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Adolescent mental disordersA global perspective

Vikram Patel

Wellcome Trust Senior Research Fellow Professor of International Mental Health

Plan

The burden

The challenges

The action needed

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Global burden of child and adolescent mental and substance use disorders

(Murray et al, 2012)

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Proportionate burden in boys

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Proportionate burden in girls

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Impact

• Adverse impacts on educational enrolment and achievements

• Stigma, discrimination and human rights abuse

• Premature mortality

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Neurodevelopmental understandings

Differential maturation of brain regions with delayed maturation of the prefrontal cortex

Risk-taking, reward-seeking and impulsive behaviours are normative and evolutionary

Interaction with rapidly changing environments for adolescents

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The challenges

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Barriers to promoting adolescent mental health

• Highly biomedical model which is out of step with these neurodevelopmental understandings

• Low levels of help-seeking

• Very poor mental health resources: 1 out of 10 of all mental health resources (beds, professionals, dollars) are allocated to countries housing about 9 out of 10 of the global population

• WHO study in 13 low, 24 lower-middle, and 5 upper-middle-income countries (Morris et al, J Child Psychol Psychiatr 2011)– Children and adolescents make up 12% of the patient population in mental

health outpatient facilities and less than 6% in all other types of mental health facilities.

– Less than 1% of beds in inpatient facilities are reserved for children and adolescents.

– Training provided for mental health professionals on child and adolescent mental health is minimal

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CAMH SCIENTIFIC OUTPUT 2002-2011(Kieling & Rohde, J Am Acad Child Adol Psych)

70,498 items originating from 165 countries

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The global iniquity of evidence

No item for 42 countries – where 76 million children and adolescents live 12

The action needed

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Principles

• Focus on high burden conditions • Cost-effective interventions for prevention and

care which are consistent with neurodevelopmental findings

• Integrated with established platforms, e.g. youth friendly services, schools

• Delivery by non-specialized workers, including peers, lay counsellors and community health workers

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Examples of actions

• The early detection and management of mental disorders

• Preventive strategies to train children and youth to improve cognitive control and manage stress to reduce the propensity for “hot cognition.”

• Limiting access to harmful risk-taking situations and providing opportunities to engage are less harmful, but equally rewarding

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Priority actions

Top 5 challenges ranked by disease-burden reduction, impact on equity, immediacy of impact and feasibility.

Challenge

1Integrate screening and core packages of services into routine primary health care

2Reduce the cost and improve the supply of effective medications

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Improve children’s access to evidence-based care by trained health providers in low- and middle-income countries

4Provide effective and affordable community-based care and rehabilitation

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Strengthen the mental-health component in the training of all health-care personnel

Collins et al, 2011

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The impact

New resources: e.g. Grand Challenges Canada (C$50m in 2012/3 in two programs: Saving Brains and Global Mental Health)

Over 50 institutions around the world engaged in research to address the GCGMH in past 24 months

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Other research priorities

Examining how shared genetic predispositions and neurodevelopmental trajectories interact with environmental factors to lead to differential phenotypes of dysphoria and risk behaviors in youth.

Large population-based cohorts of young children with explicit interdisciplinary leadership, in diverse sociocultural contexts.

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Summary

The proportionate burden of mental disorders in childhood rises with age, reaching 15 to 30% in adolescence

The interaction of the features of neurodevelopment in adolescence and rapidly changing environments predispose to a range of risk behaviours and mental illness

Highly biomedical approaches relying on scarce resources, combined to low levels of help-seeking and very low levels of research from developing countries mean that probably <5% of the mental health care needs of adolescents are addressed

Developmentally appropriate interventions integrated with youth friendly services and promoting global research are key strategies for the future

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