Global Health Matters
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Global Health Matters
Pockets of optimism: empowering youth to improve mental health
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UNICEF estimates that 13% of adolescents live with a diagnosed mental health disorder, with depression and anxiety accounting for 40%. To explore the challenges surrounding the mental health of today’s youth, host Garry Aslanyan speaks with Jaime Young, a passionate youth leader, mental health advocate and family caseworker at the Saint Lucia Social Development Fund, and Zeinab Hijazi, a clinical psychologist and Global Lead on Mental Health at UNICEF. Together, they discuss how resilience can be cultivated and share inspiring examples of young people around the world developing solutions for mental health for their peers.
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Hello and welcome to the Global Health Matters podcast. I'm your host, Gary Aslan. In this episode, we will be exploring the perspectives and challenges surrounding the mental health of youth. Young people are living in turbulent times. In the last few years alone, they lived through a pandemic, faced escalating global conflicts, and are burdened by the ongoing threat of climate change. UNICEF estimates that 13% of adolescents live with a diagnosed mental health disorder, with depression and anxiety accounting for 40%. There is no better way to gain a deeper understanding of these issues than from a young person and a technical expert. I'm delighted to be joined by Jamie Young and Zainab Hijazi. Jamie is a passionate youth leader, mental health advocate, and family caseworker at the St. Lucia Social Development Fund in the Caribbean. She focuses her efforts on empowering young people to realize their potential, engage with mental health issues proactively, and to be involved in driving change in this area. Zeina Pijazi is a clinical psychologist and the global mental health lead at UNICEF based in New York City. She provides program guidance and technical support to enhance UNICEF's multi-sectoral approach to mental health and psychosocial support for children and families, with a dedicated focus on humanitarian and development settings. Hi Zaynab, hi Jamie, how are you today?
SPEAKER_00Good, how's everyone doing? Hi Gary, hi Jamie. Wonderful to join you.
SPEAKER_02So let's get started. Jamie, living on an island sounds very idyllic and very nice. Is it really that nice, especially growing up on an island and living there as a young person?
SPEAKER_03It definitely can be. I think it's more so than a lot of places, especially first world countries, as you can imagine. For example, on my daily commutes to work, I see the mountains, people are always smiling. If you go to work at the same time every day, chances are you'll see the same people and you become friends. Hi, how are you? So it definitely can be very idyllic. Um, we do have our issues, perhaps that more so than other countries. So lack of resources, and especially I want I'd say climate change affects us majorly, especially between our hurricane season period, which is between June, July to November. We already got hit by one, which was Beryl, and we're expecting a lot more. So, as you can imagine, a small country with persons living on the coast or with a country like ours that relies on tourism for the majority of our money, it can be a little challenging, as you can imagine, but I would definitely say it helps to live where people vacation, honestly.
SPEAKER_02Zainab, uh being young should be time marked with a lot of optimism, new possibilities. Do you find that to be the case with young people who you work with globally?
SPEAKER_00Yeah, absolutely. Being young should be filled with dreams and opportunities. But the young people I work with globally are experiencing a wide range of realities, right? Their lives are shaped by their unique experiences, but also the broader sociocultural and political landscapes of their communities. You know, they're living at the crossroads of significant global geopolitical and local events. For example, many young people are dealing with the devastating impacts of wars and conflicts in places like Palestine and Congo and Sudan, while others face immediate threats of climate crises like Jamie spoke about, but also in other parts of the world, like the floods in Pakistan and rising heat in many parts of the world, and unemployment in countries like South Africa also adds another layer of stress. But many young people I encounter are also incredibly optimistic and resilient. You know, it's incredible and deeply humbling and impressive. They bring fresh ideas and are often at the forefront of critical movements for social change. They take on leadership roles in their schools and communities and organizations, developing skills that are really critical to raise awareness and take actions to address the challenges faced within their communities, but also prepare them for the future. And I think their passion for social justice, environmental issues, and human rights is really inspiring. They are really global citizens using community networks, social media, and technology to connect with others worldwide, learning and really driving impact.
SPEAKER_02We looked into statistics from Caribbean overall in terms of some of the numbers of young people experience mental health problems. And a staggering number we found about 24% are experiencing symptoms. What are the most common mental health issues you have observed among your peers?
SPEAKER_03For me, I think as a young person, you know, interacting with each other, I can speak for my immediate surroundings. And I would definitely say probably anxiety and depression. So I think anxiety and depression really is. And UNICEF actually did a study in 2021, the state of the world's children, and anxiety and depression account for almost 50% of mental health disorders in Latin America and Caribbean in in young people aged 10 to 19. 50%, that's like half of us. We're dealing with a lot more that than we were dealing with maybe a five, 10 years ago. Like it was mentioned prior, wars, we've I've gone through a pandemic, I've gone through a category or close to a category four hurricane, I've gone through um hearing about wars in different places all in my lifespan of 25 years old. Some people have never gone through a pandemic. And then as a young person, you're expected now to perform, to get a job, to provide for your family, especially within this region. So as you can imagine, we're a lot more anxious. We have a lot more stresses. Um and then depression can be something that if you're not sure how to cope, or if you don't have that support, whether it's with your family or friends or whatever, you feel like your back is against a wall. So you feel anxious or you have anxiety, you're depressed, and you can't talk to anybody about it. Because access to actual resources, so let's say a counselor or a therapist is extremely expensive in the cases where they are available and where they're not, they're just not. And we sometimes in our families don't have the support from parents and friends because it's still sort of a taboo subject. So you would hear things like, I say you don't need to talk to anybody because you're fine, or you know, it would be deemed as weakness to try to express yourselves. So I think all of that just compounds the issue because we know what anxiety and depression is like. We know what it's like to be in your head about something and not not know where to go. And then to have the idea that you can't talk to anybody about it makes it worse.
SPEAKER_02And Zainab, you think that these problems described by Jamie also are a reflection of global trends?
SPEAKER_00Jamie's insights, I think, are a really powerful reflection of what we see globally. Jamie mentioned UNICEF State of the World's Children report on mental health, and you know, some additional statistics to draw and feedback to you are really heartbreaking to talk about. But really, everyone should know that one in four children live with a parent who has a mental health condition. And for us, this is really a stark reminder of the importance of caregiver mental health and well-being and the needs for interventions that seek to address these needs. As Jamie mentioned, adolescents are really struggling. Globally, one in seven uh young people ages 10 to 19 is living with a diagnosable mental disorders. And half of these mental health conditions start by 14 years of age. I think it's really unfathomable that we know this. And we know that all of these conditions, most of them, are treatable, but they go undetected and they go untreated. Why are we not investing more in prevention in early ages to really prevent long-term suffering and struggles by young people as they grow into adults? Suicide is devastatingly the fourth leading cause of death for adolescents globally. And I mentioned earlier, you know, there are children and young people who are struggling with a multitude of issues. I mean, we have 460 million children who are living in conflict zones. And these young people experience tragic losses and violence and displacement and missed education opportunities. And so their mental health really suffers profoundly. And also, I think it's important to mention that these are just estimates that we've gathered primarily from high-income countries. The reality actually may be much graver, especially in low resource settings. And this is because we also face a lack of sufficient data and evidence on the global mental health burden, particularly for children in low and middle-income countries. And mental health data about children and adolescents covers only about 2% of the population in these regions, which is really, I think, um, a staggering realization. And it makes it difficult to calculate the global burden. And without this data, we are not really able to adequately address young people's needs.
SPEAKER_02Right, right. I imagine because how do you actually get around getting all of that information from especially places which are under stress or in conflict, etc. So it's an additional layer of complication. Jamie, from your experience as a youth uh mental advocate, what is the most you already alluded to some, but what is the one uh biggest barrier to youth gaining support? What is your experience?
SPEAKER_03I'd say stigma and perception first. Um reason being, I've always been of the opinion, and I can see it within my community, that if even if we have the resources, because sometimes they are there, very few, but they're there. If there is a stigma, if there is a negative perception, and I'm speaking about society or in your community about receiving that help, I've found that it's been a major barrier for persons going to get the help. Because, for example, we don't have that many mental health resources in St. Lucia. We do have a national mental wellness center. But if, for example, I say, you know what, I need professional help, I'm struggling, and someone sees me going there, they'll be like, Oh, she's crazy, she's she's going to this mad house, or she's, you know, she's not okay. So there's a big stigma about persons who seek that help. You have the persons around you saying, You'll be okay, or you know, go to church or go do something else. They don't deal with the issue that is at hand because I think we've been socialized to believe that it's not really an issue. Caribbean people are extremely resilient and we continue to say that we're we're always okay. After a disaster, are you okay? I'm good. You just lost your house, you just lost everything. We don't sit with our trauma, and sometimes the trauma is compounded. So I would say definitely stigma and perception first, and then of course we have the lack of resources, but mostly stigma and perception. Because, like I said, if you have the resources there, you can have all the resources there. But if people don't believe that they work, if people don't feel safe to go there, then they just won't go.
SPEAKER_02Right. Is this the same uh thing up globally? Is um not uh isolated just uh in the Caribbean? How do youth in different parts of the world receive care, or is stigma um one of the major barriers?
SPEAKER_00Absolutely. I mean, stigma around mental health is a universal issue that affects young people all over the world. There's fear of judgment or being labeled prevents many young people from seeking mental health care. There are concerns about confidentiality and potential social repercussions that also plays a role. Uh, young people may internalize negative stereotypes that lead to self-blame and low self-esteem, which can then also exacerbate mental health issues and discourage proactive management. Um, stigmatize young people also face social exclusion affecting their support networks and hinders recovery. Um, and so yeah, absolutely, Gary. I mean, like Jamie said, stigma can be incredibly damaging. And of course, we talked a lot about other stressors that young people are facing, including discrimination based on race and gender, and disability and sexual orientation or personal history. For example, we know that males are more likely to be stigmatized and to perpetuate stigmas than females. And it's not an issue that we only face in one country or another. In high-income countries, there might be better access to services, but persistent stigma can still deter utilization of those services. And in low-middle-income countries, we have both the limited resources coupled with stigma, which creates significant barriers. And I think maybe just to touch on what uh Jamie said on resilience, I think that's such an important statement about young people's being perceived as resilient, that they could just get over it. And I think there for far too long, resilience was thought of as something inherent. You either had it or you didn't. We know now that that picture is far more complicated. Instead, resilience needs to be understood in the context of supportive parenting and families, communities, and schools, the values and beliefs of communities and the ways in which children and young people interpret and understand adversity and loss and mental health. So there's really good evidence to show that children can be helped to develop resilience by, for example, helping parents to be more responsive to children's emotional and material needs, building community cohesion and providing children with high-quality learning opportunities. So it's really unfair to place that burden on young people that they have this inherent resilience to deal with their mental health issues. We need to create that enabling environment to support their mental health, to reduce stigma, and help them access the services that they need.
SPEAKER_02That's important insight. Jamie, are there any ways you tried to address this stigma issue and to what success and what have you learned?
SPEAKER_03Um, yeah, definitely. I think for me, in my immediate circle, I always say be the change you want to see. So impact as you would like to be impact. And um, I always say it's okay to not be okay. And sometimes in situations, again, traumatic situations, um, like Zainab mentioned, we're expected as young people to be resilient. So, specifically, for example, if you have an eight or nine-year-old child, primary school child, going through a series of changes and they're having behavioral issues, we don't take the time to say, okay, maybe this is something, this is a lot for them. They're just expected to come on, get with it, you know, move on. You have to change schools, you're not thinking of they've lost friends, that they have to rebuild attachment and trust and all of these things. So for me, like I say, I try to be the change that you want to see. We have to be able to influence this unlearning that mental health is weakness, that expression is weakness, that seeking help is weakness. And we need to do that by influencing not just our systems, we don't just need programs and projects. And of course, those things are super important. But again, it needs to be reflected in the leaders that we have. It needs to be reflected not just in mental health leaders or health leaders, but in leadership in general, because people are influenced by those who lead them. That is the purpose of leadership. So we need to have our leaders in front of this charge, really pushing, whether it be re-education in schools, whether it be prioritizing health in our budgets. Because currently, based on a study that I've I saw, we we only have 8% of our gross domestic products, and 4% of that is allocated to mental health. Only 4%. And in that, it only goes to our mental health center. So we have no outpatient projects, we have no community center mental health, we have nothing. So you can imagine how hard it is. You might need to reach out to someone. And the next question is going to be who do I reach out to? Because the only available person is a therapist who will charge you $200 an hour to speak to you. And with a country like ours, not many people can afford $200 an hour to deal with their mental health issues. So it's it's a plethora of issues. But I honestly believe that if we as individuals are more aware of the situation and we are more choosing with the words that we use, yes, it will take an unlearning. It needs to be something where we're reducing on the stigma, but we're also re-educating as to what mental health is and what it is not. But I honestly believe that it is possible because I've seen it happen. And we have amazing youth like um let's unpack it youth and our national mental health focal points who are doing amazing work. We have a workbook that we're trying to share that can help people with their mental health issues, whether it's a little colouring here or there, or you know, just going through facts. So learning and unlearning what it is and what it's not supposed to be, and also just being there for people when they don't have anyone else to be there for them.
SPEAKER_00It's so profound, I think, what you say, just around how do we learn and unlearn unhelpful things, education really is at the heart of this, of tackling stigma. And I, you know, I think stigma starts affecting children early in life. By age six, kids recognize negative terms like crazy. And you mentioned this, Jamie, as well. I mean, by age 10, they know cultural stereotypes about mental health and often associate it with being dangerous. And this stigma can really shape young people's self-esteem and their actions and their emotions and their coping strategies. And I think really it doesn't need to happen, right? This doesn't need to be this way. I think if COVID-19, if the pandemic is to teach us anything, it should be that we need to talk about mental health. We need to be able to talk about it as something natural. There will be good days, there will be bad days, and young people need to know where to turn when their world is looking a little cloudy or is turned upside down. As Jamie said, it's not about just knowing you need support, it's about knowing where and how to access those supports.
SPEAKER_02And Jamie, you said how important it is for young people to use their voice and speak up about mental health, especially to support others who may not be able to do so. Why do you feel this participation of young people in addressing mental health is so important? I know many of our listeners are in different settings. I think they will benefit from your experience if you could allude to that a bit more.
SPEAKER_03For me, I was not always as outspoken as I am now. I started off very, very shy, and I was very grateful for the people who are around me who spoke up for me because I couldn't speak up for myself. So eventually I said, you know what, I want to be that for someone else. And I hope that me being able to speak out and be honest about my mental health can influence and inspire other persons to do so. So as young people, I think we need to be the ones leading the charge. We're we hear it all the time, we're the leaders of the future. And what's going to happen is that if we have, if we do not change the stigma now, if we do not make those strides now, it's just going to continue in another cycle when we get older. So at some point, it needs to be broken. And you know, to adequately address the burden of mental health, we have to challenge these existing norms. It has to be a challenge. And young people, we're creative. You know, we're always looking for something, especially I find in our generation, we tend to push the boundaries a lot more. And I think that's definitely something that we need to be doing. For example, there previously was no comprehensive directory for mental health, and a group of young people within our region, we challenge that. And with the help of UNICEF, we now have our very first mental health workbook where young people around the region and everywhere, as long as you have access to the internet, you can go and find a directory for the Caribbean region of where you can get mental health access. And that did not exist before. So now if I'm in Barbados, I can go in the director and say, hey, there is access to mental health if I'm struggling here. And these are the little things that we're we're talking about, and we say we have to start pushing the boundaries. We have to start engaging our leaders and having conversations and challenging them because we cannot continue to stay and say, oh, well, that's how it's been. And that's something that I hear all the time. Oh, when I was younger, there was no mental health resource. Well, it needs to change now. And just because you survived, it doesn't mean that you survived. You might have just survived in spite of that. And we want to ensure that going forward, there is resource, there are resources everywhere that people know that if you need help, that it is there. So youth leading the charge is very close to my heart because, like I said, we are going to be the policymakers of tomorrow. And I would hate for us to make the same mistakes that our forefathers made, that persons before us made in not adequately addressing it because it trickles down into who we are. You might start off with some anxiety, and then that might become something so big 10 or 15 years down the line. Like Zana mentioned, it didn't have to be that way. And again, it's not just for me, but it's for people who are for the younger ones who are coming after me. I have a little sister who's 14, I have a brother who's 18. I want them to see a different world than what I grew up in as it relates to mental health. It is definitely the job of a young person and with the support of everybody else around us to be able to push forward and to make the changes that we want to see.
SPEAKER_02And Dana, maybe you can build on this and share with us some experiences from UNICEF globally. And also, I mean, in your report that we read, there is a real uh big number of estimated losses in terms of economic loss or every year due to mental health among children in Latin America, Caribbean, uh, particularly because we're talking to Jamie here. But I'm sure this number is even probably greater because if we talked about the underestimated numbers and data that we have. So, how has UNICEF been able to embed these things into your policies, your advocacy, your work? Share maybe some insights into it.
SPEAKER_00The economic cost of neglecting mental health is severe globally. Um, and it's estimated at around $387.2 billion a year for children ages zero to 19. The return on investment in mental health can be tremendous. You know, research shows that for every uh one US dollar that's invested in treatment for common mental health issues, uh, there is a return of four US dollars in improved health and productivity. And we know much more about the efficacy of school-based mental health resilience programs as well, which provide a return on investment of five US dollars for every one US dollar investment. So for us, you know, this coupled with what we know now as well about addressing mental health in uh crisis-affected uh zones as well, which could also result in billions of dollars in lost lifetime earnings at the global level, um, it is critical for us that we embed mental health strategies across policy and advocacy and service delivery and ensuring that those services meet the needs of young people. And a good example of this successful integration of strategies in our work is Serbia. In 2023, there were six ministries that came together and signed a memorandum of understanding. The MOU established sector-specific roles and responsibilities to promote positive mental health across the child's life cycle. Like Jamie was saying, you know, resources, uh, opportunities evolve, and our thinking has evolved from this narrow thinking that the health sector can solve everything and can support young people. For us to be successful in meeting the needs of young people, we need to be meeting them where they are in the community. And that means involving different line ministries and ensuring that their accountabilities to young people's mental health is clear. Recommendations in that memorandum of understanding included forming a national multisectoral working group to implement a multisectoral action plan, ensuring that there is resource allocation for mental health services, that we're integrating mental health care into primary and community-level services, supporting the provision and access to evidence-based mental health care, strengthening evidence and research on mental health, integrating within school systems and addressing stigma and discrimination. And there were 40 young people who provided recommendations that influenced national strategies and fostered a strong link between youth and government to enhance mental health and psychosocial support in Serbia. So it's an important example that I think really highlights one, the importance of the multisectoral approach to mental health services within policy dialogue, but also integrating a youth voice and youth participation into those processes.
SPEAKER_02Jamie, we are listened uh in more than 180 countries, and we already learned a lot from you and from Zainab. And if you could leave a message that could reach youth in other countries, what would that message be?
SPEAKER_03I would say prioritize your mental health. I know you might hear it everywhere or you might see it everywhere, but it is one thing when we're sick or we have a broken bone or something, we make our duty to go to the doctor. And it always baffles me that when we know or we suspect that we have a mental health issue, we do not look for the resources, we ignore it. You wouldn't ignore a sprained ankle or a broken leg because you need your leg. So I would say do not ignore your mental health because you need your mind, you need to be healthy. Also, prioritizing positive coping mechanisms has worked wonders for me and the people around me because I know as a young person what it is to be stressed out. And I think that in the absence of those resources, make sure to find somebody that you are that can support you, even if it's one person, and to constantly just check on your mental health and be the change that you want to see as well.
SPEAKER_02Thank you. And as we discussed today, much of course remains to be done, but we were able to really put under spotlight some of the critical issues. In your view, what are some of the pockets of optimism that could serve as an inspiration to our listeners and how can they take forward the lessons in the discussion we had today and how they can use this in their own settings?
SPEAKER_00First of all, I love that phrase, several pockets of optimism. I think that's such a wonderful phrase, and there are really many. I think, you know, I think as I mentioned, it's really not all doom and gloom. I think I am uh generally optimistic about our direction. Uh, you know, Jamie serves as a beautiful and an inspiring example of the work that young people are doing across the globe. Um, in Latin America and the Caribbean region, uh, I'm inspired by this, the innovation that's coming out, the utility of digital platforms and online access to create opportunities and solutions for mental health care. We're seeing other wonderful momentum that's being gained across the globe on work on policy and advocacy, for example. In Kenya, the government has incorporated mental health and psychosocial support into its national health strategy with substantial input from youth networks. Recent emergencies in the MENA region, including COVID, the Beirut port explosion, the different earthquakes, and the worsening socioeconomic conditions have deeply affected the mental health of everyone, including humanitarian frontline workers. And I'm inspired by efforts coming out of that region that is putting a focus on the stress of frontline service providers and really developing support systems for them. And there's more good news, you know, we have now a suite of mental health interventions that are available designed to meet the needs of children and young people across different age groups. These resources span the full spectrum from prevention and promotion to more focused psychological interventions. For example, we have the Caring for Caregivers to support the very foundation of a child's mental health by supporting the mental health of parents. So we really are making strides in ensuring that there are focused psychological interventions for different age groups in young people. UNICEF recently concluded a trip to Vietnam where we witness a training of trainers on helping adolescent thrive, equipping young people with strategies to navigate their mental health challenges. This package actually targets young people from 10 to 19 years. So really, I think there's so much optimism that we can draw from. But I think the mostly I am really optimistic about the power of young people who are speaking up and driving change, like Jamie and others across the globe. And I'm really fortunate to be able to be working with them in this pursuit of improved mental health and well-being for children globally.
SPEAKER_02On that note, Zainab, thanks for joining us today. And Jamie, thanks for sharing uh your experiences and joining us today. I wish you the best with all of the work that you're doing.
SPEAKER_03Thank you so much. It was amazing meeting you guys and speaking to you. Thank you so much, Zenab and Gary.
SPEAKER_00Thank you, Gary. Thank you, Jamie. Wonderful to chat with you today.
SPEAKER_02Young people today face alarming rates of anxiety and depression. And as Jamie highlighted, the social stigma associated is a huge challenge. Who better to address this than young people themselves? I'm inspired by Jamie's proactive nature and by her boldness to speak up on behalf of the young people. Zainab highlighted how mental health in children and young people is so dependent on the health of their parents and society. Resilience is required for young people to thrive despite adversity, and this can be cultivated through supportive parenting, community cohesion, and ongoing education. Whether in St. Lucia, as Jamie shared, or from the innovative other examples mentioned by Zainab, there are plenty of pockets of optimism driven by young people for young people. May all of us always remain open to learning and being challenged by those younger than us. Let's hear from someone special who had views about our podcast. Thanks, Dr. Tedros. Our team and I are so pleased you find value in the podcast. To learn more about the topic discussed in this episode, visit the episode's webpage where you will find additional readings, show notes, and translations. Don't forget to get in touch with us via social media, email, or by sharing a voice message. And be sure to subscribe or follow us wherever you get your podcasts. Global Health Matters is produced by TDR, a United Nations co sponsored research program based at the World Health Organization. Thank you for listening.
