Dr. Gordana Milavić on World Mental Health Day 2021

Gordana Milavić
Dr. Milavić is a Consultant Child and Adolescent Psychiatrist at the Maudsley Hospital, London. She has over 40 years of experience in acute clinical practice, teaching and training. During her career she has been at the forefront of the organisation of mental health services for children and adolescents in southeast London. She is a Trustee and medical advisor of a number of mental health charities in the UK and internationally.

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This year, on World Mental Health Day, the World Federation for Mental Health1 has chosen the theme of ‘Mental Health in an Unequal World’.2

It is estimated that 10-20% of children and young people worldwide have mental health problems. 9 out of 10 of the world’s children live in low- and middle-income countries (LAMIC), where they constitute almost half of the entire population.3 Mental health difficulties are one of the leading causes of disability in this age group. The mental health needs of children and young people are not adequately met anywhere in the world, and particularly not in LAMIC.

In addition to the immediate burden put upon children and young people who suffer with mental health problems, research has shown that 75% of adult common mental health disorders begin during childhood, with nearly half developing by age 14.4 Mental health conditions confer poor health outcomes, unemployment, substance misuse, premature death, and global and national economic loss.5

The COVID-19 pandemic has brought into sharp focus the social, economic, health and cultural inequalities between individuals and in our communities. With the onset of the pandemic, children and young people around the world were forced to experience varying degrees of social deprivation and isolation. Health measures and consequent government-enforced restrictions, lockdowns, and school closures meant that the lives for children and young people changed radically. Many young people faced strained relationships at home with parents and carers facing financial, and employment, uncertainty. Current research in high income countries (HIC) has highlighted the impact that prolonged social deprivation and isolation can have on children and young people with increased rates of depression and anxiety.6 Further research suggests that the effects are likely to be more pronounced for younger children.7 According to NHS Digital (2020) mental health problems were found to affect 1 in 6 children and young people. This is a noticeable difference by comparison to data from 2017, which found that 1 in 9 children and young people were presenting with probable mental health difficulties.8 The 2021 figures have remained high with particularly high rates of probable mental disorder for girls.9

The Association for Child and Adolescent Mental Health (ACAMH) has a proud tradition of over 60 years of disseminating evidence-based scientific research and practice on child and adolescent mental health through its publications and events. ACAMH Journals are truly international with a global outreach. The Association’s international activities have been strengthened by the establishment of branches and professional hubs in a number of countries, including regions where there are scarce resources and few mental health professionals. ACAMH’s collaborative international work has engaged local practitioners and researchers, ensuring local needs are most likely to be met.

The challenge remains to reach those populations where the risks are greatest. Professor Theresa Betancourt in her address at the ‘Global Mental Health Research: Time for the Kids’ satellite meeting, at the 2019 Consortium of Universities for Global Health (CUGH) annual meeting, referred to the children of refugees and children in violent and conflict-ridden zones.

‘Globally, at the end of 2017, there were 69 million forcibly displaced people, 40 million internally displaced people, and 25 million refugees; over half of these people were under 18 years old. The number of children living in conflict zones rose by 74% over the last decade’.10

Supporting practitioners and researchers who work in these difficult settings poses specific challenges in disseminating evidence-based practice.

Young people with mental health conditions everywhere remain the subject of little understanding, stigma and lack effective treatment. We have excellent evidence-based interventions which can be delivered at low cost; ensuring that this information is available to practitioners, researchers and policymakers in health, social care and schools is ACAMH’s main goal.

To help meet some of the challenges stemming from the inequalities in the availability of evidence-based mental health research, and to raise practice standards in the understanding and management of child mental health disorders, we offer free Online Membership to mental health professionals in 51 countries.11 A comprehensive range of free resources is available to all, including recorded talks, podcasts, blogs, topic guides, and research digests. We are in the process of digitalising our learning resources with a video portal including recorded lectures, cross-referenced to our publications, transcribed, and translated into several world languages.

The WHO Director-General, Dr. Tedros Adhanom Ghebreyesus in identifying mental health for accelerated implementation of the 13th General Programme of Work, (GPW) covering 2019-2023 states:

“The highest standard of health can only be achieved when mental health and wellbeing are ensured, and the rights of individuals and communities respected”.5

In addition to raising the profile of mental health and wellbeing, advancing mental health policies, strengthening advocacy and human rights, the WHO initiative is set to scale up evidence-based interventions within local contexts and programmes, to focus on priority groups such as women, children and young people and to evaluate and monitor progress.5

In advancing standards and sharing best evidence, ACAMH is perfectly positioned to be at the centre of efforts to protect and serve the interests of children, young people, their families, and carers, as well as to support researchers to help combat mental health inequality.

By focusing on ‘mental health in an unequal world’, alongside our vision of ‘sharing best evidence and improving practice’ we hope that our educational resources based on scientific knowledge, evidence-based practice, and ACAMH’s global reach will continue to contribute to attaining the highest standards of health, mental health and wellbeing in children and young people, their families and communities.

References

1 World Federation for Mental Health, 2018. https://wfmh.global/

2 World Federation for Mental Health (2021). 2021 World Mental Health Global Awareness Campaign – World Mental Health Day Theme – World Federation for Mental Health, https://wfmh.global/2021-world-mental-health-global-awareness-campaign-world-mental-health-day-theme/

3 Weine, S. et al. (2019) Global Mental Health Research: Time for the Kids. Satellite meeting on Global Child Mental Health Research at the 2019 Consortium of Universities for Global Health (CUGH) Annual Meeting. https://bit.ly/3AiAA5T

4 Kessler, R.C., et al (2005) Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. JAMA Psychiatry https://bit.ly/3FpAtZS

5 World Health Organisation (2021). The WHO special initiative for mental health (‎2019-2023)‎: universal health coverage for mental health. https://bit.ly/2WKEHtI

6 Crawford, P. (2021). Editorial Perspective: Cabin fever – the impact of lockdown on children and young people. Child Adolesc. Ment. Health doi: 10.1111/camh.12458

7 Adegboye, D. et al. (2021). Understanding why the COVID-19 pandemic-related lockdown increases mental health difficulties in vulnerable young children. JCPP Advances doi: 10.1111/jcv2.12005

8 NHS Direct (2020). Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey. https://bit.ly/3ASCtaB

9 NHS Direct (2021). Mental Health of Children and Young People in England 2021 – wave 2 follow up to the 2017 survey. https://bit.ly/2ZTEy8t

10 Betancourt, T. (2019) Global Mental Health Research: Time for the Kids. Satellite meeting on Global Child Mental Health Research at the 2019 Consortium of Universities for Global Health (CUGH) Annual Meeting. https://bit.ly/3AiAA5T

11 The Association for Child and Adolescent Mental Health (2021). Join Us https://www.acamh.org/join-us/

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