Strengthening the Knowledge Base for Youth Mental Health in ASEAN
By Cameron Tan
Abstract
Youth mental health is an increasingly important priority area within ASEAN, with the youth constituting a significant third of the region's population. The World Health Organization highlights alarming rates of suicide attempts among adolescents, with numerous national and regional dialogues emphasizing the urgent need for strengthened mental health support. This op-ed underscores the pressing need to prioritize and invest in strengthening the regional knowledge base to foster a healthier future for youth mental health in ASEAN.
Introduction
Youth mental health is an increasingly important priority area within the Association of Southeast Asian Nations (ASEAN). The ASEAN youth population comprises 213 million individuals aged 15-34, constituting a third of ASEAN’s population (ASEAN Secretariat, 2020). The emerging discourse on youth mental health has been spotlighted at national and regional dialogues, signalling an impetus for greater efforts to strengthen mental health support in the region. This op-ed underscores the pressing need to prioritize and invest in strengthening the regional knowledge base to foster a healthier future for youth mental health in ASEAN.
The Current Landscape of Youth Mental Health
The World Health Organization (WHO) defines mental health as more than the absence of mental disorders. It is also a state of well-being in which the individual is able to realize his or her own abilities, cope with the normal stresses of life, work productively and fruitfully, and contribute to his or her community. A person’s mental health may be affected by multiple interrelated social, psychological and biological factors (WHO, 2007).
Globally, mental health issues constitute a major burden of disease for young people due to psychological distress and disorders such as anxiety and depression (WHO, 2020). The onset of mental ill-health peaks in adolescence and early adulthood – 50% of mental ill-health begins by age 14 and 75% by 24 years (Kessler et al., 2007). These issues are compounded by a lack of services and programs both to promote young people’s mental health and to prevent mental illness (UNICEF, 2021). In line with the United Nations Sustainable Development Goal 3 on Good Health and Well-being, it is therefore essential to improve early identification and intervention to mitigate the resultant risks of poor mental health for youths.
In particular, there is an urgent need to tackle the high prevalence of poor mental health in the ASEAN region. A study on ASEAN youth mental health by the WHO found that suicide and self-harm pose the second greatest threat to mortality after road accidents, with almost one in eight adolescents reportedly attempting suicide one or more times in the past year (WHO, 2017). Furthermore, a systematic review of the mental health of university students in ASEAN found that the prevalence of mental health problems among university students in ASEAN countries was staggeringly high. Depression and anxiety were the most prominent problems, with their median point prevalence being 29.4% and 42.4% respectively (Dessauvagie, 2022).
Crucially, the COVID-19 pandemic triggered a 25% increase in the prevalence of depression and anxiety globally, with young people being disproportionally at risk of suicidal and self-harming behaviours (WHO, 2022). According to the Global Survey on Youth and COVID-19 by the International Labour Organization (2020), more than 40% of respondents representing Asian countries, including ASEAN member states, were affected by symptoms of anxiety or depression. Collectively, these statistics highlight the pressing need for greater prioritization of youth mental health in ASEAN.
Knowledge Gaps as a Key Barrier to Address Youth Mental Health
Efforts have been made to map out and address mental health at a regional level such as the Policy Brief on ASEAN Mental Health by the ASEAN Task Force on Mental Health (2013), ASEAN Mental Health Systems report (2016), and ASEAN Plus Three Leaders' Statement on Cooperation on Mental Health Amongst Adolescents and Young (2021). However, numerous scholars have critiqued that many ASEAN countries lack mental health legislation, effective policies, and strategic plans to address mental health needs across communities and for specific populations, particularly young people (Anwar & Thamarangsi, 2017; Chong et al., 2016; Maddock et al., 2021).
The ASEAN Youth Development Index 2022 highlights a significant gap in mental health data availability. This gap includes the lack of data collection mechanisms and the lack of knowledge sharing platforms between research, policies, and practice (Maddock et al., 2021). This gap is particularly noticeable in lower- and middle-income countries like ASEAN, where access to evidence-based information and research capacity building is limited (Lavis, 2009; Niessin et al., 2000). The ASEAN Secretariat has recognized this gap and sought to address it in the ASEAN Work Plan on Youth 2021-2025. Under the Health and Wellbeing Priority Area, they sought to provide access to data and information on youth mental health, but the effects of these policies are yet to be seen.
The uncertainties arising from these knowledge gaps can be categorized according to the needs to (1) understand psychological and social complexities, (2) ensure cultural relevance of interventions, (3) map community and system needs, and (4) evaluate effectiveness of interventions.
Understand Psychological and Social Complexities
Youth mental health distress and disorders often stem from a complex interplay of intricate factors such as social, environmental, political, and economic conditions and stressors (WHO, 2017). Furthermore, there is a notable absence of data on these factors, especially concerning youth in East Asia and the Pacific, highlighting an urgent need for in-depth research to inform strategies and interventions that promote the mental well-being of youth (UNICEF & Burnet Institute, 2022).
Ensure Cultural Relevance of Interventions
Culturally appropriate psychological and social interventions are crucial to establishing effective and accessible mental health systems in ASEAN (Maramis et al., 2011). Experts have criticized international services for their lack of cultural sensitivity and integration with local communities (Seponski et al., 2014). Moreover, most mental health interventions such as Cognitive Behavioral Therapy were developed in high-income Western countries. This potentially reduces their effectiveness in Southeast Asia due to cultural variations in expressions of emotional distress (Ballenger et al., 2001; Lutz, 1985).
Map Community and System Needs
According to the ASEAN Mental Health Systems report (2016), substantial disparities exist between the existing mental healthcare provisions and the actual needs within both communities and the broader healthcare system. Comprehensive data on mental healthcare is indispensable in policymaking and enhancing service quality (Lora et al., 2017). It aids in evaluating treatment outcomes, departmental efficiency, policy effectiveness, care quality, and resource transparency. Unfortunately, the lack of comprehensive data collection and analysis hampers rational planning, quality improvement, and accountability in mental healthcare (Coton et al., 2008; Lora et al., 2017).
Evaluate Effectiveness of Interventions
A systematic review of 32 randomized controlled trials for psychological and social interventions for mental health in ASEAN revealed that there was generally insufficient evidence in the literature to determine the effectiveness of most interventions (Kumar et al., 2020). The authors posit that further extensive research, particularly high-quality and large-scale randomized controlled trials, is necessary in ASEAN to determine the effectiveness of mental health interventions for specific individuals and disorders.
To address the uncertainties above, it is thus essential to bridge policy gaps by strengthening information systems and advancing youth mental health research in ASEAN (Kumar et al., 2020).
Strengthening Mental Health Information Systems
A practical recommendation to enhance data availability and access to youth mental health in ASEAN is to strengthen the regional Mental Health Information System.
The WHO defines a Mental Health Information System as a sustainable system that collects, processes, analyzes, disseminates, and utilizes information about mental health services and the mental health needs of a population (WHO, 2005). This is a crucial building block of the monitoring and evaluation of health systems, aiding in informed decision-making and effective governance (WHO, 2011).
In the context of youth mental health in ASEAN, strengthening the Mental Health Information System involves five key components as outlined by Lora et al. (2017):
1. Collection: Gathering information from various mental health facilities and related health subsystems, including primary care and non-health-related services (such as social services). This should include participatory and co-design methodologies to elicit youth perspectives, thereby engendering greater accuracy and relevance of research and policies.
2. Transmission: Moving data from collection points to central collation areas for preparation and analysis. In addition to a centralised database, this component should include a harmonization of dataset measures and indicators between countries.
3. Analysis: Studying and examining the collected data to derive meaningful insights and trends related to youth mental health. This should include sense-making sessions with youths to gain insights into the contextual applications of such findings.
4. Dissemination: Communicating the analyzed results to all stakeholders, including the general public, ensuring transparency and accountability. Making information publicly available through interactive databases empowers stakeholders and promotes service democratization. This parallels the ASEAN Mental Health Systems Report 2016 and the WHO Mental Health Atlas 2020, which is released every three years.
5. Use: Applying the results derived from the Mental Health Information System analysis to enhance planning, service development, service delivery, and monitoring and evaluation in the context of youth mental health. This can include regional workshops for knowledge sharing.
A key enabler for the strengthening of the regional Mental Health Information System is the adoption of the Paro Declaration in September 2022. It underscores the commitment of WHO South-East Asia Region member countries to Universal Access to People-centered Mental Health Care and Services. Furthermore, one of their next steps includes the establishment of a regional knowledge and training hub to coordinate evidence and data generation. This collaborative effort aims to foster a conducive environment for the sharing of best practices, knowledge, and resources. Thus, this presents a timely opportunity for youth mental health since the regional hub can enhance data gathering and reporting, conduct implementation research, and monitor performance to ensure context-sensitive improvements in youth mental health systems in ASEAN.
The regional hub can build on existing mental health research in ASEAN that has been used to inform national policy (Chong et al., 2012), government investment (Rajkumar, 2022), intervention evaluation (Nguyen et al., 2018), knowledge translation (Kelley et al., 2015), and stakeholder engagement (Stockwell et al., 2015). These examples emphasize how data generation and synthesis facilitate evidence-based decision-making, improve service delivery, and enhance mental health outcomes (Sharon et al., 2017; Shekhar, 2006). Therefore, these studies should be adapted in the context of youth mental health to strengthen research capabilities and knowledge sharing within ASEAN.
By incorporating the above components and aligning them with the Paro Declaration, policymakers, healthcare providers, and communities in ASEAN are empowered to make more informed decisions. This creates immense opportunities for more salient interventions and funding, thereby enabling a whole-of-society approach to contribute to a more comprehensive and responsive mental health system for youths in ASEAN.
The Road Ahead
In conclusion, youth mental health in ASEAN is a critical concern that demands regional attention and action. It is evident that strengthening the Mental Health Information System in ASEAN is a fundamental step towards building a stronger knowledge base for youth mental health. By prioritizing youth mental health through collaborative and comprehensive research efforts, ASEAN countries would be better positioned to bridge the gap between research findings, policy formulation, and practical implementation. Overall, strengthening the knowledge base for youth mental health contributes to our collective responsibility to create a brighter and healthier future for youths in ASEAN.
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