Promoting good mental health in children and young adults

To help countries close policy gaps and put promotion and prevention at the forefront of their mental health approach, the OECD has identified1 and assessed 11 candidate best practice interventions that promote good mental health and prevent mental ill-health in children and young adults (Table 1). These interventions cut across five domains including school-based implementation, training front-line actors (e.g. parents, teachers, social workers), increasing mental health literacy and addressing stigma, facilitating access to low-threshold mental health support, and preventing suicide.

Applied effectively, and broadly, these best practice interventions have the potential to transform the mental resilience and mental health outcomes of young people across European countries. These interventions have been shown to positively affect child mental health, and school-related and occupational outcomes, from infancy to young adulthood.

Good maternal mental health is a major predictor of mental health of infants and children. Maternal post-partum depression (PPD) has been associated with increased childhood morbidity and mortality, as well as lasting consequences on cognitive and social-emotional development. Next Stop: Mum is a PPD screening programme from Poland which supports perinatal and maternal health, with indirect benefits for children’s mental health. Next Stop: Mum aims to inform women about PPD and train midwives to screen for PPD in perinatal women and refer those with higher risk for psychological consultations. Research indicates that receiving a PPD diagnosis is associated with a reduced risk of depression within a year after childbirth (O’Connor et al., 2016[25]), suggesting the potential of programmes such as Next Stop: Mum to prevent mental health issues. By enhancing perinatal and maternal health, the programme indirectly benefits children’s mental health.

School-based programmes with a focus on social and emotional learning and support can improve prosocial behaviour and reduce dropout from learning and training. They also help children navigate the challenges through adolescence and into adulthood. This is me and Zippy’s friends, teach essential skills to manage emotional and mental problems, and provide solutions to mental health problems. The universal design of school-based interventions can reach individuals from different socio-economic backgrounds and those at higher risk who may not seek help. Zippy’s Friends is a multi-country social and emotional learning programme for school-based children aged 5‑7 years. The programme reduced oppositional behaviour by 9%, reduced social isolation by 15%, and improved social and emotional skills including for children with low socio-economic backgrounds.

School-based interventions can be combined with online or off-site approaches. This is Me from Slovenia encompasses an online information and counselling service (#Tosemjaz) available at any time and at no cost for adolescents with mental distress; and a school-based workshop programme that teaches social-emotional competencies for successful psychosocial adaptation. The programme reaches 180 000 unique visitors per year and has been found to reduce interpersonal difficulties by 4% and to improve the overall classroom climate. Icehearts in Finland uses team sports to provide long-term mentoring support to socially vulnerable children and adolescents. The programme improved prosocial behaviour amongst 49% of participants and reduced the number of young people out of education, training or employment by 50%.

Peer-based programmes, involving front-line actors who are not mental health professionals, help improve mental health literacy and destigmatise seeking mental health support. While treatment of mental illnesses should remain with healthcare professionals, these programmes can help lift the taboo regarding mental ill-health, and can encourage people to seek help. Reducing the stigma of mental health helps young people discuss their own emotions and needs – a protective factor for mental health – making them more likely to seek help when needed. @Ease are walk-in centres in the Netherlands where young people who experience mental distress can come, seek help and talk with a young adult peer. The young peers are trained and supervised by a healthcare professional on site. @Ease has been found to improve social functioning by 6%, reduce mental distress by 19%, and reduce school dropout by 61% between the first and third visit. Mental Health First Aid (MHFA) is a multi-country training programme that teaches front-line actors, including parents, teachers, and social workers, how to recognise, understand and help someone experiencing mental distress or a crisis. MHFA was found to increase mental health literacy, helping-behaviour and confidence in helping people with mental health problems.

In Belgium, access to psychological support for children is now easier, faster, and free thanks to a major mental health reform initiated in 2009. The country created multidisciplinary mental health networks, including 11 networks for people under 24, offering rapid and free access to psychologists. Reimbursement is now available for 8 consultations for low-threshold support and up to 20 consultations for specialised treatment per patient per year, a crucial step given that nearly 40% of users (of all ages) report that they have previously foregone treatment due to its cost. Across all ages, these multidisciplinary networks have been found to reduce by 10% the prevalence of mental health disorders and by 60% the number of absence days after six months.

Teleconsultation and online tools offer the potential for greater reach and may be perceived as offering greater confidentiality by patients. For instance, the Prompt Mental Health Care (PMHC) from Norway uses teleconsultations to facilitate access for individuals with mild to moderate symptoms. Additionally, online services can increase the coverage and reduce waiting times. Evidence from Next Stop: Mum show that the intervention’s coverage doubled from 5% to 10% when face‑to-face deployment was supplemented with virtual interventions. Similarly, the I Fight Depression® (iFD) online tool – which has a dedicated version for young people with less formal language and specific workshops on social relationships and social anxiety – provides early support to patients by making available information and exercises to address mental health challenges, while the patient waits for an appointment with a professional.

Suicide Prevention Austria (SUPRA) is a national strategy for suicide prevention, including a gatekeeper programme (e.g. front-line actors trained to listen to people at risk of suicide and provide essential support), safeguarding hotspots for suicide attempts (e.g. bridges, railways), and reducing access to means of suicide (e.g. firearms, substances). SUPRA includes actions on crisis management and suicide prevention in school-based programmes related to addiction and violence. The programme also aims to inform policy makers nationwide about these actions targeting children and young people.

VigilanS is a suicide reiteration prevention programme in France that maintains contact with patients after they are discharged from hospital following a suicide attempt. The programme has been shown to reduce reiteration of suicide attempts by 24% within one year. VigilanS Ado, a version specifically for children and adolescents, offers tailored support through earlier phone calls after discharge and includes text messaging as an additional communication tool.