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Breaking the cycle: Addressing poor adolescent mental health in diverse regions

May 22, 2024 Jive Media Africa

Young people face significant adversity in diverse settings such as South Africa, parts of the United Kingdom, and Afghanistan. In these contexts, understanding adolescents’ mental health challenges requires a comprehensive view of the broader environments young people live in and how this shapes their mental health.

During the Siyaphambili Webinar series first episode, facilitated by Rochelle Burgess (University College London), speakers emphasised the need for policies and interventions that recognise the intersection of factors such as poverty, racism, gender norms, oppression, and violence in shaping young people’s poor mental health. In conflict-stricken areas, interventions often focus on immediate challenges like food shortages and healthcare. However, prioritising young people’s mental health alongside other basic needs is essential for breaking cycles of trauma and poverty.

“You feel guilty and useless… You just wake up and eat and do nothing,” said 24-year-old Kwanele, describing his life in an urban informal settlement in KwaZulu-Natal, South Africa. Kwanele was one of twenty young peer research assistants (YPRAs) in the Siyaphambili Youth Project, which sought to develop interventions to address overlapping challenges facing young people in marginalised communities. The project was a collaboration between researchers, including Smanga Mkhwanazi from the South African Medical Research Council, practitioners from the local South African NGO Project Empower, and young people from local communities employed as Youth Peer Research Assistants (YRPAs). 

Speaking at the Project Empower Webinar, Mkhwanazi highlighted that, among the male YPRAs , poor mental health emerged as a key theme in descriptions of their lives. During in-depth interviews, the men spoke about the impact of joblessness and traumatic life experiences in communities characterised by high rates of unemployment and violent crime. In another study involving young men from marginalised communities in KZN – Stepping Stones and Creating Futures – Mkhwanazi and his colleagues found that a quarter of the participants had engaged in suicidal ideation (thoughts about ending their life) in the past month.  

“When we ran the multivariate analysis, it showed that experiences of childhood abuse, other adverse events in adulthood, and drug use were significantly associated with suicidal ideation.” The team also found a positive relationship between hunger and suicidal ideation.

“There are many possible reasons for this relationship,” Mkhwanazi said. “We speculated one reason might be the pressure on young men to provide for their families and in intimate relationships… This [hunger] is a clear indication that they couldn’t provide.” In the Siyaphambili study, a participant voiced this pressure: “There are many expectations placed on us [as young men]. Most of the time, people want what we are not capable of doing.”

The two studies painted a picture of how gender norms and social factors drive poor mental health among young men in marginalised communities. “Effectively addressing mental health challenges, including suicide ideation, requires addressing the structural everyday challenges and gender norms that young men experience,” Mkhwanazi emphasised. 

Adultification of black teens

In marginalised settings, social or healthcare workers may view young people’s struggles through a lens of personal responsibility or deficit that fails to account for social and structural drivers. Mkhwanazi’s fellow speaker, Professor Claudia Bernard (Goldsmiths, University of London), discussed the adultification of black adolescents in low-income neighbourhoods in the UK. 

Due to racial bias, black children are perceived to be older, less innocent, and less in need of protection than white children. Bernard referred to the case of a 15-year-old black girl in foster care who was raped by a 36-year old man. The report’s language suggested that she was ‘streetwise’ and complicit in her exploitation, reflecting the racial bias and adultification that black children face in the UK’s child welfare and justice systems. “They’re seen as the risk, rather than at risk,” Bernard said. “In the UK context, the safeguarding strategies and practices can pathologise, criminalise and harm black children rather than keep them safe.” 

In her presentation, Sorcha Ni Chobhthaigh (University College London) illustrated how the wording and framing of policies in the UK affect their implementation and those they aim to support. Her research assessed whether the special educational needs and disabilities (SEND) policy aligns with a human rights-based approach. SEND aims to identify children who need additional support or services to address learning difficulties.  However, biases can derail this process, leading to the over- and under-representation of racial and ethnic minority young people in mental health services.

Ni Chobhthaigh’s research found that the SEND system often ignores structural determinants of health such as housing and income security, instead focusing on family-based risk factors. She called for clear definitions and a shared understanding of co-production and person-centred care to genuinely involve young people and families in their support and development. Engaging communities in this way helps ensure interventions are contextually relevant and meet local needs. 

Afghanistan’s mental health crisis

The co-production approach is particularly relevant in conflict-affected regions. Ahmed Nisar of Orygen Global highlighted the unmet demand for mental health services in Afghanistan. Since the Taliban took control in 2021, the country has faced international sanctions, economic decline, and widespread unemployment. With women and girls largely confined to the home, rates of domestic and intimate partner violence have rocketed. At the same time, mental health remains heavily stigmatised. 

In response to these challenges, Nisar and his colleagues worked with local communities to develop an online counselling programme called Changemaker. This youth-led collective provides mental health support through counselling, storytelling, and advocacy.  

“It’s an open source for everyone to come and seek support in all their diversity,” he said. The programme uses a survive-led and trauma-informed care model to create a safe and inclusive environment for clients. Remote services work best in conflict-stricken areas like Afghanistan because they are the most accessible. 

As well as providing a means to reach women and girls, the programme also reaches Afghan refugees, who often experience discrimination and human rights abuses in neighbouring countries. The collective comprises diverse team members across South Asian countries to better understand the needs of different communities. 

Despite challenges of scope and access, Nisar emphasised the need for aid agencies to incorporate mental health into their aid responses, which tend to stop at the provision of food and basic supplies in immediate relief strategies. 

“When we look at it from this perspective, there are these tough and terrible experiences on the one hand, and then on the other hand, this creates a cycle of intergenerational trauma for people,” he said.