Using the World Health Organization's 4S-Framework to Strengthen National Strategies, Policies and Services to Address Mental Health Problems in Adolescents in Resource-Constrained Settings

Abstract

BackgroundMost adolescents live in resource-constrained countries and their mental health has been less well recognised than other aspects of their health. The World Health Organization's 4-S Framework provides a structure for national initiatives to improve adolescent health through: gathering and using strategic information; developing evidence-informed policies; scaling up provision and use of health services; and strengthening linkages with other government sectors. The aim of this paper is to discuss how the findings of a recent systematic review of mental health problems in adolescents in resource-constrained settings might be applied using the 4-S Framework.MethodAnalysis of the implications of the findings of a systematic search of the English-language literature for national strategies, policies, services and cross-sectoral linkages to improve the mental health of adolescents in resource-constrained settings.ResultsData are available for only 33/112 [29%] resource-constrained countries, but in all where data are available, non-psychotic mental health problems in adolescents are identifiable, prevalent and associated with reduced quality of life, impaired participation and compromised development. In the absence of evidence about effective interventions in these settings expert opinion is that a broad public policy response which addresses direct strategies for prevention, early intervention and treatment; health service and health workforce requirements; social inclusion of marginalised groups of adolescents; and specific education is required. Specific endorsed strategies include public education, parent education, training for teachers and primary healthcare workers, psycho-educational curricula, identification through periodic screening of the most vulnerable and referral for care, and the availability of counsellors or other identified trained staff members in schools from whom adolescents can seek assistance for personal, peer and family relationship problems.ConclusionThe predominant endorsed action is not that dedicated mental health services for adolescents are required, but that mental health care should be integrated using cross-sectoral strategies into the communities in which adolescents live, the institutions they attend and the organisations in which they participate.

The prevalence of mental health problems in sub-Saharan adolescents: A systematic review

“…Overall, the prevalence rates reported for sub-Saharan adolescents in this review are high in comparison with studies from European countries and the USA [ 60 – 62 ] and other reviews of adolescent mental health problems in resource-constrained settings [ 5 , 7 , 13 , 63 – 65 ]. However, reviews by Cortina et al [ 13 ] and Kieling et al [ 5 ] included younger participants aged 0 to 16 years, whereas this review focused on adolescence, a typical age of onset and manifestation of mental health disorders [ 66 , 67 ].…”

“…Globally, females are more frequently exposed to risk factors, such as gender discrimination, exposure to violence and sexual abuse, and more frequently affected by internalizing mental health disorders [ 65 , 66 ]. Furthermore, the majority of studies included utilised screening tools, which have been shown to overestimate prevalence rates compared to diagnostic interviews [ 13 , 67 ].…”

The prevalence of mental health problems in sub-Saharan adolescents living with HIV: a systematic review

“…In the African context, data on adolescent mental health is scarce and capacities for mental health care are limited, as is the case in many low-income settings (Fisher and Cabral de Mello, 2011 ; Erskine et al ., 2017 ; WHO, 2018 ; UNICEF, 2018c ). Regarding the mental health of HIV-positive adolescents in sub-Saharan Africa, numerous studies have been published in recent years (Kamau et al ., 2012 ; Louw et al ., 2016 ; Lwidiko et al ., 2018 ; Hoare et al ., 2019 ; West et al ., 2019 ).…”

Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities

“…Unlike other health system strengthening strategies which are disease-specific [ 13 ] or narrow [ 14 – 16 ], the WHO’s health system framework intends to improve the overall health in a responsive, financially fair and most efficient way [ 11 ]. Evidences revealed that the framework helps to assess in-country healthcare performances [ 17 ], interactions between health reforms and country health systems [ 18 ], implications of health sector reforms [ 19 ], and the status of health facilities [ 20 ] and specific health problems [ 21 ].…”