World Mental Health Day

Looming mental health crisis - better investment in systems

Rachel Harvey and Shirley Mark Prabhu
Indonesia mental health
09 October 2020

Since the onset of COVID-19, the mental health crisis for children, adolescents and families is growing, overwhelming underdeveloped systems and services.

Globally, there is only one mental health professional for every 10,000 people. Mental health services, particularly for children and adolescents are neglected.

Before the pandemic, an estimated 10–20 per cent of children and adolescents worldwide experienced mental health challenges with one in four children living with a parent who has a mental health condition.

COVID-19 brought this often-stigmatized issue into the open with a recognition that trauma and stress can impact everyone. And provided an opportunity to promote investment in mental health services; a critical response for the recovery.

In East Asia and Pacific

The mental health of adolescents and high suicide rates are alarming - deaths by suicide are more common for adolescent boys than girls in all countries, except Myanmar where rates are similar. A survey from 2011-2017 showed a significant trend of students aged 13-17 years who seriously contemplated suicide, 5.4 per cent in Indonesia, 23 per cent in Mongolia, 11.6 per cent in the Philippines, 12.5 per cent in Thailand and 16.9 per cent in Vietnam.

Vietnam mental support
UNICEF/UNI304109/Viet Hung

The pandemic has worsened existing uncertainties and distress. It has isolated children and adolescents from their social networks. Self-isolation has resulted in anxiety and sleep problems among adolescents including because of increased screen time, irregular eating habits and reduced physical activity. And specific stressors linked to quarantine, fear for one’s own health and infecting others, isolation and boredom, financial loss and stigma; risks negative and long-lasting psychological effects.

The impact was compounded by the limited or absence of available services, including because of widespread disruption as a result of containment measures.  

The negative mental health impact of COVID-19 may also be worse for young people with existing psychological disorders, especially those whose treatment may have been disrupted as result of the pandemic. These challenges can be further exacerbated among adolescents with disabilities, who may not be able to maintain physical distancing or access basic services or therapy. Adolescents with learning or cognitive disabilities may not be able to fully understand the situation brought about by COVID-19, or effectively use available virtual channels for communication and to access remote support. Marginalized and high-risk groups, such as migrant and displaced children, also struggled to access services that were available.

loneliness in VN
UNICEF/UN0156011/Viet Hung

What’s needed

Mental health and psychosocial support services is a priority for UNICEF in the region with an emphasis on systems strengthening and sound investment to ensure availability, quality and access to services that meets the needs of children and adolescents.

To coincide with World Mental Day, UNICEF has issued a brief to capture the provision and adaptation of mental health services for children, adolescents and parents/caregivers during COVID-19 (insert link to brief). It presents the many approaches and adaptations that UNICEF in the region have adopted to providing mental health and psychosocial support services in collaboration with government, civil society, development partners and young people’s networks.

Action across the region

With containment measures in place, face to face delivery of direct mental health and psychosocial support services was widely disrupted, even as needs have increased. To overcome this challenge, UNICEF across the region has supported and expanded helplines or hotlines, providing direct support to children, adolescents and parents/caregivers. Parents and caregivers were further supported to care for their children and manage their own stress through positive parenting messaging, tips and chat bots. My Hero Is You – a story book for parents to help their children cope during COVID-19 – was widely distributed by UNICEF including through television and radio adaptations.

My Hero is You

Recognizing that the return to school is the first time some vulnerable children were reunited with trusted friends and adults since before lockdown and that children could struggle to cope, UNICEF developed mental health and psychosocial support services and child protection tips for teachers and school management and messages for children and adolescents, as well referral pathways between schools and relevant authorities. There is a package of guidance to promote disability inclusion, including a minimum care package for children with disabilities, guidance for frontline responders and on ensuring an inclusive return to school for children with disabilities.

UNICEF reached out to youth networks and youth-led organizations to understand how young people have been coping with the impact of COVID-19. Youth Voices Count, a regional organization working with LGBTIQ youth documented the challenges of LGBTIQ youth and interventions led by youth organizations to mitigate the impacts of the pandemic. The Interagency Task Team on Young Key Populations in Asia and the Pacific surveyed the impact of the pandemic on young people aged 18–29, they reported significant disruption to essential mental health services due to COVID-19.

Recognizing the heightened vulnerability of migrant workers and their children during COVID-19, UN agencies jointly advocated for the end of discrimination and stigma.

mental health indonesia

The way forward and our vison

Provision of mental health and psychosocial support services is an essential part of government responses to COVID-19 and beyond. Part of our vision is to ensure that mental health is recognized as fundamental to overall health and well-being and is integrated into universal health care. Barriers in law and practice, as well as stigma and discrimination, that prevent safe access to support, especially for vulnerable groups need to be identified and addressed. Also, children, adolescents and families, regardless of their financial or legal status, must have access to quality support services, staffed by trained professionals.

As the world continues to grapple with COVID-19, the conversation on meeting the mental health needs of children and adolescents needs to be accelerated, so that we can Reimagine better and more sustainable services for some of our most vulnerable populations.