It is estimated that around 20% of the world’s adolescents have a mental health or behavioral problem. Depressive disorders, anxiety, behavioral problems, and self-harm are among the greatest contributors to young people’s burden of disease, and suicide consistently ranks among the leading causes of death for older adolescent girls and boys (ages 15-19) globally. Yet, mental health resources are very scarce and investment in mental health is < 1% of the health budget in many low and middle income countries (LMIC). 

Poverty, low education, social exclusion, gender, conflict, and disasters are the major social determinants of mental disorders. Poor mental health is strongly associated with other negative health and development outcomes including higher rates of substance use, early pregnancy, school dropout, delinquent behaviors, and suicide, and can contribute to mental disorders and poor health later in life, with an estimated three-quarters of adult mental health disorders starting before the age of 24. Poor mental health also impacts economic development through lost production and consumption opportunities at both the individual and societal levels. It is estimated that the lost economic output caused by untreated mental disorders as a result of diminished productivity at work, reduced rates of labor participation, and increased welfare payments amounts to more than 10 billion days of lost work annually – the equivalent of US$1 trillion per year. Meta-analyses of gender differences in mental health indicate that gender difference in depression emerges as early as age 12, and that diagnosing and noticing symptoms of depression at that age have important implications for the timing of preventive interventions. Gender determines the differential power and control men and women have, their social position, status and treatment in society, and their susceptibility and exposure to specific mental health risks. Strengthening gender-responsive care and services for adolescents with mental disorders should be a priority but this will need additional investment in research and programming. Further research is required to better understand the local needs of adolescents and identify effective interventions to improve their mental health. 

The inclusion of mental health and substance abuse in the Sustainable Development Goals is an opportunity to invest in the prevention and treatment of mental health through the strengthening of health systems, prioritizing mental health on the global healthcare agenda, improving organization of and integrating mental health services into programming, addressing the gendered drivers of mental health, and developing policies to inform the design and implementation of gender-responsive interventions in LMICs. Increased efforts to meet the health needs of adolescents are critical to achieving the Sustainable Development Goals and represent a worthwhile opportunity for investment.

Manual on Community-Based Mental Health and Psychosocial Support in Emergencies and Displacement

This manual, developed by the International Organization for Migration (IOM), aims to facilitate MHPSS experts and managers in designing, implementing, and evaluating community-based MHPSS programs, projects, and activities for emergency-affected and displaced populations in humanitarian settings. Forced migration and displacement are not only disruptive to the individual but lead to shared struggles on a community level that impact psychosocial wellbeing. For this reason, this manual responds to the call to shift the focus of MHPSS programs from the treatment and prevention of psychological symptoms to collective and contextual elements of consequences of adversities. The manual points to research on the impact of displacement on communities, highlighting that strengthening the resilience of a community is critical to recover from adversity, and to prevent long-term mental health and social difficulties. The resource focuses on building existing strengths of affected communities, rather than limiting the intervention to the provision of services to respond to the deficits created by the emergency. It includes information and guidance on a wide range of PSS interventions, and provides guidance specific to MH interventions such as counseling, and guidance on a community-based response for those with severe mental disorders.     

Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Humanitarian Settings

This toolkit from WHO and UNHCR provides guidance on assessing MHPSS needs and resources for populations affected by conflict and other emergencies. The development of the toolkit involved expert consultations, peer review, and pilot testing of the tools. The toolkit will help you select assessment topics related to MHPSS, estimate the prevalence of mental health problems, and collect qualitative and quantitative data. It includes 12 recommended tools for assessing the mental health and psychosocial needs of affected populations. This resource is useful when assessing MHPSS needs in the acute phase of an emergency.  

International Medical Corps Toolkit for the Integration of Mental Health into General Health Care in Humanitarian Settings

This Toolkit aims to support the understanding and implementation of integrated mental health programs in humanitarian settings. Information gathered through a desk review, mapping of agencies, and assessment of agency needs was used to create a temporary field test version shared with eight piloting agencies working in 13 different settings. The final Toolkit was developed based on feedback collected from field testers and there continue to be periodic updates based on user-analytics and feedback. This Toolkit provides a framework for essential steps and components, with associated key guidance and resources, that strengthen the integration process. It is focused on integrating mental health in primary health care settings, primarily in humanitarian settings. This resource can be useful during program design and implementation to build in activities that support local health care providers strengthen their mental health systems. 

The impact of mental health and psychosocial support programmes for populations affected by humanitarian emergencies

This systematic review, draws together primary research on mental health and psychosocial support (MHPSS) programmes for people affected by humanitarian crises in low- and middle-income countries (LMICs). It investigates both the process of implementing MHPSS programmes and the barriers to, and facilitators of, implementing and receiving MHPSS interventions delivered to populations affected by humanitarian emergencies as well as assessing their intended and unintended effects.

Mental health and psychosocial support in humanitarian settings: linking practice and research

This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007–10); funding by analysis of the financial tracking service and the creditor reporting system (2007–09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomized controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list. In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD, but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalizing symptoms. Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny.