Leveraging South-South and triangular cooperation in Advancing Child and Adolescent Mental Health in the context of COVID-19

On 15 July 2021, the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the Pan American Health Organization (PAHO/WHO), in cooperation with the International Policy Centre for Inclusive Growth (IPC-IG) organized a global discussion on Leveraging South-South and triangular cooperation in Advancing Child and Adolescent Mental Health in the context of COVID-19.

The session is part of a series of global webinars showcasing solutions and experiences from countries in the global South on different areas of the SDGs taking into consideration COVID-19. The global webinar provided an updated review on the challenges and opportunities for countries in sustaining delivery of child and adolescent mental health services in the context of COVID-19 and in the post-pandemic period. Three case studies were presented, namely from Argentina, China and Iran, highlighting successes and challenges and what other countries may learn from their experiences. The webinar seeks to promote country-to-country learning and exchange of practical knowledge to bolster mental health and psychosocial support (MHPSS) within primary health care, universal health care, and other health services. Also, the session intended to discuss how governments, development agencies, international organizations, and other stakeholders can build strong partnerships to leverage South-South and triangular cooperation (SSTC) in advancing child and adolescent mental health in order to help countries of the global South “build back better” in the context of COVID-19 and similar global crises.

The webinar was moderated by Mr. Andrés Franco, Deputy Director Multilateral Partnerships, Public Partnerships Division, UNICEF, and the panel was formed by the following speakers:

• Dr. Batool Fatima, Technical Officer, Department of Mental Health and Substance Use, WHO
• Dr. Ahmad Hajebi, Director General of the Psychological and Social Health & Addiction Office, Ministry of Health and Medical Education, Iran
• Dr. Liliana Ensisa, Head of El Chaco Adolescent Health Program, Ministry of Health, Chaco, Argentina
• Mr. Xu Jiannong, Director of National Youth Hotline Call Center and Beijing Youth Legal and Psychological Counseling Service Center, China 
• Dr. Anselm Hennis, Director of Department of Noncommunicable Diseases and Mental Health, PAHO/WHO

You can find the webinar recording here, and the presentation slides here.

Mr. Andrés Franco opened the discussion and recalled that mental health was one of the most neglected areas of the SDG3 on good health and well-being. He pointed out that COVID-19 has made the provision of mental health and psychosocial support services an urgent priority for all populations, especially vulnerable groups, and affects greatly children, young people, and their families. To address this problem, exacerbated by COVID-19, governments with their partners are implementing different approaches covering a range of policies, programs, and services to mainstream support to mental health. South-South and triangular cooperation provide an opportunity to share solutions and lessons learned with other countries and to scale up good practices by increasing access to technical assistance and catalytic resources.

 

Overview and recommendations

Dr. Batool Fatima provided an overview of child and adolescent mental health situation in the context of COVID-19 and shared recommendations from WHO. During the pandemic, children and adolescents struggled due to curtailed education, diminished job prospects, and reduced social contact with peers. According to the statistics[1], 1.58 billion learners or 90 percent of the world’s students have been affected by national closures, and 40 percent of the youth tend to have psychological problems during COVID-19, such as increased fear and anxiety. She highlighted that mental health accounts for 35 percent of the global economic burden of non-communicable disease; it would lead to reduced productivity and learning capacity, increased social welfare costs as well as growing crime and suicide rates if no action has been taken. By urging to ensure greater investment to change challenges into opportunity, she shared several interventions carried out by WHO in partnership with UNICEF, MHPSS and other collaborators: 1) resources for children and adolescents such as My Hero is You, Storybook for Children on COVID-19.pdf (interagencystandingcommittee.org); 2) “Doing What in Time of Stress: an Illustrated Guide”; 3) guidelines for parents and teachers/schools to protect and support children; #HealthyAtHome - Healthy parenting (who.int), 4) Early Adolescent Skills for Emotions (EASE) to deliver group-based psychological intervention targeting young adolescents with high distress and impaired functioning; 5) Sustainable Technology for Adolescents to Reduce Stress (STARS) based on artificial intelligence to allow adolescents to engage themselves; 6) WHO-UNICEF Helping Adolescents Thrive (HAT) HAT package of materials include "Guidelines on promotive and preventive mental health interventions for adolescents" and a Toolkit which provides details on how to implement the above-noted Guidelines and what complementary action is required to support adolescents and their caregivers and to improve the environments in which they live. The Toolkit is accompanied by a Teacher’s Guide and Comic Book that can be used for the planning and facilitation of classroom activities focused on socio-emotional learning.

 

Iran

Dr. Ahmad Hajebi acknowledged that during the COVID-19 pandemic and similar emergency situations, children and adolescents are more vulnerable to mental health issues, which should be addressed urgently. He introduced various programs adopted by Iran that have been integrated into the primary health care system: 1) Parenting Skills Training Programs provide parents with counseling services and aims to develop new competencies of parents in child support and learning, and especially in the management of emotional and behavioral reactions of children during COVID-19; 2) Life Skills Training Programs entail behavioral counseling for lowering risk in adolescents, such as screening and detection of risky behaviors, determination of different levels, prevention and elimination of risky behaviors; 3) Child Maltreatment Prevention Program provides psychosocial interventions for children and parents based on family assessment, offer medical treatment, and refer to specialized levels of care or the emergent department when necessary; 4) School Mental Health Program aims to increase teachers’ knowledge on psychological aspects of child development and carry out effective initial interventions. He pointed out that during the pandemic, the temporary cessation of these programs and non-attendance of target groups due to anxiety and fear consisted of the main challenges. Iran government has then designed several activities to overcome these challenges, including launch of helpline to provide remote counseling services, development of online training packages for teachers, and promotion of educational multimedia toolkits for adolescents. These initiatives contribute to an upgraded level of service coverage, enhanced quality of training, increased awareness toward adolescent mental health issues, and clearer identification of students with mental problems or mental disorders.

 

Argentina

Dr. Liliana Ensisa shared the lessons learned in the province of El Chaco in Argentina, including the need for an inter-sectorial approach with regards to, for example, suicide in adolescence. She introduced that suicide in young populations in Argentina is the second cause of death in adolescents between 10 and 19 years of age, and this problem worsened in the context of COVID-19. Since March 2020, the ASPO (Mandatory Preventive Social Isolation) was implemented in Argentina, which provoked marked restrictions, as suspension of classes, and negative impacts on nutrition, education, and communication, lack of access to internet in remote areas, and absence of mental health services. In response, the Argentine Province of Chaco government established a provincial inter-ministerial working group (Ministries of Health, Education, Justice, Human Rights, etc.) and identified key policy actions (psychology/epidemiology) in order to address the situation of suicide in the province of El Chaco, with a focus on young people and adolescents. In a more practical way, the El Chaco program has been developed to generate common and centralized responses in this region with an intercultural approach and in different indigenous languages. The program includes: 1) weekly dialogue meetings with the community leaders for 8 months to guide care providers on suicide prevention and response, 2) joint mapping of training spaces to encourage community engagement led by teachers, 3) group work with adolescents to the extent that ASPO allows, in order to provide direct support, 4) plan ENIA to ensure community presence of a comprehensive adolescent health advisor in the remote areas, 5) introduction of community cultural interpreters to ensure better understanding of target groups, 6) exchange of experiences with other provinces and 7) remote support through community-centered communication devices. Dr. Ensisa highlighted the importance of South-South cooperation and learning from other countries, recalling their collaboration with UNICEF to set up protocols and flow charts to share with other countries. Finally, she made some recommendations for successful South-South cooperation towards addressing child and adolescent mental health, including continuous training, inter-sectorial approach, community participation, continuum of evidence-based work, and follow-up.

 

China

Mr. Xu Jiannong first introduced the adolescent mental health situation in China during the pandemic: adolescents experience stress reactions such as fear, nervousness, and worry about the disease and emotional problems represented by anxiety; there has been an increase in the amount of time adolescents spend online; nearly 90 percent of lower grade students were more likely to seek help from their parents when experiencing mental health issues, while higher grade students showed a more diverse approach to mental relief. In response, the Beijing Youth Legal and Psychological Counseling Service Center aims to conduct research on the adolescent mental state to provide technical support for government’s decision-making, promote mental health literacy among young people, develop a team of counselors for adolescents to access timely counseling, and provide professional support to mental health workers in areas with severe outbreaks. He shared the major work implemented by the Center: 1) conduct more than 100,000 questionnaires regarding adolescent mental state throughout the country; 2) launch mental health information toolkit, including guidance manual, interactive Q&A, case studies, informative posters, videos, and episodes of Youth Podcast; 3) provide one-to-one counseling service through“12355 Youth Service Helpdesks”, which has enabled service to teenagers and parents nationwide over one million times online or on the phone; 4) facilitate experience sharing through online platforms and provide skill training to more than 100 social workers and volunteers in Hubei Province on mental health assistance. He highlighted that three key experiences, the adolescent mental health work should closely cooperate with the government's epidemic prevention and control work; secondly,  professionalism and well-preparedness of mental health institutions, as well as, school mental health education to stabilize the mental state of students during the pandemic. He finally called for more attention to be paid to adolescent mental health, more informative platforms to be leveraged for technical support and experience-sharing, and more investment to be placed in adolescent mental health programs to address the needs of adolescents, families, schools, and the community.

 

Implications of South-South cooperation for child and adolescent mental health

In his closing remarks, Dr. Anselm Hennis expressed appreciation to the organizers and panelists for facilitating this important exchange and sharing of invaluable experience. He pointed out that adolescents and youth make up some 30 percent of the population in Latin America and the Caribbean region, yet mental health services for this group remain neglected, and that the overall adolescent mortality rate in the region has increased with suicide being among the leading causes. Despite the high burden of child and adolescent mental health problems, financial and human resources in this domain are lacking, only around 50 percent of PAHO countries and territories report having a plan or strategy for child and adolescent mental health; community and school-based mental health services are inadequate. In the context of COVID-19, high rates of stress, depression, and anxiety have been documented in numerous countries globally as well as in the region, children and adolescents in particular, whose physical, cognitive, social, and emotional growth and development have suffered in unique and profound ways. Many countries are taking action to address the increased demand for mental health and substance use services, but continue to face barriers related to disruption of service. He highlighted the necessity of South-South cooperation to effectively and sustainably address shared health challenges, achieve common targets, and tackle issues of health equity within and across all countries. He reiterated the commitment of PAHO/WHO to foster South-South cooperation in child and adolescent mental health, and shared experience of programs in partnership with UNICEF in the Americas, including school mental health literacy curriculum for teachers, joint webinars, mental health, and psychosocial support packages and “My Formula” campaign for adolescents to exchange their experience in managing COVID-19. He finally recalled the importance of working together through South-South cooperation to learn from each other and build a more resilient mental health system that can respond to the increasing needs of our future generations during and after the pandemic.

 

The webinar concluded with a lively Q&A session with the participation of attendees, which you can access here.

 

 

[1] Liang et al. Psychiatric Quarterly (2020)