ON MY MIND Promoting, protecting and caring for children's mental health - THE STATE OF THE WORLD'S CHILDREN 2021 - UNICEF
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REGIONAL BRIEF: EUROPE T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 2 0 2 1 ON MY MIND Promoting, protecting and caring for children’s mental health
1 THE STATE OF THE WORLD’S CHILDREN 2021 A TIME FOR LEADERSHIP ON MENTAL HEALTH Fear. Loneliness. Grief. disrupted learning; and the girl and caregivers, the connections dropping out to work on a farm or they form with friends and their As the coronavirus pandemic in a factory. It will hang over the chances to play, learn and grow. descended on the world in aspirations and lifetime earnings of Mental health is also a reflection of 2019, these powerful emotions a generation whose education has the ways their lives are influenced enveloped the lives of many been disrupted. by the poverty, conflict, disease millions of children, young people and access to opportunities that and families. In the early days Indeed, the risk is that the exist in their worlds. especially, many experts feared aftershocks of this pandemic will they would persist, damaging the chip away at the happiness and If these connections were not mental health of a generation. well-being of children, adolescents clear before the pandemic, they and caregivers for years to come certainly are now. COVID-19 In truth, it will be years before we – that they will pose a risk to the has put the mental health and can really assess the impact of foundations of mental health. well-being of an entire generation COVID-19 on our mental health. at risk, but mental health concerns For if the pandemic has taught are not new: Indeed, long before For even if the potency of the virus us anything, it is that our mental the COVID-19 pandemic struck, fades, the pandemic’s economic health is profoundly affected by the parents, teachers and many others and social impact will linger: over world around us. Far from being were voicing growing unease the fathers and mothers who simply a question of what is going about the mental health of children thought they had left the worst of on in a person’s mind, the state of and adolescents. times behind them, but are once each child’s or adolescent’s mental again struggling to put food in a health is profoundly affected by This is the reality that is at the baby’s bowl; over the boy falling the circumstances of their lives heart of The State of the World’s behind in school after months of – their experiences with parents Children 2021. A challenge ignored Indeed, what we have learned is is about a young woman having a and the importance of mental that mental health is positive – an sense of purpose in her life and health in shaping life outcomes, asset: It is about a little girl being the self-confidence to take on are increasingly being able to thrive with the love and and meet challenges. It is about recognized. They are reflected in support of her family, sharing a mother or father being able to the connection between mental the ups and downs of daily life. support their child’s emotional health and the foundations of a It is about a teenage boy being health and well-being, bonding healthy and prosperous world able to talk and laugh with his and attaching. acknowledged in the Sustainable friends, supporting them when Development Goals. Indeed, they are down and being able to The links between mental and that agreement among the turn to them when he is down. It physical health and well-being, nations of the world positioned
Regional Brief: Europe 2 the promotion and protection of Despite all this, governments and of children, young people and mental health and well-being as societies are investing far, far too their caregivers. key to the global development little in promoting, protecting agenda. and caring for the mental health A time for leadership At the heart of our societies’ failure in their development to minimize And we need action: We need to respond to the mental health risk – and maximize protective – to better support parents and needs of children, adolescents factors. caregivers so that they can better and caregivers is an absence of support their children; we need leadership and commitment. As well as commitment, we need schools that meet children’s social We need commitment – especially communication: We need to end and emotional needs; we need to financial and political commitment, stigmas, to break the silence on lift mental health out of its ‘silo’ from global, regional and national mental health, and to ensure that in the health system and address leaders and from a broad range young people are heard, especially the needs of children, adolescents of stakeholders – that reflects the those with lived experience and caregivers across a range important role of social and other of mental health conditions. of systems, including parenting, determinants in helping to shape Without their voices being heard education, primary health care, mental health outcomes. The and their active participation and social protection and humanitarian implications of such an approach engagement, the challenge of response; and we need to improve are profound. They demand that developing relevant mental health data, research and evidence to we set our sights on a clear shared programmes and initiatives will better understand the prevalence goal of supporting children and not be met. of mental health conditions and to adolescents at crucial moments improve responses. A time for action The COVID-19 pandemic has parents and caregivers in shaping The European Union (EU) upended our world, creating a mental health in early childhood; institutions should scale up their global crisis unprecedented in our we know too about children’s action to build back better by lifetime. It has created serious and adolescents’ need for laying down the foundations for concerns about the mental health connection; and we know about more resilient national health and of children and their families during the dire impact that poverty, social protection systems, while lockdowns, and it has illustrated discrimination, marginalization centring the recovery on the new in the starkest light how events and domestic violence can have generation’s well-being with a in the wider world can affect the on mental health. And while focus on making mental health world inside our heads. It has also there is still much work to be services accessible to all who highlighted the fragility of support done in developing responses, need them. systems for mental health in many we already know the importance countries, and it has – once again of key interventions, such as We have a historic chance to – underlined how these hardships challenging stigmas, supporting commit, communicate and take fall disproportionately on the most parents, creating caring schools, action to promote, protect and disadvantaged communities. working across sectors, building care for the mental health of robust mental health workforces, a generation. We can provide But the pandemic also offers and establishing policies that support for the foundation of a an opportunity to build back encourage investment and lay a generation equipped to pursue better. As this report sets out, solid foundation for mental health their dreams, reach their potential we know about the key role of and well-being. and contribute to the world.
3 THE STATE OF THE WORLD’S CHILDREN 2021 BY THE NUMBERS Prevalence of mental disorders 9 million adolescents The prevalence of mental disorders for boys and girls in Europe aged aged 10–19 in 10–19 is 16.3 per cent, while the global figure for the same age group Europe live with a is 13.2 per cent. This means that 9 million adolescents aged 10–19 in Europe live with a mental disorder. mental disorder. Estimated prevalence and number of adolescents with mental disorders in Europe, 2019 6,000,000 20% 18.6% 18% 5,000,000 16.1% Number of adolescents with mental disorders 15.6% 16% 14.8% 2,296,000 14% 4,000,000 2,260,000 x 12% Prevalence 3,000,000 10% 2,494,000 8% 2,000,000 2,027,000 6% 4% 1,000,000 2% 0 0 10 to 14 15 to 19 Age group Number – girls Number – boys Prevalence – girls Prevalence – boys Note: The number of adolescents with mental disorders are rounded to the nearest 1,000; calculations are based on these disorders: depression, anxiety, bipolar, eating, autism spectrum, conduct, schizophrenia, idiopathic intellectual disability, attention deficit/hyperactivity (ADHD) and a group of personality disorders. Source: UNICEF analysis based on estimates from the Institute for Health Metrics and Evaluation (IHME), Global Burden of Disease Study, 2019.
Regional Brief: Europe 4 Estimated percentage of mental disorders among adolescents aged 10–19 in Europe, 2019 Girls and boys aged 10–19 Girls aged 10–19 Boys aged 10–19 Country Prevalence % Number Prevalence % Number Prevalence % Number Austria 18.2% 159,786 18.7% 79,179 17.7% 80,607 Belgium 16.3% 208,372 16.0% 100,137 16.6% 108,235 Bulgaria 11.2% 73,808 10.6% 33,742 11.8% 40,067 Cyprus 17.8% 23,697 18.6% 11,918 17.1% 11,779 Czechia 11.0% 114,767 10.2% 52,123 11.7% 62,645 Germany 16.0% 1,266,180 17.6% 667,356 14.5% 598,824 Denmark 15.0% 102,346 16.3% 54,264 13.8% 48,082 Spain 20.8% 982,291 21.4% 489,830 20.4% 492,461 Estonia 11.6% 15,495 10.9% 7,085 12.2% 8,410 Finland 16.7% 101,237 15.9% 46,845 17.6% 54,392 France 18.3% 1,508,307 19.5% 783,737 17.1% 724,569 United 16.2% 1,237,430 15.9% 594,720 16.4% 642,710 Kingdom Greece 18.0% 187,808 18.7% 95,394 17.4% 92,414 Croatia 11.5% 49,272 10.9% 22,657 12.1% 26,614 Hungary 11.2% 108,953 10.5% 49,808 11.8% 59,144 Ireland 19.4% 128,782 19.9% 64,661 18.9% 64,120 Iceland 16.6% 7,332 16.9% 3,661 16.4% 3,671 Italy 16.6% 956,071 17.2% 478,554 16.1% 477,518 Lithuania 12.5% 33,623 12.0% 15,740 13.0% 17,883 Luxembourg 16.5% 10,975 16.9% 5,453 16.1% 5,521 Latvia 11.9% 22,332 11.2% 10,288 12.5% 12,044 Monaco 17.3% 604 18.0% 307 16.6% 297 Malta 17.6% 7,175 18.3% 3,628 17.0% 3,547 Netherlands 18.0% 357,457 18.2% 176,199 17.8% 181,258 Norway 18.2% 116,283 18.3% 56,783 18.1% 59,500 Poland 10.8% 409,125 9.8% 181,498 11.7% 227,627 Portugal 19.8% 218,014 21.1% 113,741 18.5% 104,273 Romania 11.2% 238,914 10.5% 108,630 11.9% 130,285 San Marino 17.2% 688 17.7% 351 16.7% 337 Slovakia 11.2% 60,640 10.6% 27,904 11.7% 32,736 Slovenia 11.3% 21,665 10.7% 9,975 11.8% 11,689 Sweden 16.2% 188,991 17.0% 95,769 15.5% 93,222 Switzerland 18.7% 159,921 19.3% 79,909 18.1% 80,012 Note: Figures are based on these disorders: depression, anxiety, bipolar, eating, autism spectrum, conduct, schizophrenia, idiopathic intellectual disability, attention deficit/hyperactivity (ADHD) and a group of personality disorders. Source: UNICEF analysis based on estimates from the IHME, Global Burden of Disease Study, 2019.
5 THE STATE OF THE WORLD’S CHILDREN 2021 Suicide estimates An estimated In Europe, suicide is the second most common cause of death three lives per among adolescents aged 15–19. Tragically, almost 1,200 children and day are lost to adolescents aged 10–19 end their own lives every year – that is an estimated three lives per day lost to suicide in Europe. suicide in Europe. Top five causes of death among adolescents aged 15–19 in Europe Cause Deaths (per 100,000) Road injury 5 Suicide 4 Congenital anomalies 1 Drowning 1 Drug use disorders 1 Source: UNICEF analysis based on WHO Global Health Estimates, 2019; estimates were calculated using population data from the United Nations Population Division World Population Prospects, 2019. Estimates of suicide as a cause of death in Europe by age and sex, 2019 Age 10–19 Age 10–14 Age 15–19 29% 31% 41% Total: Total: Total: 1,198 161 1,037 59% 69% 71% Girls Boys Note: Confidence intervals for estimated number of deaths for adolescents aged 10–19 are 955–1,488; 10–14 are 115–220; 15–19 are 840–1,268. Source: UNICEF analysis based on WHO Global Health Estimates, 2019; estimates were calculated using population data from the United Nations Population Division World Population Prospects, 2019.
Regional Brief: Europe 6 Anxiety and depression The cost of mental In 2019, anxiety and depression accounted for 55 per cent of mental disorders among adolescents disorders in Europe aged 10–19 in Europe. Estimates of key mental disorders among adolescents in Europe, 2019 Boys and girls aged 10–19 100 US$57.6 billion 80 This figure is the annual loss of human 60 54.8% capital from mental disorders based on a country-specific value of disability-adjusted 40 life years (DALYs). The estimate is based on the value of lost mental capital – or cognitive 19.5% 18.1% 20 12.2% and emotional resources – that children and 4% young people would contribute to economies 0 0 if they were not thwarted by mental health conditions. David McDaid and Sara Evans- Girls aged 10–19 Lacko of the Department of Health Policy of 100 the London School of Economics and Political Science started with estimates of the burden 80 70.1% of disease attributable to mental health 60 expressed in DALYs. One DALY represents the loss of a year of healthy living caused by 40 disability or premature death. The researchers then assigned a monetary value to each 20 13% 10.4% 10.4% disability-free year based on the average output 5% each person contributes in an economy. One 0 DALY is therefore equivalent to a country’s gross domestic product (GDP) per capita, Boys aged 10–19 expressed in purchasing power parity (PPP) 100 terms. This formulation allows comparisons to be made globally. (see The State of the World’s 80 Children 2021 for a full account of the costs of 60 mental disorders.) Note: The countries in this calculation are: Austria, Belgium, Cyprus, Czechia, 39.6% Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, 40 Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, 28.6% Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland and the 23.1% United Kingdom. 20 10.8% 6.1% 0 Anxiety and depression disorders ADHD Conduct disorder Bipolar disorder Eating disorder Autism spectrum disorders The analysis in these pages includes data from all European Union Member States and Iceland, Norway, Switzerland and the Remaining mental disorders United Kingdom. IHME data were available for all these countries Note: The sum of the prevalence of individual disorders exceeds 100 per cent due to the except for Andorra and Liechtenstein; World Health Organization co-morbidity between the disorders; calculations are based on the disorders noted above. and World Population Prospects data were available for all these Source: UNICEF analysis based on IHME Global Burden of Disease Estimates, 2019. countries except Andorra, Liechtenstein, Monaco and San Marino.
7 THE STATE OF THE WORLD’S CHILDREN 2021 CASE STUDY Ireland MindOut: Social and emotional learning for adolescent well-being Like his classmates at Gonzaga three issues in Ireland’s National College, a secondary school Youth Strategy in 2015. in Dublin County, Jude* wants to do well in school but MindOut, an evidence-based sometimes finds the pressure social and emotional learning overwhelming. programme, aims to address some of these mental health and “Some of us do need to well-being concerns. gain perspective,” Jude, 17, said. “I’ve seen some people As part of Ireland’s Health Service having panic attacks before Executive, MindOut is offered to exams; there definitely 15- to 18-year-olds in schools and is a sense of pressure.” youth settings. It is also integrated into the mandatory Social Personal Besides academic pressure, and Health Education (SPHE) adolescents also often face curriculum. peer pressure, social stigma and restrictive stereotypes, which MindOut features 13 sessions can take a toll on mental health. based on a structured teacher’s Indeed, young people identified manual. It uses interactive mental health as one of the top teaching strategies to
On My Mind: Promoting, protecting and caring for children’s mental health 8 Under pressure: “I have seen some people having panic attacks before exams,” says Jude, 17, a student in Dublin. © UNICEF/UN0505797/UNICEF Ireland engage students, focusing on “It really allowed me to see the “I think the course does imparting essential social and schooling experience through bring up some really useful emotional skills, including: self- the lens of well-being, whereas stuff,” he said. “There’s awareness, self-management, so often we are fixated on stuff that you realize you social awareness, relationship achievement… I was able to know deep down, but it did management and responsible reflect on my own experience help to go over them. You decision-making. as a teacher and reframe that in realize when you are under terms of helping young people at stress that you should be An evaluation of MindOut in 32 this vulnerable time in their lives,” using these techniques.” disadvantaged schools indicated Penn said. that, when implemented well, it produced improvements in Students have learned skills such participants’ social and emotional as how to be a good listener, skills and a reduction in stress and recognizing ways to access depression. support and reaching out to peers in need. Aryn Penn teaches SPHE at Jude’s school and was trained in MindOut has helped Jude foster MindOut. The programme helped his communication skills, develop * Jude’s family name is being withheld to her become more empathetic to self-acceptance and acquire protect his identity. He was interviewed in the struggles of her students. coping strategies. Dublin.
9 THE STATE OF THE WORLD’S CHILDREN 2021 CASE STUDY Spain Journey to Mental Health: A culturally sensitive approach to mental health care for migrant young people According to Dr. Francisco Some of the children and Collazos, psychiatrist and founder young migrants the programme of the Transcultural Mental Health reaches out to are in Spain’s Programme for Unaccompanied child protection system; others Migrant Children and Young live on the streets. For many, Migrants at Hospital Vall their circumstances and life d’Hebron in Barcelona, cultural experiences are complicated, competence is the guiding including challenges faced even principle of the programme. before they began their difficult migration journeys, including “Our commitment obliges us marginalization in the country of to seek alternatives that are origin and violence at home, such equitable, culturally competent as physical violence, abuse and and adjusted to the particular neglect. needs of each population group we serve,” said Collazos. “Culture Once they arrive at a destination, is considered a risk factor and a many experience anxiety and protective factor,” said Abdallah frustration over their status as Denial Kandil, a community migrants or refugees. Some health agent who works with struggle under the pressure Collazos. of family expectations and the difficulty of finding work and
On My Mind: Promoting, protecting and caring for children’s mental health 10 Transcultural: “Each person is unique and has to be treated as such,” says Dr Francisco Collazos, left. © UNICEF/UN0489155/Erasmo Fenoy sending remittances to their The success of the programme families. They often have to deal can be seen in many of the young with social exclusion and the people Collazos has worked with challenge of navigating a new over the years in the programme. language and culture. One example is of a young Moroccan immigrant who had Founded in 2001, the Transcultural struggled with substance abuse, Mental Health Programme homelessness and had run-ins embraces this complex interplay with the police and immigration of risks to migrant children’s authorities before finding his way and young people’s mental to Superacció, where he now health in order to respond remains active as a volunteer, effectively. The programme even as he looks for work. engages professionals from non-governmental organizations With the support of the Spanish – such as Superacció – and trains National Committee for UNICEF community mental health agents and local and regional authorities, and mental health professionals the Transcultural Mental Health using a specially designed course Programme is expected to on culturally aware assessment expand and become integrated and multidisciplinary assistance. into the child protection system in Catalonia.
11 THE STATE OF THE WORLD’S CHILDREN 2021 WHAT YOUNG PEOPLE SAY Background: For this edition of meeting friends can often “Some people may be The State of the World’s Children be something that, like, ashamed to talk about report, UNICEF teamed up with calms one from anxiety and [mental health]... because researchers from the Global stress.” (Older girl, Sweden) in our society, even though Early Adolescent Study at Johns it has become more like Hopkins Bloomberg School of “With classes online, for people really say that it’s Public Health (JHU) to host focus example, I found that it was normal, it may still be that group discussions on mental health very hard to be motivated some people think it’s kind of and well-being. From February when we are confined to our embarrassing or something.” to June 2021, local partners home and there are a lot of (Older girl, Sweden) facilitated focus group discussions people that completely let go for adolescents aged 10–14 and because it was online…You Adolescents also pointed out a 15–19 in 13 countries worldwide. don’t realize it but staying at potential generation gap when In Europe, the focus groups home locked in, it’s really not talking to parents about mental were implemented in Belgium, the same when you study.” health issues and remarked on Sweden and Switzerland. This brief (Older girl, Switzerland) some of the challenges of peer includes quotes from some of the relationships: adolescents who participated in the “I was really sad for a while focus groups. A fuller companion because I went out every “If you don’t have a good report on the discussions will be weekend with my friends relationship with your released in 2022. and stuff and suddenly parents, well then maybe you, you weren’t allowed to see you might turn to friends, or The COVID-19 pandemic has anyone in the beginning maybe siblings who are of an dramatically shifted the lives and then it was really equal age because they maybe of young people all over the hard.” (Older girl, Belgium) can understand [you] better. world. When schools closed, Because I think... that you adolescents – who increasingly Issues regarding mental health feel that [many adults] don’t rely on connections with peers as stigma were echoed during the understand because… they are they mature – were cut off from focus group discussions, in which adults.” (Older girl, Sweden) those social networks. During adolescents discussed the ways the focus group discussions, in which such stigma can impede “True friends are not obliged adolescents described significant help-seeking behaviours: to speak to each other every impacts on mental health. day. Me, I know that with Social isolation and challenges “With stress and mental my friends, it’s been years with remote learning are two illness, for many it’s a [we’ve known] each other. examples of issues raised: very anxious subject. And We don’t go out together, you don’t really want to we don’t see each other. “Not meeting friends… it talk about it... society has But when we speak to each has probably made many kind of made it into a big other, it’s back to the way young people’s mental illness thing, that it’s supposed it used to be. And I think worse. Or, mental health to be something negative.” that it’s a true friendship.” has deteriorated. Because (Older girl, Sweden) (Older girl, Belgium)
Regional Brief: Europe 12 “Well, it’s certainly difficult health is more dangerous “We need to hire people, for parents to notice such in boys than girls because social workers for example, things, or it depends on boys cannot talk about it.” to accompany the families. person to person, but if (Younger boy, Switzerland) The parents need to take you’re, like, quite introverted their anger out on something as a person, then maybe “We are scared of being other than us." (Boy, 17) you hide away quite a lot judged, all the time… I don’t of emotions and then it is wear skirts… It is harder in “You have to ask the children difficult for parents to, like, summer. I really like to wear directly, ask them if the child know what to do, but... a tank tops [but] I have to be is well in his family, if he person may actually be careful, like always pull it up is doing well. If the child is very depressed or very, very or put a T-shirt underneath. not well, we should try to stressed even though it’s not So [even in summer] it’s understand why.” (Girl, 16) visible.”(Older boy, Sweden) back to… suffering in the heat.” (Older girl, Belgium) It was clear from focus group discussions around the world The focus group discussions that gender norms matter for also emphasized complexities in mental health for boys and girls the relationship between digital alike. Some of the issues raised technology usage and adolescent by girls reflect concerns with mental health: body image and experiences of sexual harassment and violence. “It becomes an obsession. If Adolescents generally agreed she falls below the bar, for that girls are less constrained example, of seven hundred than boys by norms around help- likes, well, she has to find seeking and could more easily [followers] to subscribe [so reach out to friends and family she] removes pictures that members for support: do not get enough likes. It’s… it’s an obsession.” “Well, girls speak more (Older girl, Belgium) about it in general, they have more opportunities to talk Adolescents in Belgium about it because between expressed important concerns girls, with their friends, they about domestic violence and can cry in each other[’s] emphasized the need of proper arms, its normal. But us, support to parents and children: we won’t start crying in the arms of our buddies. “Parents must not be allowed It’s evident that for [girls], to hit us anymore. There it is much more noticeable, must be a law and that law but… I also think that mental must be respected." (Girl, 15)
13 THE STATE OF THE WORLD’S CHILDREN 2021 A FRAMEWORK FOR ACTION The State of the World’s Children The cost for us all is incalculable. governments, schools and 2021 has set out the mental other stakeholders in Europe health challenges facing children It does not have to be this way. do just that, grounded in three and adolescents and their And it should not be this way. core principles, for every child, families. It has shown that these everywhere: Commitment from challenges are global – from the Our priorities are – or should be leaders, backed by investment; poorest village to the wealthiest – clear. We may not have all the Communication to break down city, children and their families answers, but we know enough to stigmas and open conversations are suffering pain and distress. be able to act now to promote on mental health; and Action At an age and stage of life when good mental health for every to strengthen the capacity children and young people should child, protect vulnerable children of health, education, social be laying strong foundations and care for children facing the protection and other workforces; for lifelong mental health, they greatest challenges. better support families, schools, are instead facing challenges and communities; and greatly and experiences that can only This report sets out a framework improve data and research. undermine those foundations. to help the community, Commitment, Communication, and Action for Mental Health TO COMMIT means strengthening and set priorities to develop Invest in supporting mental leadership to set the sights of financing models that can help health. Mental health is woefully a diverse range of partners and bridge the investment gap; to underfunded: Many governments stakeholders on clear goals and share knowledge and experience do not allocate enough funds to ensuring investment in solutions on delivering services, building mental health, and allocations and people across a range of capacity, gathering data and from international development sectors. evidence, and providing mental assistance are meagre. There health and psychosocial support is a strong need to scale up Provide regional leadership. in crisis and emergency settings; investments in different priority Building on existing efforts to develop with relevant partners areas, such as: and towards the new health and stakeholders intervention preparedness and resilience packages co-created and co- • The EU institutions and national mission for the whole of the EU designed with children and young governments should support that was recently announced, people to promote a holistic and interventions to facilitate the EU must lead the way in community-based approach to vulnerable groups’ access to laying the foundation to ensure mental health, and crucially, to mental health-care services and that all children have access monitor and evaluate progress. improve regional infrastructures to mental health services. EU This would position the EU as a through the European Social leadership is needed to align champion of children in Europe Fund Plus and the European stakeholders around clear goals and worldwide. Regional Development Fund.
Regional Brief: Europe 14 • National governments should Holistic and to create awareness, enhance include access to mental community-based mental health literacy, combat health services in their national approaches misinformation about mental action plan for the Recovery health and tackle stigma related and Resilience Facilities What are holistic and to mental health conditions. (RRFs), including exploring community-based approaches the opportunities offered by to mental health services? Ensure young people have a digital and online technologies say. Children and young people to reduce gaps in access to They include expanded are gradually raising their voices mental health support and to community-based social and sharing concerns about reach populations traditionally work; schools informed on their mental health and well- lacking access to these trauma response, equipped being. The EU should provide services. with mentors and child and support to all children and • The EU should invest adequate adolescent psychologists young people, especially those resources to target actions to where relevant; non- with lived experience of mental train health and social workers institutional approaches to health conditions, with the on mental health under the mental health services that means for active and meaningful EU4Health Programme and prioritize access to quality engagement. This can be under the Asylum, Migration psychiatric and psychological achieved through, for example, and Integration Fund (AMIF) care; and early interventions investment in community youth Programme to support to support families and groups, peer-to-peer initiatives services for children on the young people struggling with and training programmes. move. addiction and violence. Ensuring that children and young • The EU should incorporate people have a voice can help targeted actions on mental mental health services to better health and psychosocial TO COMMUNICATE means reflect their needs. well-being in the 20 per cent tackling stigmas around mental of Official Development health, opening conversations TO ACT means working to Assistance (ODA) dedicated and improving mental health minimize the risk factors and to human development in the literacy. It means amplifying the maximize the protective factors Global Europe instrument, regional conversation on mental for mental health in key areas as well as in humanitarian health to raise awareness and of children’s and adolescents’ programmes for preparedness, mobilize all stakeholders to take lives, especially the family and response and recovery, action and facilitate learning. school. More broadly, it also to meet the needs of all means investment and workforce populations affected by Break the silence, end development across some key emergencies. stigma. Misconceptions about sectors and systems, including • The EU should continue to mental health fuel stigma and mental health services and social expand its pioneering work discrimination, and prevent protection, and the development on education in emergencies children and young people from of strong data collection and and the mainstreaming of child seeking support and participating research. protection in emergencies, fully in their families, schools including exploring innovative and communities. A simple Support families, parents support for mental health and message: It is not just OK to and caregivers. The EU should psychosocial support across all talk about mental health – it is support national governments humanitarian responses linked essential. The EU should promote in rolling out programmes to nutrition, shelter, livelihoods campaigns involving children to support families and and education. and young people through its caregivers; in the case of the permanent representations in EU governments, by ensuring the EU Member States and alignment with the European its EU delegations worldwide Pillar of Social Rights Action
15 THE STATE OF THE WORLD’S CHILDREN 2021 Plan in the EU framework of the access to the means of suicide; Improve data, research and European Semester. National providing specialized training evidence. Lack of data and governments should champion for teachers, parents and health evidence renders children with the promotion of parenting workers; encouraging responsible mental health conditions invisible programmes – which teach media reporting; and identifying and is a major obstacle to policy positive parenting and nurturing and removing harmful content development and planning. Greater caregiving – and support caregiver on social media. Schools should investment is needed across well-being and mental health. be a crucial partner in suicide national governments in research prevention, helping to identify at- on children and adolescents, Ensure schools support mental risk children and providing support. which should be cross-culturally health. The EU should promote applicable, adaptable to local a coordinated approach to Strengthen and equip multiple realities and capable of capturing promoting mental health and systems and workforces to diverse experiences and realities. psychosocial support in the meet complex challenges. To A determined effort is also needed framework of its commitment bring mental health services closer to routinely monitor mental health, towards a European Education to those who currently cannot developing a consensus-based Area by 2025. The EU should access them, services need to set of core indicators around promote programmes aiming to be provided not just through child, adolescent and caregiver build mental health awareness health systems but across a mental health. Additionally, the and emotional coping skills for wide range of different sectors EU should increase investment in adolescents in schools, integrating and delivery platforms, such as implementation science, which mental health counselling education, social protection and investigates how a range of factors services, training teachers and community care. The EU should can impede or accelerate the staff, creating safe spaces for support partner countries to build implementation of policies and children to discuss and to build and strengthen mental health interventions. their resilience, and preventing services across different sectors self-harm and suicides. The EU and delivery platforms, strategically Mainstreaming mental health should support the Safe to Learn using these platforms and the across EU policies. The EU initiative to end violence in and community to bring services closer should adopt an integrated through schools so children are to most children, adolescents and and coordinated approach to free to learn, thrive and pursue caregivers who still cannot access mainstreaming children’s well- their dreams. such services. Disadvantaged being and promoting children’s groups require dedicated attention mental health in the EU policies. Prevent suicide. Regional and and specific programmes to It can do so by adopting a national suicide prevention ensure services meet their needs. comprehensive EU strategy on programmes can play an important Additionally, explore opportunities mental health by 2025 as a key role. The EU should invest and offered by digital and online building block for a reinforced set priorities, providing guidance technologies to reduce gaps in EU Health Union in line with the and exchange of best practices, access to mental health support in recommendation made by the such as identifying at-risk children order to reach all populations. Employment, Social Policy, Health and adolescents; restricting and Consumer Affairs Council. In this brief, Europe refers to Member States of the European Union and eight other European countries: Andorra, Iceland, Liechtenstein, Monaco, Norway, San Marino, Switzerland and the United Kingdom of Great Britain and Northern Ireland. © United Nations Children’s Fund (UNICEF) October 2021 To download the full report, please visit www.unicef.org/sowc. Cover photo: Changes to everyday life during COVID-19 put a strain on children and young people. Here a girl heads to school in Germany wearing a protective mask. ©️ UNICEF/UNI332775/Bänsch
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