Patricia Ibeziako, MD, directs the Boston Children’s Hospital Global Partnerships for Psychiatry Observership Program and the Psychiatry Consultation Service at Boston Children’s Hospital.
Children and adolescents constitute almost a third of the world’s population—2.2 billion individuals—and almost 90 percent live in low-income and middle-income countries, where they form up to half of the population. Yet, for many years, child mental health has largely been glossed over—with long-term negative effects on educational attainment in addition to chronic disability and lost productivity.
Major international non-governmental organizations and United Nations agencies work in settings where children are at risk for mental health difficulties. However, with the exception of the World Health Organization (WHO), these agencies often fail to acknowledge or focus on child mental health issues. In 2005, the WHO Atlas of Child and Adolescent Mental Health Resources reported that less than one third of 66 countries surveyed had an entity with sole responsibility for child mental health programming, and that national budgets rarely had identifiable funding for child mental health services.
Developing countries are triply disadvantaged as they attempt to manage a growing toll of chronic non-transmissible diseases and endemic infectious diseases, but the service gap is high even in high-income countries. The WHO identified stigma as a barrier to mental health care in 68 percent of countries. Counter to prevailing belief, stigma was more significant in high-income countries; in low-income countries, the most significant barriers to care were transportation and lack of available treatment resources.
Up to 50 percent of mental health disorders in adults begin before the age of 14, making the promotion of child and adolescent mental health a worthy worldwide challenge. Investing in children and adolescents yields high returns: realization of developmental potential, reduced severity of adult disorders and better economic health. Accumulating evidence suggests that early mental health interventions can prevent the onset of mental health problems and their development into chronic disorders. Recognition that mental and physical health are indivisible is crucial: Infectious diseases, malnutrition and poor obstetric practices all affect a child’s mental health. Conversely, emotional stress can make children more vulnerable to infections, asthma attacks and somatic symptoms. Integration of child mental health with other pediatric and primary care services might benefit both mental and physical health outcomes.
Every child mental health clinician or researcher can play a role in promoting child mental health globally.
A country or regional commitment—through policy, legislation and governance—is key to providing the appropriate needed services. In May 2013, the 66th World Health Assembly, with all 194 WHO member states, adopted the Comprehensive Mental Health Action Plan 2013-2020 which includes specific targets for child mental health. The plan highlights programs to support the development of safe, stable and nurturing relationships between children, their parents and caregivers in the formative stages of life, as well as early identification, prevention and treatment of emotional or behavioral problems in childhood and adolescence.
Knowledge and understanding of different health care systems are pivotal for developing effective practices to improve health care delivery worldwide. Differing theoretical orientations toward mental health among countries affect how children and their families are assessed and treated: For example, the use of psychotropic medications in children plays a much smaller role in some countries than others. Local economic conditions, family environment and cultural models of parenting also affect a child’s well-being and development.
Global mental health research and training: A call to action
More research is needed on the efficacy of interventions for treatment, recovery, prevention and promotion, and not just in high-income countries where most research is currently conducted. The World Health Assembly recognized a need to conduct research in different cultural contexts, to foster local understandings of mental health problems and protective or harmful traditional customs and practices. Such research requires a strengthened collaboration and resource exchange among national, regional and international research centers, enabling countries to critically review strengths, weaknesses and resources in their health care systems.
International mental health training programs can enhance global child health by building meaningful partnerships between academic psychiatry and a world of underserved children and adolescents. Every child mental health clinician or researcher can play a role in promoting child mental health globally, whether we travel the world or stay within our shores.