Introduction Key Definitions Terminology Literature Review Frameworks Ensuring Inclusion Tools, Resources, and Annexes Group Pull-outs
Literature Review
The social, economic, and physical environments we all live in influence MHPSS needs (WHO and Calouste Gulbenkian Foundation 2014). Mental health challenges are directly related to the serious gaps that exist in mental health and psychosocial well-being, which include a historic underinvestment in, and lack of action on, the promotion of states of well-being and the prevention among those living with mental health challenges, determinants of mental health and psychosocial well-being, and barriers to mental health services and care (UNICEF 2022a). This is more pronounced within marginalized and underrepresented communities who face structural and systemic barriers to accessing MHPSS services, making it difficult to receive appropriate care, which results in higher rates of mental health conditions (Baylor University 2021). In addition to the structural and systemic barriers, many marginalized and underrepresented groups face psychosocial challenges and protection risks, which increase the chances of developing mental health and psychosocial challenges. Therefore, intentional efforts are required to:
- Make sure mental health programming is equitable and inclusive by providing opportunities for youth from marginalized and underrepresented groups to meaningfully engage in the development of programs aimed to support their mental health and psychosocial well-being
- Support the fulfillment of the right to access to quality MHPSS services that safely and effectively address their mental health and psychosocial needs
Despite recent successful knowledge-building on effective MHPSS interventions and approaches for quality mental health service delivery in LMICs and humanitarian settings, there has been little progress globally on improved access to safe, appropriate, and culturally relevant care for most people, including marginalized and underrepresented groups. Regarding the services that do exist, most youth and families worldwide, and especially in LMICs, still face major barriers to access—for example, in many settings, services are located at a central psychiatric care facility, which translates into costs, remote distance, and stigma that make youth from marginalized and underrepresented groups less likely to seek formal MHPSS.
From the literature, we know that:
- Persons with disabilities are more likely to experience several protection risks than their non-disabled peers, including exposure to sexual violence and violent discipline, neglect, exploitation, exclusion (UNICEF 2021), and bullying (Fang et al. 2022). For a deeper dive on persons with disabilities, please see the pull-out.
- The marginalization, discrimination, and violence LGBTQI+ youth experience on the basis of their sexual orientation, gender identity, gender expression, and sex characteristics; the increased sense of vulnerability; and the pressure to hide their sexual orientation or gender identity has direct consequences on their mental health and substance misuse, as well as implications for self-harm and suicide. For a deeper dive on LGBTQI+, please see the pull-out.
- Victims of torture and cumulative trauma (i.e., violence, traumatic loss and witnessing gross human right violations, living in fear or under threat of one’s safety [Hoy-Ellis 2023]) have increased risk of mental health and psychosocial challenges, such as somatic complaints, depression, anxiety, social withdrawal, and disrupted attention (Hoy-Ellis 2023). For a deeper dive on victims of torture, please see the pull-out.
- Mental health and psychosocial well-being outcomes among Indigenous Peoples in many countries often appear to reflect similar mental health inequities (e.g., in suicide, psychological distress, depression, anxiety, intergenerational trauma [Hoy-Ellis 2023], and substance misuse) that Indigenous Peoples themselves may understand as connected to the historic injustices of colonization. The World Health Organization (WHO) acknowledges this concern and notes reports of Indigenous Peoples’ ongoing disproportionate subjection to violence, including gender-based violence (GBV), racism, poverty, and cultural barriers (WHO 2023). For a deeper dive on Indigenous populations, please see the pull-out.