WHO Mental Health Gap Action Program (mhGAP)

The mhGAP at the WHO has been ongoing since 2008 and has developed several resources focused on mental health that can be used to inform program design and implementation. The program has an evidence resource center on the following topics: depression, epilepsy and seizures, dementia, conditions related to stress, psychosis and bipolar disorders, child and adolescent mental disorders, alcohol use disorders, self-harm and suicide, drug use disorders, and other significant emotional and medical unexplained somatic complaints. mhGAP has developed several key publications that are useful for program developers including:  

• mhGAP Intervention Guide: Provides practical guidance for mental, neurological and substance use disorders in non-specialist health settings. It includes guidance on essential care and practice and thematic specific modules. The intervention guide was updated in 2016 to reflect learning gathered during use and emerging research on key topics. It includes a section on child and adolescent mental and behavioral disorders, substance use, and suicide. This resource has been translated into multiple languages. 

• mhGAP Humanitarian Intervention Guide: Provides guidance for first responders for mental neurological and substance use conditions during emergencies where access to specialists and treatments are limited. The guidance provides staff in health facilities and programs with the necessary skills on how to assess and manage the following: acute stress, grief, depression, post-traumatic stress disorder, psychosis, epilepsy, intellectual disability, harmful substance use and risk of suicide. This resource has been translated into multiple languages.  

• mhGAP Community Toolkit: This resource is useful for program teams who are looking to increase access to community based mental health services in the primary health care system. It provides tools for community providers on mental health promotion and prevention, and how to increase access to mental health services. This resource has been translated into multiple languages. 

• Problem Management Plus (PM+) and Group Problem Management Plus (PM+): PM+ and Group PM+ is an evidence-based intervention published by the WHO that provides brief psychological interventions to reduce symptoms of depression, anxiety, and distress in adults. Tested in Kenya, Nepal, Pakistan, and Uganda, the approach was found to be effective in reducing feelings of distress, depression, and anxiety. The tools were developed specifically for adults, making them appropriate for youth ages 18-29. 

Helping Adolescents Thrive (HAT) Toolkit

The HAT toolkit was produced by the WHO and UNICEF to accompany the “Guidelines on Promotive and Preventive Mental Health Interventions for Adolescents.” The Toolkit includes a core set of evidence-informed strategies to promote and protect adolescent mental health. These strategies focus on the implementation and enforcement of laws and policies; environments to promote and protect adolescent mental health; the provision of support to parents and other caregivers; and psychosocial interventions for adolescents, including for groups exposed to vulnerabilities. Each strategy provides practical guidance on approaches, examples, focus exercises, implementation considerations, and key resources. Tools to guide implementation and examples of programs already introduced in countries across regions are included.  

I Support My Friends

This resource kit builds on existing evidence-informed materials on Psychological First Aid (PFA) to equip older children and adolescents with the skills and knowledge to support their friends in distress, under the mentorship and guidance of trusted adults. Like medical first aid, PFA involves helping to ease a person’s overwhelming emotions and if needed, referring them to someone who can provide more support. The content in this resource has been informed by evidence on children’s emotional, social, and cognitive development. It includes a theory and implementation guide, training manual, a training of facilitators package, and a participant workbook. I Support My Friends is for children and adolescents aged 9-17 years. 

Waves for Change Learning Brief

This learning brief outlines key findings and recommendations from a study of the Waves for Change (W4C) surf therapy program in South Africa. The W4C program was designed using participatory processes with young people along with supervision from mental health experts. It is an innovative intervention that is youth friendly, and evidence based, grounded in research on trauma, toxic stress, and their adverse impact on wellbeing. The study outlined in this brief was multi-modal, longitudinal, included quantitative pre/post-tests, and a two-group design. Recognizing that self-report measures alone may not be accurate, they used a combination of three standardized data collection tools: self-report surveys, computer-based behavioral measure tasks (specifically chosen to triangulate self-report data), and physiology using HRV (the variation in time between each heartbeat) as a marker for resilience and behavioral flexibility. 

Adolescent Well-Being: A Definition and Conceptual Framework

The Partnership for Maternal, Newborn & Child Health and the WHO are leading an initiative of the United Nations H6+ Technical Working Group on Adolescent Health and Well-Being to develop a consensus framework for defining, programming, and measuring adolescent well-being. This article provides a definition and framework for adolescent well-being and the requirements for adolescents to achieve well-being within five interconnected domains. The definition and framework were developed based on a scoping of the literature and consultations across the UN H6+ Technical Working Group, youth networks, and adolescent-serving organizations. 

Adolescent Mental Health: Time for Action

Mental health promotion and the prevention of mental health conditions, self-harm and risky behaviours are key to helping adolescents thrive.There is a growing evidence base on interventions to care for and treat mental health conditions. A range of multi-sectoral strategies and programs have been shown to have positive returns. However, more research is needed on this neglected area of adolescent health and well-being, to strengthen measurement, improve existing interventions and to design new scalable intervention packages for mental health promotion, prevention and care in adolescents. This knowledge summary calls for increased attention to and action on adolescent mental health, where everyone has a role to play.

Can mental health treatments help prevent or reduce intimate partner violence in low- and middle-income countries? A systematic review

Epidemiological research suggests an interrelationship between mental health problems and the (re)occurrence of intimate partner violence (IPV). However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries (LMIC). There is a paucity of studies which investigate whether mental health treatments may provide a beneficial strategy to prevent or reduce IPV in LMIC. Key future research questions include: whether promising initial evidence on the effects of depression interventions on reducing IPV hold more broadly, the required intensity of mental health components in integrated interventions, and the identification of mechanisms of IPV that are amenable to mental health intervention.

Preventing suicide: a global imperative

Social, psychological, cultural and other factors can interact to lead a person to suicidal behavior, but the stigma attached to mental disorders and suicide means that many people feel unable to seek help. Despite the evidence that many deaths are preventable, suicide is too often a low priority for governments and policy-makers. The objective of this report is to prioritize suicide prevention on the global public health and public policy agendas and to raise awareness of suicide as a public health issue. The report was developed through a global consultative process and is based on systematic reviews of data and evidence together with inputs from partners and stakeholders.

Mental Health Matters: Social Inclusion of youth with mental health conditions

The objectives of the present report are to: 1) Disseminate information on the needs of youth with mental-health conditions; 2) Raise awareness of the cultural and contextual dimensions related to the mental-health conditions of youth; 3) Identify the critical skills to be developed among youth with mental health conditions to overcome challenges to their self-development and social integration; 4) Increase understanding of support systems and raise awareness of access issues relating to youth with mental-health conditions; and 5) Summarize research and provide case studies of effective programs and approaches for preventing and addressing youth mental-health conditions.

Interventions for adolescent mental health: an overview of systematic reviews

Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions; community-based interventions; digital platforms; and individual-/family-based interventions. Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms and anxiety. School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide and knowledge of suicide prevention with no evidence of an effect on suicide-related attitudes or behaviors. Community-based creative activities have some positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous research is warranted to further establish the conditions. Among individual- and family based interventions, interventions focusing on eating attitudes and behaviors show no impact on body mass index and bulimia. Exercise is found to be effective in improving self-esteem and reducing depression score with no impact on anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission. Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms. The studies evaluating mental health interventions among adolescents were reported to be very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of the included reviews. Future trials should also focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a need to report differential effects for gender, age groups, socioeconomic status, and geographic settings since the impact of mental health interventions might vary according to various contextual factors.

What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries

Child and adolescent mental health (CAMH) problems are common and serious all over the world and are linked to pre-mature deaths and serious dysfunction in adult life. Effective interventions have been developed in high income countries (HIC), but evidence from low income settings is scarce and scattered. The aim of this paper is to identify the most promising interventions in the area of global CAMH. A systematic review of all randomized controlled trials in CAMH in low and middle income countries (LAMIC) was carried out and supplemented by 1a level evidence from HIC as well as suitable information from child program evaluations and adult studies in LAMIC. In behavioral disorders parent training is a highly promising intervention, which can successfully improve children's compliance and bring down rates of conduct problems significantly. In young children cognitive, emotional and behavioral development can be enhanced through nutritional supplements and by stimulation through play, praise and reading. Trauma treatments can bring positive results even in severely traumatized children, who remain in unstable living conditions. In developmental disorders, there are successful prevention strategies as well as programs that bring children out of isolation and improve their independence. Some classroom-based interventions for adolescents have reduced symptoms of common mental disorders as well as risk taking behaviors.

A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries

This systematic review provides a narrative synthesis of the evidence on the effectiveness of mental health promotion interventions for young people in low and middle-income countries (LMICs). Commissioned by the WHO, a review of the evidence for mental health promotion interventions across the lifespan from early years to adulthood was conducted.

Mental health interventions in schools in low-income and middle-income countries

Increasing enrollment rates could place schools in a crucial position to support mental health in low-income and middle-income countries. In this Review, we provide evidence for mental health interventions in schools in accordance with a public mental health approach spanning promotion, prevention, and treatment. We identified a systematic review for mental health promotion, and identified further prevention and treatment studies. Present evidence supports schools as places for promotion of positive aspects of mental health using a whole-school approach. Knowledge of effectiveness of prevention and treatment interventions is more widely available for conflict-affected children and adolescents. More evidence is needed to identify the many elements likely to be associated with effective prevention and treatment for children exposed to a range of adversity and types of mental disorders. Dissemination and implementation science is crucial to establish how proven effective interventions could be scaled up and implemented in schools.

Mental health and psychosocial interventions for children and adolescents in street situations in low- and middle-income countries: A systematic review

This article reviews the available quantitative literature on mental health and psychosocial interventions among children and adolescents in street situations (CASS) in low- and middle-income countries (LAMIC). PRISMA standards for systematic reviews were used to search five databases as well as grey literature. There were four inclusion criteria; studies had to involve a description of an external (i.e. outside of the home) mental health or psychosocial intervention/treatment, must be focused in LAMIC, must be focused on CASS, and must empirically evaluate the effectiveness of the intervention described. A quality assessment tool was used to assess the risk of bias in included articles. A multidisciplinary care approach was significant in reducing psychological distress, substance use and improving sleeping arrangements. Residency step programs were on average 52% successful in reintegrating children back into communities. Resilience training significantly increased psychological well-being components. Emotional regulation training had a beneficial improvement in emotional regulation. FORNET (Forensic Offender Rehabilitation Narrative Exposure Therapy) (n = 32) reduced the number of self-reported offenses committed. There are not enough credible studies available to develop a firm conclusion on the effectiveness of mental health and psychosocial interventions delivered to CASS in LAMIC. The limited amount of studies, inconsistent outcome measures, interventions and imperfect study designs maintain that this is an area in need of greater attention and research focus.