Children and young people’s mental health: the case for action

One in seven adolescents has a mental health condition. Suicide is the third leading cause of death among young people globally. Without support, mental health conditions can negatively impact children and young people’s (CYP) education, employment and relationships, limiting life trajectories. Timely care and enabling environments can improve outcomes and reduce long-term costs. Every dollar invested in adolescent mental health yields an estimated US$24 return over 80 years.

Today, climate change, conflict, poverty, inequality and displacement are intensifying risks. Yet investment remains low: mental health receives less than 2% of national health budgets on average, with little allocated to children and adolescents. In low-income countries, there are fewer than 0.01 child mental health workers per 100,000 people, and services are often out of reach. 

From fragmented efforts to holistic impact

WHO advocates for a comprehensive response to the mental health needs of children and young people, with a focus on strengthening policies and legislation; promoting enabling environments (in homes, schools, communities, workplaces and digital spaces) and building preventive and care services.  

Multiple sectors have a role in creating enabling policy environments for child and adolescent mental health, to protect families against economic and social adversity, support caregivers in promoting nurturing care, ensure access to learning opportunities and employment and to reduce self-harm and substance use. National laws, policies and plans are also important to build systems for delivery of mental health preventative and care services. In Viet Nam, for example, the government formally has initiated a process to create psychosocial counselling positions in all primary and secondary education schools.

At family level, interventions to support caregivers’ well-being and improve parenting can make considerable contributions to preventing mental health conditions in children and youth – these interventions are relevant for caregivers of young children as well as older children and adolescents, and of particular importance when caregivers and/or their children are experiencing mental health issues or face adversities. In fact, when these interventions reach caregivers with mental health conditions, they could reduce the risk of mental health conditions in their children by 40%. For caregivers of children with developmental delays or neurodevelopmental conditions, parenting programmes can empower them to foster their children’s learning, social communication and adaptive behaviour.

Schools can be places that nurture well-being, inclusion, equipping students with the knowledge, skills, competencies and lifestyles they need to thrive. School-based anti-bullying programmes and socioemotional learning are important components of a whole-school-health-promoting approach, can be delivered for all school ages, can improve students’ well-being, academic performance and reduce risk behaviours, including self-harm and harmful substance use. Beyond schools, any intervention that successfully addresses stigma, violence and other adversity in the community can be considered promotive.

There is growing concern on the impact of engaging with social media and digital platforms on young people’s mental health. In the past few years, several countries have initiated actions to regulate access to mobile phones and social media for children and adolescents. Evidence to inform a public health approach for safe and healthy engagement with social media and digital technology for children is limited. However, promising interventions include skills-building programmes for adolescents and for caregivers to promote responsible and safe engagement with social media; and technological tools to promote online safety, including reporting systems.

Services need to be responsive to different levels of need, from prevention to recovery. Care services should be provided through both health (general and community health services) and non-health settings, like schools and youth centres. A strong country response fosters social inclusion and connectedness, and addresses structural issues such as housing, education, and employment. It expands community-based services, whilst phasing out care in custodial settings.

To make this happen, it is critical that system strengthening is supported by strong leadership and governance, solid coordination across sectors, sufficient financing, a skilled and diverse workforce, and robust health information systems.
 

Maximising opportunities to drive change

Despite the evidence on effective interventions, many opportunities to make information and services for mental health available to CYP and their caregivers through the health, education and other sectors remain untapped.

To that end, WHO has partnered with UNICEF, governments, and local stakeholders to deliver a Joint Programme on Mental Health and Psychosocial Wellbeing and Development of Children and Adolescents to strengthen country leadership and capacity to provide services for CYP and their caregivers. Each year, over 10 million children and young people have access to improved services, with more than 6 million reached through prevention efforts and at least 330,000 receiving care. 

Across regions, there are encouraging examples of evidence-based interventions and good practices that have been successfully implemented and scaled including:

• In Serbia, a digital one-stop shop developed by the government provides educational resources and counselling sessions for young people in need of mental health support. It has directly reached nearly 170 000 young people and is accessible to more than one million young people in the country.
• The Ministry of Health of Cote d’Ivoire in partnership with the Ministry of Social Affairs established a roster of social workers trained in child mental health and deployed to emergency-affected areas in response to the Central Sahel crisis, providing services to 50 000 people living in refugee camps and host communities.
• In Kenya, in a stepped care model called Shamwiri, young high school graduates were trained as peer counsellors to identify cases and deliver support in schools, or coordinate referrals to more intensive support according to mental health needs.
• In Brazil, community-based mental health service provision takes place through child psychosocial care centres (Centro de Atenção Psicossocial Infantil, CAPSi), which provide multisectoral services to CYP with mental health needs and their caregivers across the country. 

Strengthening advocacy and accountability

Accountability and capacity to track progress globally and in countries remain hugely inadequate.  In 2020, health information systems in nearly half of low-income countries did not have capacity to disaggregate mental health data by age. 

WHO is working with UNICEF and other partners, including youth, to facilitate platforms to define commitments for children and young people’s mental health and track change.    

Key messages

• One in seven adolescents experience mental health conditions.Suicide is the third-leading cause of death among youth worldwide. Accessible mental health care and enabling environments support young people to meet their potential and lay a foundation for a health adulthood – yet investment in the mental health of children and young people remains low.
• WHO calls for a comprehensive approach to child and adolescent mental health, including stronger policies, legislation, prevention and care services, and cross-sector coordination across health, education, social welfare, youth, sports and justice.
• There are multiple untapped, cost-effective opportunities to integrate mental and brain health into health services, with growing evidence of successful, scalable interventions.
• Advocacy efforts must meaningfully involve children, young people and caregivers, ensuring government action meets their needs.