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Fiona Samuels: Prevention and management of mental health problems

Updated: Jan 7

Fiona Samuels, Senior research fellow at ODI's Overseas Development Institute

Fiona Samuels is a senior research fellow at ODI's Overseas Development Institute. She has worked for the World Bank, the Department for International Development and UNICEF, among others. Fiona has also carried out work on gender and social norms, studying the role of community structure and social norms in meeting the needs of vulnerable groups including women, girls, children and the elderly. Her main research areas include gender-based violence, mental and psychosocial health, health and HIV vulnerability.

Prevention and management of mental health problems

Responses to questions based on Botnar (and other studies) so far:

1. Compared with other countries and regions, what are the distinctive features of mental health problems faced by adolescents in Vietnam and Tanzania?

What stands out in Vietnam is that a key driver of mental ill-health amongst adolescents is academic pressure to do well at school. This pressure comes from the adolescent themselves but also from family members, teachers and peers. The technology environment is also potentially a driver of mental ill-health – with widespread use of digital platforms adolescents often feel pressure to conform to certain stereotypes of ‘beautiful’ bodies/body images, which are made more visible on these digital platforms. When adolescents do not conform, they feel anxious and stressed, this is especially the case for girls.

In Tanzania, the pressures to achieve academically are less pronounced and given the technology environment is less advanced than in Vietnam, the potentially damaging effects of digital platforms are less in evidence here. However, other drivers of mental ill-health Tanzania include norms around educating boys at the expense of girls, resulting often in girls being more likely to drop out of school and marry early, thus causing anxiety, stress and isolation for these girls. Also in Tanzania, difficult home environments caused by poverty and inability to meet basic material needs, also result in sadness or stress amongst adolescents.

In both countries inability to discuss mental health-related issues, especially between parents and their children, results in yet further anxiety and isolation. In Vietnam in particular, there is a sense of a divide between the two generations, with parents unable to understand their children’s outlook let alone the fact that they may be having mental health related challenges.

2. What are the shortcomings of the intervention by NGOs and the government? How can it be improved?

Globally and also in Tanzanian and Vietnam there is very limited funding and programming on mental health – both by governments and NGOs. What programming does exist, is often focused on medical approaches and targeting severe mental illness such as schizophrenia and bi-polar disorders. Similarly, while common mental disorders such as anxiety and depression are by far the most common and faced by many adolescents, these are often overlooked, again globally and specifically in countries such as Tanzania and Vietnam. Reasons for this relative neglect include that mental ill-health is not seen as a priority, it continues to be stigmatised in many contexts, people often have the attitude that they just ‘have to deal with it themselves and get on with things’ and there are no appropriate services / programmes available. Where services which seek to address these more common mental health disorders amongst adolescents do exist (e.g. school counsellors, anonymous school ‘mail boxes’), these are often not well advertised, used or operated effectively in practice.

Some features of appropriate services / programmes include: they need to be community based and include non-medical staff (e.g. counsellors, peers); they need to be targeted for different age groups and different genders; and they need to be context specific including taking into account wider drivers of mental ill-health such as gender norms which often discriminate against girls and women.

3. What new impacts will digital development bring to the mental health protection of adolescents in the future? How can digital and intervention be better combined?

Digital technologies have opened up new spaces for carrying on mental health related programming and service-provision. There are many success stories where digital and other remote platforms (including phones) have been supportive of adolescent mental health, adolescents have found a space to ask questions and receive confidential advise and there is evidence of youth run mental health networks also using digital platforms. However, there are dangers that using digital technologies can exacerbate digital divides, that they can also lead to mental distress and anxiety caused also by online harassment, abuse or exposure to disturbing or otherwise unwanted content, and that face-to-face interaction remains critical.

Therefore combining digital and non-digital solutions is critical, drawing on existing evidence of what has worked. Amongst other things approaches and interventions need to be co-created and co-designed with end users – adolescents in the case. They also need to involve important others in the lives of adolescents including parents and teachers. Approaches need to be creative and fun to stimulate interest and engagement; they need to be context specific including in relation to the digital environment and gendered realities; and they need to build on existing platforms such as schools or other community based institutions.

4. What experience and lessons can we learn from COVID-19 on the prevention and management of mental health problems?

On the positive side COVID-19 has raised awareness on mental health issues globally, highlighting how school closures, online learning and isolation can be key drivers of mental ill-health including in countries such as Tanzania and Vietnam. It is hoped that this heightened awareness will continue and be followed by adequate and appropriately resourced policies and programmes in high, middle and low-income countries. Lessons which COVID-19 have helped to drive home in relation to mental health include: people are affected in different ways according to a range of inter-related factors including age, gender, ethnicity and socio-economic status, hence ‘one size does not fit all’ in terms of mental health related services and programming; that context is critical to both understand the effects of a crisis on mental health but also understanding how to respond to it; and that one needs to go beyond a solely medical approach when addressing mental ill-health which includes understanding and addressing the wider social determinants of mental health.

(Ps: This interview is based on ongoing and previous work on mental health and psychosocial wellbeing in Tanzania, Vietnam and beyond. The authors are currently analysing data and will soon be publishing further findings related to mental health and adolescents in Tanzania and Vietnam, including on the effects of Covid-19. )

Scholars want to look over the journal before it's published. Please inform us when finalizing the draft ~ thanks! Here are the scholars' special responses:Find attached my responses to your questions. It’s longer than 450 words since it’s difficult to respond to your great questions in less words. But feel free to edit it, though I would be grateful to have a look at it before you publish if you do edit it. As you will see, the style is a bit chatty as I assume it’s more of an interview style than academic writing, I hope that’s ok. As you will see, I’ve included links in the text to mental health related work. I’m not sure how you intend to foreground the piece. But perhaps you could mention that this is based on ongoing and previous work on mental health and psychosocial wellbeing in Tanzania, Vietnam and beyond and that we are currently analysing data and will soon be publishing further findings related to mental health and adolescents in Tanzania and Vietnam, including on the effects of Covid-19. Or something like that?

Editor Assistant Research Fellow: Xianglin Gu

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