condition

Ask whether they would like your support

Talk with them directly, not with their friends or family members

Listen earnestly and avoid interrupting them

Don’t assume that you understand. Clarify what you’ve understood by asking

Display kindness, respect and understanding

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#DoYourShare Stigma Reduction Campaign

Targeting health workers and youth

ACTIVITIES

Paid and print ads
Influencers
Social media (Facebook, Instagram, TikTok, Twitter, LinkedIn)
Green benches
Videos
Web pages (EN, SP, POR, FR, Creole)

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Summary

Multiple studies have reported on the deterioration of the mental health of children and young people during the pandemic
A comprehensive response to the mental health of young people must include timely dx, tx, as well as promotive and preventive measures.
It is essential to strengthen mental health services for youth and increase the investment in youth mental health actions.
Essential to reduce stigma and discrimination