Supporting Young People's Mental Health

Mental health is having a moment. The COVID-19 pandemic has heightened awareness about the importance of mental health for all people and has opened space for conversations--in homes, schools, workplaces, places of worship, and communities--that help destigmatise this important topic.

However this long-overdue attention has revealed a worsening worldwide mental health crisis among young people. Whist the pandemic led to conditions that decrease mental health, like social isolation, violence, economic and food insecurity, the stress of dealing with sickness, poor mental health among young people can’t be blamed on the pandemic alone. Mental health among young people worldwide was in decline even before COVID-19 ever emerged. The pandemic did however, unmask underlying vulnerabilities and remove supports that had been keeping people at risk of poor mental health afloat.

Data on mental health isn’t collected with the same rigour and frequency as other issues of interest in young people’s lives, like the proportion who are in school or who become pregnant. But what is available suggests mental health challenges are widespread and on the rise. ¹  Mental disorders account for an estimated 13% of the global burden of ill-health among 10-19 year-olds. Suicide is a top cause of mortality among 15-19 year-olds: #3 among females and #4 among males. ²  Rates of suicide are even higher among groups that experience marginalisation and discrimination, like LGBTQI+ young people, refugees, migrants, indigenous people, and people who experience disasters, abuse, violence or conflict. ³ 

Yet a focus on such extreme issues like suicide, or even depression and anxiety, mask the more common, everyday mental health challenges that young people face. It is important to recognise that mental health is a continuum that all people move along throughout the course of their lives. ⁵  All people need help appropriately responding to stress and helping others experiencing difficulty in their community. Some individuals will need more specialised care if they find themselves further to the distress side of the continuum, whether temporarily or regularly. All such care is most effective if it is community-based, culturally-appropriate, and functions as multi-faced support accessed by everyone, not just those in crisis.

 Research shows that many mental health disorders have their origins in childhood and adolescence, with half connected to experiences that took place before the age of 14 and 75% linking back to experiences that took place before the age of 24. ⁷  While adolescence is a period when mental health disorders start to emerge, it is also a crucial time to develop skills to cope with life’s challenges.

Young people who experience traumatic events tend to struggle with emotional regulation. Marginalised young people, like the ones who participate in programmes funded by EMpower, are more likely to experience violence, social exclusion, poverty, and other factors that contribute to poor mental health. Repeated exposures to violence and losses can contribute to a range of mental health problems for young people. Such issues make it difficult to focus on what young people should be doing, like learning, making healthy decisions, and engaging in supportive relationships with their families and peers. Good mental health is foundational to young people’s ability to achieve positive outcomes, and to having healthy, future-oriented lives.

This highlights the importance of early adolescence as a key time when interventions can effectively work to strengthen young people’s mental health skills before they are most needed, so that young people can effectively manage the challenges associated with the transition to adulthood.

There have been recent strides in data collection for mental health; for example  UNICEF recently announced that the widely-used MICS (a survey that tracks population-level health indicators for children and adolescents across a wide range of indicators) will now include mental health indicators.  However, even this effort, while a welcome change, focuses solely on mental health problems.

At EMpower we recognise that mental health problems are important and widespread, but we also see mental health as a positive attribute, something that can be nurtured and strengthened just like physical health. ⁸  Such a strengths-based approach is valuable for helping young people experiencing traumas know that there is more to them than their negative circumstances and experiences, fostering a sense of safety and empowerment. Grantee partners identify and assist young people who are “surviving” or “struggling” by offering them support to deal with the challenges they are facing and by sharing tools to manage the feelings that come with these difficult experiences. Good mental health is foundational to well-being, something that is vital to nurture so that individuals can achieve other goals, like employment or health outcomes.   

Mental health is affected by myriad factors at multiple levels, including individual neurological and genetic makeup, socioeconomic determinants in families and communities, intergenerational ways of coping (or not) with stress, situational issues, and more. On a more mundane basis, feeling worried, anxious or upset are all normal responses to everyday challenges, and some young people encounter more challenges than others.

One country where EMpower has chosen to have a strong mental health focus is South Africa, a country with among the highest documented rates of depression in Africa. South Africa has many features that work together to produce poor mental health outcomes, especially for marginalised young people. For example, South Africa has the most income inequality in the world. ¹²  More than half the children in South Africa (63%) live in households that are below the poverty line, and youth unemployment is extremely high. ¹³  The connections between poverty and mental health problems is well documented: People who live with mental health disorders often face additional challenges in making a living, and people living in poverty have been shown to be at greater risk of developing mental health disorders. ¹⁴  Additionally, families with limited resources may struggle to pay for transportation and fees related to accessing mental health services, which can fuel the intergenerational cycle of poverty and poor mental health. ¹ ⁵ Hunger and malnutrition are also directly linked to poor mental health. Approximately 40% of adults in South Africa who live with children in food insecure households show “signs of depressed mood.” ¹⁶  Financial and food insecurity creates high levels of stress for affected families. South Africa also has high levels of violence, often even within the home, giving marginalised young people few places where they feel safe and can thrive.

While some of these issues may be especially acute in South Africa, ¹⁷  the country is far from alone; poverty, food insecurity and exclusion exist across all the countries where EMpower funds grantee partners to work with young people.

EMpower supports grantee partners to address mental health in a variety of innovative ways.

Just as mental health problems have a constellation of causes, so must approaches to addressing mental health and resilience-building be multi-faceted. Mental health issues do not only have biomedical origins; research has shown that social and economic determinants are equally or even more important. Some cultures also look for spiritual or cultural causes, affecting where individuals will seek care and support. Despite some inroads in making mental health a more acceptable topic for discussion, much stigma remains, meaning mental health cannot always be the explicit approach taken by an organisation. Additionally, mental health initiatives must always be carefully contextualised, which means that approaches will be very different depending on local understandings of mental health, availability of care, and more. There is no one-size-fits-all approach to mental health work.

Our grantee partners are at different places in their journeys to including mental health in their interventions, which are largely focused on other outcomes related to education, health, and livelihoods. Some partners have been working on mental health for years, and others were spurred to action during the COVID-19 pandemic, providing mental health supports to programme participants and staff that had not been previously identified as a need. Many of our grantee partners do not explicitly include mental health work at all; this storymap focuses on those 61 grantee partners who do, in ways both large and small.

Grantee partners take a range of approaches to including mental health in their work.

The map below gives an overview of the types of work EMpower supports across our current grantee partners. Each partner is colour-coded based on the primary approach their programme is taking to address mental health. Clicking on the map gives information about each organisation's mental health approach, along with links to their websites.

The following stories give more detail about how these programmes are impacting young people's lives. You can click on the map or scroll through the stories to see grantee partners' mental health work in action.

• Who provides emotional support and how it is provided matters—relationships of trust are most easily built between young people and someone who shares their cultural or economic background or has faced similar challenges. Safe, non-judgmental spaces are essential.
• Having former programme participants as staff can be powerful, providing real role models for programme participants who have overcome the struggles they face. Organisations can harness young people’s sense of personal leadership by inviting them into real leadership roles, making use of the skills they have gained. Young people who have come through the programmes often know best what works and why.
• Creative approaches are key. Approaching mental health in the context of other activities young people enjoy, including sports and physical activity, or art and creative expression, help make it fun and accessible, and give young people the opportunity to reflect, lead, and create new narratives about their lives.
• Programmes and staff must be gender sensitive. Gender powerfully shapes how young people respond to distress. Gender-specific programming that takes into account what all young people need to feel safe and welcome helps young people feel comfortable discussing sensitive issues and processing and challenging gender norms that may be harmful.
• Nothing works without collaboration. Young people thrive when they are surrounded by a circle of support, including peers, families, and networks of organisations that provide age- and culturally-appropriate care.
• Time spent developing suitable learning and impact systems is not wasted. Measuring mental health and well-being, and what makes a difference, can be highly contextual, so it is worth the time understanding what matters in each context and how an organisation will know whether key issues are changing or not. A mix of approaches is usually best.

The need to invest in mental health is urgent. While EMpower wasn’t as focused on mental health just a few years ago, the world has changed, and we support partners to be responsive to emerging needs. The work we support runs the gamut from direct mental health support with trained counselors, to programmes that use sport as a medium to talk about mental health, to programmes that incorporate resilience-building as a core life skill.   We directly support organisations that do mental health work, and convene communities of practice so organisations can learn collectively and work together to support young people.  

Our grantee partners demonstrate the importance of offering services in culturally sensitive ways and creating safe spaces where youth can speak openly about their challenges. They have shown the value of creating strong partnerships, strengthening networks of support, including for referrals, and creating communities of care around young people. Inviting and supporting youth to lead can powerfully influence this change and ensure that the systemic work is guided by their voices and what matters most to them.

One lesson we have learned is that mental health is a skill, a muscle to be exercised and trained. All people have mental health, and every person benefits from resilience skills-building. Mental health must not be medicalised, pathologised and further stigmatised. While there are certainly aspects of mental health and well-being that have their origins in the body and must be dealt with by professionals, the social determinants are stronger, and easier and cheaper to address, with broader benefits. Building an ecosystem of support for young people is the lower-hanging fruit that can lead to a big payoff with even small investments. Mental health support added to existing programmes will make them more effective at whatever it is they are trying to achieve.

• Recognise the importance of supporting young people’s mental health in its own right, but also as a critical element in achieving a range of development outcomes.

• Invest in the full range of mental health services including community-based care.

• Fund posts for trained staff to provide mental health support and ensure that organisations have the capacity to train and support staff.

• Invest in processes that help organisations build awareness of and address gender discrimination and inequality.

• Support organisations in developing tracking and measurement systems and tools.

EMpower hopes the lessons and examples presented here help our grantee partners and other like-minded organisations continue to grow in their efforts to provide desperately needed mental health services for young people worldwide.