Child and youth mental health

• Anxiety and depression alone in adolescents – young people aged 10 to 19 – make up 40% of the global burden of disease. More than 1 in 7 adolescents are living with a diagnosed mental health condition, such as depression, anxiety, or behavioural disorders, with 50% of these beginning before the age of 18 (and almost two-thirds by the age of 25). 

• Each year, an estimated 45,800 adolescents tragically lose their lives to suicide, leading to suicide being the third leading cause of death among people aged 15 to 29, with youth suicides increasing in most parts of the world for years.

• There are several key drivers of poor mental health among children and young people, such as poverty, domestic and community violence, bullying, family dysfunction, substance use, and the abuse of technology and social media. Failing to address these issues through prevention and support measures prevents children and youth from growing up to realize their full potential. 

• Investment in the prevention and treatment of mental health conditions among children and young people, and the promotion of their mental wellbeing, remains extremely low. The adoption of national child and adolescent mental health (CAMH) policies remains slow: in the WHO Mental Health Atlas 2020, only 53% of 168 responding countries had a plan or strategy for CAMH. In 2020, approx. 60% of countries reported that they had updated their policies/plans for children and adolescents since 2017 and other should follow suit.

• The contribution of children and young people to society is limited by mental health conditions. Anxiety and depression, for example, influence a child’s ability to learn, develop, form relationships, and reach their full social and economic potential.

• Not addressing the mental health of children and youth, as well as their psychosocial development, can limit opportunities and may have potential long-term consequences. Mental health across the life course requires holistic strategies for early intervention promotion, prevention and care that involves multi-sectoral approaches, including the education, health and social care sectors, among others.

• A multisectoral strategy is necessary, that aims at promoting mental health for new parents, and caregivers, through home- and health facility-based antenatal and postnatal care for new parents, the provision of early childhood mental health screening, mental health programmes that address the cognitive, sensory-motor and psychosocial development of children and the promotion of non-violent and healthy child-caregiver relationships, and by introducing or strengthening community protection networks and systems.

• Governments should develop universal and targeted school-based programmes to promote mental health and well-being and integrate mental health services and psychosocial support in schools (and in associated community settings for out-of-school children), including through socioemotional life skills and peer support programmes to counter bullying, violence and improve social connection, both online and offline, and counter stigmatisation and discrimination against young persons living with mental health conditions and psychosocial disabilities.

• Young people are more than beneficiaries of mental health interventions - they are experts in the programmes and circumstances that affect their own mental health and should be fully included and facilitated to lead in discussions and decisions about their wellbeing.

Suicide prevention (incl. decriminalisation)

Suicide is a major contributor to global mortality and is an example of inefficient mental health services and inadequate social protection policies.

• Every year, more than 720,000 people lose their lives to suicide. Almost three-quarters of these deaths are in low- and middle-income countries (LMICs). For each person who dies by suicide, there are likely 20 more who make a suicide attempt. Suicide represents a significant public health challenge.

• Suicide is the third leading cause of death among 15–29-year-olds, while close to 8,000 children between the ages of five and 14 are estimated to have died by suicide worldwide in 2021. 

• Suicide and suicide attempts are criminal offences in civil law in more than 20 countries worldwide. The punishment of suicidal behaviour deters people from seeking the help they need, increasing the risk of suicide, and exacerbating the stigma and shame associated with suicide. Criminalization results in suicide being underreported, preventing governments from understanding the true scale of the problem, recognizing at-risk groups needing additional support, and appropriately investing in suicide-prevention strategies. 

• Suicide can be prevented through evidence-based interventions. WHO’s LIVE LIFE approach recommends four effective, evidence-based key interventions which should be included in every national response to suicide: limit access to the means of suicide; interact with the media for responsible reporting of suicide; foster socio-emotional life skills in adolescents; early identify, assess, manage and follow up anyone who is affected by suicidal behaviours.

• Member States should adopt prevention strategies to address depression and suicide - in particular among adolescents, for whom suicide is a leading cause of death - including through public health policies that respect human rights. Such approaches include: mental health promotion and mental illness prevention, equitable access to early identification, assessment, management and follow-up of people affected, including training of first responders within the health system and all persons who come in contact with them within employment and educational settings, repealing discriminatory legislation such as the criminalisation of suicide, and restricting access to lethal means of suicide, ensuring that a helpline is available as a key means of crisis support in every country, focusing on tackling the social, economic and environmental determinants of mental health, including by enhancing life skills and resilience, addressing responsible reporting of suicide by the media, including online, digital and social, and promoting social inclusion and healthy relationships

Service reform (ending institutionalisation)

Investing in primary healthcare services is an urgent area of system reform for mental heatlh, given that in most countries, mental health care is mainly provided in institutions (i.e. mental hospitals, traditional institutions such as prayer camps and other NGO- or government-run custodial care that operates as long-term stay for people with severe mental health conditions). Institutionalising people living with mental health conditions, and the circumstances in which they are held, breach several articles of the UN Convention on the Rights of Persons with Disabilities and does not promote good outcomes in terms of recovery and autonomy. 

• On average, only around 2% of government health budgets are allocated to mental health, which drops to 1% in low-income countries (LICs). Of this limited budget, on average, 67% globally goes towards institutions. It is nowhere near enough to meet the level of need: in 2020, there were 71.8 admissions to mental hospitals per 100,000 people globally and only 10.8 beds per 100,000. 

• In certain WHO regions, including the Americas and the Eastern Mediterranean, more than 25% of all people in institutions were kept there for as long as five years, in 2020. 

• Involuntary admissions, arbitrary detentions, coercive practices, inhumane treatment and other forms of human rights abuses are common in institutions and can harm mental health. 

• There should be a systematic shift of the locus of care from institutions and an over-reliance on a biomedical model and coercion, towards human rights-based models, prioritising prevention, early intervention and a network of community-based mental health services in line with the WHO Comprehensive Mental Health Action Plan (2013-2030), the UN Special Rapporteur's report on the right of everyone to the enjoyment of the highest standard of physical and mental health, the UN Convention on the Right to Health, and the CRPD Articles on legal capacity and independent living and community inclusion. These services should be holistic, recovery-oriented, person-centred and high-quality and should protect human rights and align with the Convention on the Rights of Persons with Disabilities. 

• Institutionalization affects not only people living with mental health conditions, but also persons living with psychosocial and physical disabilities, as well as minorities, a disproportionate number of women, and children and young people. 

• People in institutions are more vulnerable to both communicable and non-communicable diseases. 

Social and commercial determinants of mental health

Mental health is profoundly shaped by the circumstances in which we are born, grow up, work, live and age. We should be collectively tackling underlying health determinants and inequities (including socioeconomic disadvantage, social inequalities, adverse living or working conditions and harmful commercial practices). Many of these co-determinants are shared with physical health and NCDs (e.g. smoking, burnout, domestic violence, unhealthy eating), however there are unique determinants for mental health that require immediate action. Mental health and psychosocial disability is not solely a health issue and requires a whole of society, cross-sectoral approach.

• Even under optimal conditions, treatment alone will never be sufficient to reduce the global burden of mental ill health. Social and economic conditions shape the mental health of populations. For example, childhood adversity is directly causally responsible for almost 30% of all psychiatric conditions (Kirkbridge et al., 2024).

• Attempting to reduce the number of people with mental ill health without combating adverse social and economic conditions would be like trying to tackle lung cancer with no regulations on cigarette smoking, or trying to reduce infectious disease without investments in public sanitation.

• We should go further to address the social, economic, environmental, and commercial determinants by recognising that the approach to quality of life should be widened beyond the biomedical model to include a holistic approach that considers all aspects of a person’s life and the risks to health and wellbeing

• There is growing attention on the potential mental health impacts of digital technology, especially on young people. The Pact for the Future, especially the commitment under Digital Trust and Safety paragraph 31, highlights the urgent need for further work in this area.

• Mental health stigma and discrimination are ever-present, and it remains important to raise awareness about early signs and symptoms, and combat discrimination and stigma surrounding mental ill health, including a shift from biomedical language (“mental disorders”) to rights-based terminology (“persons with psychosocial disabilities”). 

• The smoking, alcohol, ultra-processed foods and gambling industries' products and practices directly or indirectly harm mental health in a variety of ways, very few of which are currently addressed by policies and regulations.