Mental Health Literacy

Mental Health Literacy is defined as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention” (Jorm, 2011). Mental Health Literacy provides individuals with information, support, skills, and resources that will help them cope with the pressures and challenges they face. There is evidence from surveys in several countries of deficiencies in;

a)  the public’s knowledge of how to prevent mental disorders 

b)  recognition of when a disorder is developing 

c)  knowledge of help-seeking options and treatments available 

d)  knowledge of effective self-help strategies for milder problems 

e)  first aid skills to support others affected by mental health problems. 

Current Findings in Mental Health

Harmony Mental Wellness Solutions uses evidence-based counselling and psychotherapy interventions to address people’s life challenges. Part of our mission is to promote your mental health literacy, to make you more knowledgeable about mental health issues. In order to facilitate your mental health literacy here are some current findings on various mental health topics.  Research is one of the central aspects of knowledge development. Research refers to a systematic (orderly) way in which people are able to gather information. Mental health, which includes psychiatry, psychology and other related social and clinical disciplines, is constantly evolving as more knowledge becomes available. Researchers ask questions in an attempt to understand human phenomena (happenings) and try and find answers to those questions. Conclusions that can be drawn from what is found in the research enterprise is known as evidence based research.  Research findings have important implications for policies and for intervention. We now know for certain that “talk therapies” such as psychotherapy and counseling are as effective in treating certain mental disorders as drug therapies. We also know that many mental health challenges begin in youth and adolescents and are often not detected until the person becomes an adult by which time much emotional and social damage may have been done.

We also know that emotional states such as depression and anxiety are closely linked to physical health conditions especially to chronic (long term or long lasting) conditions such as heart disease and high blood pressure. Hence we know “there can be no health without mental health” as the World Health Organisation states. Current research knowledge has also evolved to the place where we now know that cannabis or chamba usage can result in brain damage. Research is therefore an important enterprise as it continues to generate knowledge and helps us become efficient and effective in the work that we do as mental health specialists.

Psychological Distress

 This refers to negative emotional states such as depression (sadness) and anxiety (fear). An article published in the Journal of Psychosomatic Research in April 2018, demonstrated that if you are psychologically distressed  even minimally, you raise the risk of future chronic (long term) illness such as arthritis (pain and swelling in the joints of the body), lung disease and heart disease. This means that if you worry, are sad, experience changed eating and sleep patterns, are withdrawn, fearful for example, you risk developing lung problems, heart conditions and arthritis. The findings come from a study led by Kyle McLachlan and Catherine Gale both from the University of Edinburgh in the UK involving 16, 485 adults in the United Kingdom. What is unique about this study is that whereas it has been known that there is a link between being very distressed and the development of chronic illness, this study has shown that even mild (small or little) and moderate (medium) levels of distress can lead to the health conditions mentioned above.

Numerous studies in the past have shown a link between distress and death. Being distressed can play a role in leading to death through conditions such as prostrate and colon cancers and heart disease. Distress is therefore a very serious issue. The MacLachlan and Gale study demonstrates that even minor distress leads to serious chronic (long lasting) disease which could lead to death. How do you prevent this? Develop positive mental health; having a positive outlook on life as characterised by well-being, contentment, and satisfaction (in the past); hope and optimism (for the future); and happiness (in the present). It relates to meaning and purpose in life and a sense of good self-esteem. The take home message from these current findings is, even in the midst of challenges, don’t allow them to get to you, it will affect your health. We will be running workshops to help you navigate through and overcome distress.

Mental Health of Malawi’s Mature Adults

What is the impact of depression and anxiety amongst mature adults (that is, those aged 45 years and above)?

The Malawi Longitudinal Study of Families and Health (MLSFH) is one of very few long-lasting research studies that have followed over 4000 individuals in the rural areas of three Malawi districts (Balaka, Mchinji and Rumphi) for the past 20 years. Rural areas where chosen because that is where the majority of Malawians (85%) live. Periodically, data has been collected on various aspects of the lives of the 4000 including HIV and other health status, sexual behaviours, household/family structure, physical pain experienced, water source and diet/nutrition. What is interesting about the study is that levels of those leaving the study due to death are similar to those of the general population of Malawi, including differences by gender, region and HIV status. The MLSFH is directed by Hans-Peter Kohler and Iliana V. Kohler both of University of Pennsylvania. It is a collaboration of the University of Pennsylvania with the University of Malawi, College of Medicine where Chiwoza Bandawe and Prof. Victor Mwapasa lead the research from this end.

The specific MLSFH study that looks at the mental health of mature persons in rural Malawi was led by Iliana V. Kohler of Pennsylvania. The findings were published in the journal “Demography” in 2017. We know that given the improved health conditions as well as effectiveness of Antiretroviral medication, the mature adult population is going to rapidly grow in the coming decades. We will have people living longer and an increased aging population. However, research shows that despite this growth, the well-being of this population is low and older adults are in poor physical and mental health.

There are not many studies on mental health in Sub-Saharan Africa and we wanted to assess what the impact of depression and anxiety was on the lives of mature adults in Malawi. Research has found that these conditions impact a person’s productivity, family well-being and economic development.

In the study we found that in Malawi, more women than men experience depression and anxiety. Individuals are often affected by both conditions. We were able to establish that depression and anxiety are closely linked to unfavorable situations, such as less nutrition (food) intake and reduced work efforts. Women have less mental well-being and are not as satisfied or happy with life as men are. As one grows older, one’s mental health deteriorates, as does one’s sense of life satisfaction. For example, in the Demography paper we estimated that “a 45 year old woman will live almost 55% of her remaining life with some anxieties or depressive symptoms; this figure is approximately 40% for a 45 year old man. Approximately one-half of this time is subject to moderate to severe DA [Depression and Anxiety] – levels of DA that likely have substantial effects on individual’s well-being and social/economic lives”.

Mature adults in rural Malawi regularly experience stressors due to economic and social challenges. Such challenges in the form of poor crop yields, disease, financial challenges and death of loved ones, are likely to affect their mental health and sense of wellbeing or satisfaction with life.

Instead of enjoying the later years of life, mature adults in Malawi will struggle with depression, anxiety and an inability to complete the tasks they had hoped to achieve in their day-to-day lives. There is need for policies and strategies to address this.

Religion/Spirituality and Mental Health

Does being religious or spiritual have any impact on someone’s mental wellbeing? What are the findings of research?  Let me point out that over the past two decades (20 years), there has been a tremendous increase in research into spirituality and religion and its impact on health generally. Thousands of studies have been conducted and published.

The starting point is to define what is meant by Religion and Spirituality. Researchers separate the two words. In their book “Religion and Spirituality in Psychiatry”, Philippe Huguelet and Harold Koenig define religion thus: “Religion is used to indicate specific behavioral, social, doctrinal, and denominational characteristics. In particular, it involves belief in a supernatural power or transcendent being, truth or ultimate reality, and the expression of such a belief in behavior and rituals”. Koenig in a recent paper defines spirituality as something which stands out from philosophy, morals and values: “Spirituality is distinguished from all other things—humanism, values, morals, and mental health — “by its connection to that which is sacred, the transcendent. The transcendent is that which is outside of the self, and yet also within the self — and in Western traditions is called God… Spirituality is intimately connected to the supernatural, the mystical, and to organized religion, although it also extends beyond organized religion (and begins before it)”.

It needs to be pointed out that research on religion and mental health does not address the question of whether God exists or not. It is more focused on the impact and effect that this has on persons. Hence studies of religious coping in medical settings record the high number of patients who draw on their religious beliefs and practices to help them cope with health problems.

Simon Dein of Queens Mary College of London in an article published in 2018) in the “British Journal of Psychiatry Bulletin” argues for the inclusion of religion as part of the mental health care of patients based on the findings of extensive research into religion/spirituality. He summarises some of these findings thus: “The presence of religious faith is associated with greater hope, increased sense of meaning in life, higher self-esteem, optimism and life satisfaction”.  He goes on to cite studies that show that  greater religion/spirituality (R/S) predicted lower levels of depression, “lower rates of suicide, reduced prevalence of drug and alcohol misuse, and reduced delinquency” (youth criminal behaviour). 

With regard to anxiety, Dein reports that research gives different findings. Some report that R/S reduces anxiety, whilst some studies indicate the opposite. He cites a recent Swiss study which indicates that those with mental illness (misala) which is characterized by being out of touch with reality Recent studies from Switzerland suggest that religious individuals, cope better in handling the voices they hear in their heads and follow treatment advice if they frequently pray and read the Bible. Religious conversion has generally been found to enhance mental health. It needs to also be pointed out that the Religious/spiritual research is not only confined to Christianity. Many research studies have also explored the impact of religiosity in Islam, Hinduism and Judaism. They have also found positive mental health benefits in following these religions.

Dein also argues that, “Religion may also have a negative effect on health through inducing guilt and dependency, and in extreme cases may precipitate [quicken] suicide (e.g. in extreme cultic groups)”.  Overall, however, the findings are clear:  the more religious or spiritual you are, the better your mental health is. This is now an established scientific fact!

The urgency of mental health in Africa

Current research into mental health shows us that Africa is heading towards a crisis in mental health. There is urgent need to take mental health seriously at research, policy and intervention levels. We see increased suicides, depression levels and dramatic increase in drug and alcohol use. Writing in the online publication, “The Conversation Africa”, Professor Crick Lund of the University of Cape Town in South Africa, said this lack of attention to the need for giving attention to mental health is due to “ignorance about the extent of mental health problems, stigma against those living with mental illness and mistaken beliefs that mental illnesses cannot be treated”. This is compounded by the fact that Africa faces numerous economic and disease challenges and health conditions such as high death rates of children and mothers during childbirth. Many countries also face civil and armed unrest (wars). The consequences of this neglect results in many not receiving the required mental health treatment required, something known as the “treatment gap”. He cites figures from three countries. In South Africa, 75% of people with mental illness do not get the treatment required. In Ethiopia  and Nigeria it is worse, 90% don’t get treatment. In other words, only 10% of those requiring treatment in those countries, receive it.

Lund goes on to outline reasons why Africa should give attention to mental health. First, it is impossible to separate mental and physical health. There are close links between many health conditions and mental health. Those with high blood pressure, diabetes, HIV and TB for example, also have mental health challenges such as depression. Lund cites an Ethiopian study, which shows that those suffering from mental illness (misala) die 30 years earlier than the rest of the population. We also know from research that they are more likely to become infected with HIV. Those who have the mental disorder of drug and alcohol dependency are also more likely to become infected with HIV. Meanwhile, those with HIV are twice as likely to become depressed than the rest of the population. They are more likely to adhere to treatment if put on treatment for depression. We also know that when a woman who has just given birth becomes depressed, this affects the development and growth of the baby. It can therefore be seen that giving priority to mental health leads to health advantages.

Mental health needs to be given attention given the high rates of poverty in Africa. Lund points out that in a review of 115 studies, he and colleagues found that poverty was strongly associated with mental disorders such as depression, anxiety and psychological disorders that express as physical problems and yet no biological cause is identified (known as somatoform disorder). Lund goes on to point out that: “Conditions of poverty increase the risk of mental illness. This happens through the stress of food and income insecurity, increased trauma, illness and injuries and the lack of resources to cushion the blow of these events. Conversely living with a mental illness leads those affected to drift into poverty through increased healthcare expenditure, disability and stigma”.

Lund points out that despite this neglect, there is hope. Numerous research studies in Africa have given clear evidence that mental health interventions are very effective. In Uganda, the use of group inter-personal therapy (a form of counseling) was shown to greatly improve depression and daily functioning. Similarly, in Zimbabwe, led by psychiatrist Dixon Chibanda, a counseling intervention delivered by health workers called the “Friendship Bench” greatly improves depression, anxiety and other health challenges. As Lund concludes in his article, it is clear that “Improving mental health is a means of unlocking development potential – a neglected link in the development chain in Africa….. Mental health is both a means to social and economic development, and a worthy goal in itself”.

Father’s Crucial Role in A Child’s Life

Current science recognizes that the first 1000 days of a child’s life are very crucial. The foundation for the child’s future health wise are laid in this period. Rapid brain growth and child development physically, socially, language development, reasoning skills are all determined during this time. In recognition of this countries such as South Africa have incorporated this fact into their early childhood development policies. What often misses from appreciating the foundation of  children is the role of fathers.

Writing in “The Conversation: Africa” an online publication, Tawanda Makusha of the South African Human Science Research Council and Linda Richter of the University of the Witwatersrand in Johannesburg, point out that “’fathers’ aren’t just biological parents. Very often, they are other important men in a child’s life: a grandfather, an uncle, a mother’s current partner, a teacher, pastor or a benevolent man in the community”.  The research they have been conducting on the role of fathers in child development since 2003, demonstrates that its only 36% of children  in South Africa who live with their biological fathers.  Their research goes on to show that “the vast majority of men want to be involved in their children’s lives, even if they live far away or are too poor to support their children as they would like to. These issues of distance and poverty, as well as other social factors, must be tackled so that men are able to be fathers”. Involved fathers are not only beneficial to the child but also the mother and the father himself.

The role of the father has been explored in the science. In 2017, a study by Saxbe and colleagues in the journal “Hormones and Behaviour” demonstrated, (in the words of Makusha and Richter), that “men experience hormonal and other changes if they have the opportunity of being involved with a partner’s pregnancy. Their testosterone levels decline and synchronise with the hormonal levels of the mother. This is likely to reduce men’s aggression and make them more likely to be involved and protective towards their partner and their child.”

Father involvement therefore begins during pregnancy. Apart from being in synch with the mother’s hormonal level, fathers can also play an important role in “providing practical and emotional support for the mother by encouraging positive health behaviours that indirectly affect pregnancy and foetal development”. This role directly affects the child’s increased birth weight and helps lead to the reduction of preterm (early) births. Fathers also help mothers eat healthier, exercise regularly and avoid behaviours  that are potentially harmful to the unborn child, for example smoking, drug abuse and the consumption of alcohol. 

After the birth of the child, fathers continue to play an influential role in breastfeeding decisions and infant birth registration. The scientific literature is awash with studies that demonstrate that fathers who have been involved in their children’s lives from the very beginning are more likely to be involved in the rest of the child’s life. Such involvement has been linked to reduced maternal depression and improved care and responsibility from the father’s side.  In the long term: “positive father engagement is associated with higher educational achievement, higher self-esteem especially among girls, and lower levels of machismo among boys” Makusha and Richter point out.

Father involvement  remains limited however due to reasons such as poverty and distance, as earlier pointed out, but also due to family conflict, prison, separation or divorce and death.  Men also need to be included in the health care services during pregnancy and early childhood development. Health care facilities need to cater for men as well Makusha and Richter point out. Men need to get this message loud and clear: Be involved in your children’s lives.  Even if one cannot provide for the child materially, your child values your presence and interest in their lives.

Bullying and its impact on Mental Health

As schools prepare to open for a new academic year, there is one mental health factor that may not be taken so seriously, mainly because we do not fully understand its impact on the mental health and well-being of pupils and students. Being bullied or “teased” as we call it in Malawi, is a negative experience that “casts a shadow on children’s and adolescents’ mental health and wellbeing” writes Louise Arseneault of King’s College, London, UK in the journal “World Psychiatry” in 2017. He points out that mounting evidence from numerous researches being conducted show clearly that bullying negatively affects those who are on the receiving end. Continuous teasing undermines the self-confidence of the children, leading to low self-esteem, poor academic performance resulting in failing grades and even self-harm.

What is more disturbing is that the impact goes beyond the schooling years and even affects those bullied or “teased” into adulthood long after the bullying may have stopped. Bullying has societal costs attached to it. It is clear from studies that those who were bullied when young are more likely to develop social fears of going into public places (known as agoraphobia), anxiety, depression, panic attacks and may even commit suicide in their early to mid 20s according to Arseneault. When compared with those who have not been bullied, victims of bullying have a higher risk of psychiatric hospital treatment as well as being put on medication in young adulthood. Bullying between the ages of 7 and 11 (amongst a UK population sample) reported high levels of psychological distress at the ages of 23 and 50 according to a study by Ryu Takizawa of the University of Tokyo together with colleagues from London.

Takizawa and colleagues, writing in the Journal “Psychological Medicine”, found that bullying victimisation in childhood predicts inflammation (irritation and swelling) and obesity (fatness) at mid-life. Hence bullying even affects later physical wellbeing and not just mental health. Takizawa and colleagues also found that women who were bullied in childhood had higher Body Mass Index (a measure of good health) than non-bullied participants and were at increased risk of being obese (or “fat”, a condition that can lead to numerous long term conditions such as heart disease and stroke). Writing in the “American Journal of Psychiatry”, Takizawa and colleagues reported that: “Childhood bullying victimization was associated with a lack of social relationships, economic hardship, and poor perceived quality of life at age 50.”

We know that mental health problems such as anxiety and depression are likely to stay with a person for a very long time if they begin early in that person’s life. Arseneault points out that “Untreated signs of psychological distress that appear early in life, or markers of physical illnesses, may be the precursors [forerunner] to a life of poor health, both mental and physical”.

So, what should be done? It is essential for bullying behaviours to be dealt with immediately they are reported. In so doing one is preventing mental, social and physical health difficulties in a person’s present and later life. Several anti-bullying programmes have been introduced in schools world wide and the science has shown these to generally help reduce bullying. Of course, it is impossible to totally stop bullying from happening. That is something some children feel they have a need to do to assert their power and cover up with their inner sense of inferiority and inadequacy. It is important that schools equip children with skills to help minimise the harmful effects of bullying so that they can handle these challenges without it compromising their potential and meaningful contribution to society.

Physical Exercise and Mental Health

Physical activity has long been known to influence one’s mental health by reducing depression. More recently, studies have shown that even small amounts of exercise impact one’ levels of happiness and play a role in the treatment of the drug addiction to cocaine.

A recent article published in the “American Journal of Psychiatry”, shows that regardless of age or gender, small amounts of exercise can protect against depression. In a study involving 33,908 Norwegian adults who had their levels of exercise and symptoms of depression and anxiety monitored over 11 years, it was found that “12 percent of cases of depression could have been prevented if participants undertook just one hour of physical activity each week” summarises the Website “Science Daily”. It goes on to quote lead author, Samuel Harvey from Black Dog Institute and UNSW as saying: “We’ve known for some time that exercise has a role to play in treating symptoms of depression, but this is the first time we have been able to quantify the preventative potential of physical activity in terms of reducing future levels of depression.” An hour of exercise per week is therefore seen to have the protective effect of preventing depression. Exercise is thus an important aspect of integration into mental health plans and public health campaigns. In summing the findings, Science Daily reported that “Those who reported not exercising at all had a 44% increased chance of developing depression compared to those who were exercising one to two hours a week”.  Interestingly, it is depression that is protected by exercise and not anxiety. It can however be seen that small changes to one’s lifestyle such as introducing exercising reaps immense mental health benefits.

Physical exercise is also scientifically known to lead to happiness. In a systematic literature review by Zhanjia Zhang and Weiyun Chen of the University of Michigan, bringing together many studies and seeing the commonalities of the findings in research, published this year in the “Journal of Happiness Studies”, all the research points to an association (or link) between physical activity (exercise) and happiness. They report that “As little as 10 minutes physical activity per week or 1 day of doing exercise per week might result in increased levels of happiness”. Interestingly, some studies found that happiness levels were the same “whether people exercised 150-300 minutes a week, or more than 300 minutes a week” according to a “Science Daily” summary of the review. Studies have pointed out that “both aerobic exercise and stretching/balancing exercise were effective in improving happiness” Zhang and Chen point out. Research very strongly suggests that exercise leads to happiness: “even a small change of physical activity makes a difference in happiness” they point out. Amongst young people however, the amount of exercise seems to affect the level of happiness. Those who exercised were much happier if they exercised than those who did not and if overweight, they were happier exercising than those who exercised with normal body weight.

Another study found that adolescents who exercised at least twice a week were happier than those who exercised once. College students who exercised turned out to be happier than those who did not exercise.  Zhang and Chen cite a study that shows that older adults who exercised were happier than those who did not. Health status and social functioning were also important contributors to the levels of happiness.

Exercise enables one to also cope better with the stresses of life. Since exercise is also known to reduce stress hormones and uplift one’s mood,  a cocaine addict is better able to navigate withdrawal as they experience less anxiety and emotions often accompanying withdrawal. Aerobic exercise should thus be considered an important strategy in the treatment of cocaine addiction.

The website “Science Daily” points out that “Studies already have shown that aerobic exercise (also known as “cardio”) is an effective strategy against many physical health problems, including heart disease, diabetes and arthritis, along with certain mental health issues, such as stress, anxiety and depression”.

Physical exercise should also be widely used in treatments of various mental disorders. In a study published this year in the Journal “Behavioural Brain Research”, Panayotis Thanatos of the USA University of Buffalo found that exercise prevents relapse into cocaine addiction. Cocaine  addicts who engage in regular aerobic exercise (one hour on a treadmill, five times a week) are most likely to reduce cocaine seeking behaviour as a way of handling stress.  Go out there and exercise!!!!

Protecting Youth Mental Health

It is now a recognised fact that many mental health disorders begin amongst adolescents and young adults. These disorders will stay with them into adulthood and will often go undetected. An effective response to addressing mental health disorders amongst the youth is essential for the future of the world because, according to the United Nations Population Fund, with 1.8 billion youth, “the largest generation of young people in human history is coming of age”. Mental health disorders amongst the youth lead to tremendous suffering (known as morbidity) and early death.

Writing in the journal, “World Psychiatry”, Helen Christensen of the Black Dog Institute in Australia together with colleagues, asserted that despite these facts being known, very little is being done to counter this pending mental health crisis. The barriers to the realisation of addressing mental health disorders amongst the youth can be defeated. The key barriers to early identification and prevention of mental health disorders amongst the youth are known. These barriers “include low rates of help seeking, the limited capacity of existing services to respond, and the fact that health systems are not suited to young people’s needs” Christensen and colleagues write.  Amelia Gulliver and colleagues, writing in the journal “BMC Psychiatry”, positioned that young people sensed that stigma and embarrassment, problems recognising symptoms (poor mental health literacy), and a preference for self-reliance as the most important barriers to help-seeking. The factors that help make youth seek assistance for mental disorder include positive past experiences (with the health care service provision), social support and encouragement from others.  

They concluded that “Strategies for improving help-seeking by adolescents and young adults should focus on improving mental health literacy, reducing stigma, and taking into account the desire of young people for self-reliance”.

The barriers that prevent appropriate health seeking behaviours have been overcome for other health conditions such as cancer and HIV Christensen and colleagues point out. Why then is this not translated to help the youth overcome mental health challenges such as depression? They put forward two explanations: First, “the misconceptions and falsehoods around the nature of youth depression accumulate to form the idea that mental health disorders are “too hard” or that we know too little.” Hence depression is believed to be a “First world” or rich country problem and thus not seen as important in the face of physical illnesses such as malaria.  The reality however is that deaths from infectious diseases are decreasing (going down) and we are seeing a steady rise in non-communicable and lifestyle diseases and mental health falls under such conditions.

 “Depression is the third leading cause of disability for 15-24 year olds globally after skin and subcutaneous diseases, and low back and neck pain” Christensen and colleagues argue. They go on to point out that suicide, very closely associated with mental health is, in many high- income countries, the leading cause of death for 15- 29 year olds according to the World Health Organisation. Despite this there is a tremendous lack of knowledge about depression. The lack of knowledge may lead many to believe that there are no effective treatments for depression. Hence many young people think that trying to seek help will be a waste of time and will expose them to ridicule. The literature is very clear that depression is treatable and the treatment approaches are very effective at that.

The effects of depression on a person’s life are widespread. Their productivity, contribution to society in all areas becomes compromised because of the extent to which depression drags out the life energy of a person and leads to them withdrawing into their own shell. When the depression is not seen as a “real” medical disorder, this leads to stigma as people are told to “get over it” or “pull yourself together”. Many who have a limited understanding of depression do not take seriously the inner relenting pain and deep sense of sadness that a young person feels. Even amongst the depressed youth themselves they will question why they feel this way and take it as something they will “soon get over”.

The second reason why the overcoming of challenges to address mental health problems amongst the youth is widespread is the lack of an “actionable, prioritized, implementable blueprint supported by governments around the world” Christensen and colleagues argue. Whilst there have been plans put forward, very few such plans receive the attention needed.

Most existing blueprints consistently recommend three actions according to Christensen and colleagues. First, introduce evidence based school programmes. Such programmes mean that mental health issues become part and parcel of the school programme via curriculum or intervention. Schools are key to reaching the youth. Writing in the journal “International Journal of Inclusive Education”, Jacqueline Specht of Western University Ontario, Canada, writes: “Students who are excluded from the daily life of schools are at risk for mental illness. This is especially true for children with disabilities as they are marginalized by assumptions and beliefs about what they cannot do at school as opposed to what they can do”.

Second, introduce effective treatment approaches for example in hospitals where youth services are provided so as to reduce stigma. The World Health organization (WHO) 2013–20 plan for comprehensive mental health action noted that, “The early stages of life present a particularly important opportunity to promote mental health and prevent mental disorders…Children and adolescents with mental disorders should be provided with early intervention”. The Lancet, a leading British journal in their editorial of 29th April 2017 cited an Australian youth mental health report that surveyed 21,000 young people as presenting “a grim picture of mental health, with 22·8% of young Australians meeting the criteria for probable serious mental illness”. Female youth were twice as likely than their male counterparts to suffer from mental illness whilst indigenous (Aboriginal) Australian children under 14 are “nearly eight times more likely to die by suicide than their non-Indigenous peers”. Apart from hospital settings it is also important that interventions should also include family and friend support mechanisms in place and the use of technology to support or provide an alternative to one-on-one individual care

Third, bridge the knowledge gaps that are widespread. In an article published last year in the distinguished “Malawi Medical Journal”, Stanley Kutcher and colleagues reported that they trained Community health care providers in Malawi as well as teachers to identify and diagnose youth depression amongst Malawi youth. Teachers were able to refer students for treatment and the outcomes were very positive.


World Health Organisation. (2005). Promoting Mental Health: Concepts, Emerging Evidence, Practice. A Report from the World Health Organisation, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation (VicHealth) and The University of Melbourne. Geneva: WHO

Jorm, A. F. (2011). Mental Health Literacy: Empowering the Community to Take Action for Better Mental Health. American Psychologist. Advance online publication. doi: 10.1037/a0025957