Mental Health – November 24 2022 Mental health support for children and young people lacking in low and middle-income countries More than 225 million children and adolescents globally live with a mental disorder, which is more than the population of Germany, the UK, and France combined. Of these, 197 million – or 88% - live in low and middle-income countries. On top of that, there is a wide gap in the quality and availability of mental health services offered to children and adolescents in these countries versus higher-income countries. Mental health experts at SOS Children’s Villages, together with research partners, call for adopting strategies to bridge the gap and improve mental health support for children and young people worldwide. They make the case in an article published last month in the journal Epidemiology and the Psychiatric Sciences. The article titled Adverse childhood experiences and global mental health: avenues to reduce the burden of child and adolescent mental disorders provides an overview of the literature on the role of adverse childhood experiences (ACEs) as social determinants of mental health and highlights possible ways to mitigate their effects. What are ACEs? We are still unable to pinpoint all the factors that cause anxiety, depression, learning disabilities and other mental health disorders. Yet, experts are becoming more and more aware of the impact social and economic circumstances, such as exposure to violence, extreme poverty and migration, have on the mental health of children and adolescents. The first two decades of life are a very vulnerable period in which exposure to negative events can have long-lasting consequences. These negative events are called adverse childhood experiences (ACEs) and include instances of sexual, physical, or emotional violence, neglect, deprivations and poverty, parental mental disorders, as well as loss of a parent. Children exposed to ACEs are more likely to suffer from a wide range of mental disorders, as well as alcohol and drug dependence, that often continue to affect them in adulthood. Finding solutions to prevent ACEs and support those who have experienced them is, therefore, key to improving the well-being of children and adolescents worldwide. Inequalities between high and low-income countries Finding solutions that are effective and meet the individual needs of children living in different contexts across the globe is not easy. Research on ACEs and approaches for their prevention and mitigation has so far been carried out mostly in higher-income countries. Most children and adolescents today live in low and middle-income countries, which means that their experiences of adversity and mental health distress go unaccounted for in the evaluations. Experts at SOS Children’s Villages argue that different cultural and contextual experiences must be taken into account in the strategies for mental health and psychosocial support. Targeted solutions and mental health disorder prevention measures must be in place for children who have been exposed to ACEs. ACEs and alternative care Adopting measures to address ACEs is extremely relevant to the preventative work of SOS Children’s Villages. Losing parental care or being at risk of it is an adverse childhood experience. That's why children and young people in SOS Children’s Villages' care are more vulnerable in the mental health sphere than their peers. Research shows that children and adolescents with alternative care experience are disproportionately affected by ACEs. What's more, the prevalence of mental health disorders is higher among young people with care experience compared to their peers in the general population, and this continues in adulthood. 30% of adult care leavers experience mental health disorders - this is almost double the estimates for the general population (17%). Strategies to bridge the gap To properly support children at increased risk of developing mental health disorders, experts at SOS Children’s Villages propose a minimum service package of psychosocial interventions, including those recommended in the article, such as TeamUp or Problem Management Plus. The article published in Epidemiology and the Psychiatric Sciences was conceptualized by the staff of the Global Programme Expert Group on MHPSS of SOS CV (C Ceccarelli, O Muneghina), with the support of academic staff from the University of Verona WHO Collaborating Center (M Purgato, C Barbui, E Prina). Researchers from the University of Amsterdam, King’s College London, University of British Columbia, University of Cape Town, Koc University Istanbul, Transcultural Psychosocial Organization Nepal, Vrije Universiteit Amsterdam, contributed to the writeup and review of the work.