ReliefWeb

Introduction

Despite huge strides in recent years, the mental health treatment gap remains enormous and represents a gross inequity that exists with people’s ability to access mental health provisions in Low-Income and Middle-Income Countries (LMICs) [1].
The World Health Organisation (WHO) has published data that shows the global burden of mental disorders increasing and predict health systems throughout the world will be unable to cope [2]. Approximately 85% of the world population resides in 153 LMICs and more than 80% of people who have mental disorders are located in LMICs [3]. However, it is estimated that 90-95% of mental health resources, including human resources for psychological therapies, are being delivered in countries that only account for 5% of the population. [4-8]. This is a global inequity and it is unjust.
Adult mental health and mental health throughout childhood are associated [1, 9, 10]. Estimates show mental health problems will affect at least 10–20% of youth in LMICs [11, 14]. These estimates are thought to be conservative and do not address issues such as stigma [9, 12], demand side barriers or supply side barriers [13]. However, despite decades showing the need for clear evidence-based research that leads to practical sustainable interventions, published research from LMICs contributed just 5% of the mental health research-related articles to the internationally indexed literature on mental health between 1997-2001 [12]. Furthermore, research has identified that despite the high demand for mental health and community-based support services in LMICs, availability and access to mental health services are grossly limited or often inadequate [3, 9, 11, 12]. The reality is Child and Adolescent Mental Health (CAMH) treatment is limited or simply does not exist for many children in LMICs [1-13].
Mental health problems among people with a learning disability are often overlooked, underdiagnosed, and left untreated as a result of poor understanding, awareness, evidence in this area and symptoms being mistakenly attributed to the person’s learning disability [14]. Data has shown that people with lower intellectual ability had higher rates of symptoms of common mental health problems (25%) compared to those with average (17.2%) or above average (13.4%) intellectual functioning [15]. One study found that 54% of people with a learning disability have a mental health problem [16]. Furthermore, children with learning disabilities are four and a half times more likely to have a mental health problem than children without a learning disability [17]. To date, the authors are unaware of any study that has investigated the understanding of both the learning needs and mental health needs of students in any LMIC.
For example, one study showed that 80% of people with depression had experienced discrimination from family members, work relationships, within their marriage or with other interpersonal relationships in Nigeria [19]. However, there is a scarcity of literature regarding stigma or stigma reduction strategies concerning children and adolescents, with evidence especially rare for LMICs. Mental health stigma remains a significant barrier to help-seeking and can worsen youth mental health [8]. The efforts to combat stigmatisation of youth with mental health disorders, professionals must involve educating family members, peers, and school staff in an effort to overcome their inclinations to make negative assumptions and discriminate against these youth [8].
In the absence of costly professional therapeutic support available to children in LMICs [20], community-based interventions have been suggested. Existing studies on adolescent mental health interventions in LMICs have largely focused on either generic mental-health promotion for younger children in schools or psychological treatments for highly selected trauma-affected populations [21-22]. Despite 1 in 6 children in a number of LMICs being absent from education due to child labour, disability or exploitation [23], School-Based Interventions have been proposed to provide the basis for promoting the mental health of young people in LMIC [24] as they are one of the most important community settings, central to the lives of most young people in most LMICs [21-24]. The school setting provides a forum for promoting emotional and social competence as well as academic learning and offers a means of reaching the significant number of young people who experience mental health problems [23-24].
Educational opportunities throughout life are associated with improved mental health outcomes. The promotion of emotional health and wellbeing is a core feature of the WHO’s Health Promoting Schools initiative [25]. There is good evidence that mental health promotion programmes in schools, especially those adopting a whole school approach, lead to positive mental health, social and educational outcomes [23-25].
Furthermore, as far as the authors are aware, no research has investigated the teacher, parent and student narrative on mental health attitudes or learning disabilities in LMICs.
Programmes incorporating life skills, social and emotional learning, and early interventions to address emotional and behavioural problems, can improve academic performance [25-26]. However, to date there has been no known research on direct school-based mental-health interventions, and only for the mental health promotion of young people in LMIC settings.
Utilising schools as a sustainable solution to providing mental health intervention is not new: the UK has recently pledged to develop measures to enable teachers to have confidence and skills required to identify mental health issues in young people before they become critical [27], thus, reducing the costs of mental health in the UK. All new teachers in the UK will be trained to spot signs of mental health issues, backed up by statutory guidance to make clear the schools’ responsibilities to protect a child’s mental well-being. Accessing the expertise of teachers in this way is seen as sustainable and affordable [27].
Therefore, given the mental health demand is significantly higher in LMICs, it makes sense that LMICs should adopt a position whereby they can not only identify signs of mental health in young people, but they can provide affordable and sustainable early mental health intervention to prevent a mental health crisis.