ON MY MIND Promoting, protecting and caring for children's mental health - THE STATE OF THE WORLD'S CHILDREN 2021 - UNICEF

 
ON MY MIND Promoting, protecting and caring for children's mental health - THE STATE OF THE WORLD'S CHILDREN 2021 - UNICEF
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
ON MY MIND Promoting, protecting and caring for children's mental health - THE STATE OF THE WORLD'S CHILDREN 2021 - UNICEF
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
ON MY MIND Promoting, protecting and caring for children's mental health - THE STATE OF THE WORLD'S CHILDREN 2021 - UNICEF
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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