Home Trends Leveraging South-South and triangular cooperation in Advancing Child and Adolescent Mental Health

Leveraging South-South and triangular cooperation in Advancing Child and Adolescent Mental Health

by smart

colleagues i welcome you to the webinar leveraging south south and triangular cooperation in advancing child and adolescent mental health in the context of a coveted 19. i welcome you all very dearly to what i am sure will be a very fascinating exchange and as you know mental health is one of the most neglected areas of the sdgs in reference to good health and well-being and covet 19 made this worse making the provision of mental health and psychosocial support services an urgent priority for all populations especially vulnerable groups and this affects children young people and their families governments with their partners are implementing different approaches covering different policies programs and a range of services to mainstream support to mental health much can be learned from each other including through south-south and triangular cooperation amongst countries which could scale up good practices and increase access to technical assistance and catalytic resources this webinar is called organized by the world health organization by pajo the pan-american health organization and the international policy center for inclusive growth and it is part of a serious showcasing solutions and experiences in countries of different areas of the sdgs in the context of covet 19. unicef supports south south and triangular cooperation especially in the areas of education nutrition and response to covet 19. we will have a very exciting panel today and we will have first a an initial presentation of 10 minutes by dr batul fatima the technical officer of the department of mental health and substance use from who and he will provide the context and after that we will hear three country cases very specifically addressing these issues from iran argentina and china respectively i will be introducing the speakers as we get to that moment and that each one of these case studies will run for 15 minutes and at the end dr hennis the director of department of in in the non-communicable diseases and mental health from paho will make some concluding remarks in wrapping up our discussion so um i will be your moderator for the session and my name is andres franco i am the deputy director for the public partnerships division i lead on all the multilateral engagements and partnerships and the south south corporation portfolio and triangular cooperation portfolio with my colleague martha and jiha who are connected today are part of the portfolio that i’m accountable for in unicef so i welcome you very much just make sure that if you have any questions during the session that you place these in the question and answer session and we will address them as we go so i think we’re ready to go and just so that you know the interpretation you can click on the icon interpretation for a specific interpretation in in spanish and in chinese and some segments of the webinar so i think we should uh go ahead with our first speaker um this is dr batul fatima from the department of mental health and substance use from the wo and her resume is there and i think we have in her a great asset to bring to us the right context for this succession so dr fatima i’m going to give you the floor to launch the discussion go ahead dr fatima thank you dr andre franco and good morning good evening uh good afternoon everyone um it’s nice uh talking to you all so today i’m going to talk about child in adolescent mental health situation in the context of poverty 19 response and some recommendations next slide please so we all know that a lot of mental health conditions start quite early at the age of 14 before the age of 14 50 percent of the mental health condition start and three-third of the mental health disorders or problems start by the age of 24 and this all starts very early in the life so the children the age of childhood and the adolescence is really a critical time when we can support children who have healthy mental health and we can prevent a lot of mental health conditions from developing the povert 19 has really affected everyone but when it comes to children and adolescents it has really badly hit them with curtailed education we know for long schools colleges and universities have been closed diminished job prospects for the young adult sons in reduced social contacts with their peers and the data suggests that 1.58 billion learners which is over 90 percent of the world student population is affected by national closures 40.4 of the youth have a tendency to have psychological problems during forward 19 which is also shown by recent data next slide please further data that has been collected and shows us that it has really increased a lot of fear and anxiety in children and adolescents uh as children were afraid that uh if they go back to school there will still be virus and infection around 44 percent fell that they only you know they don’t have much information about it and only one third were able to correctly uh know how overweight is spread uh 38 felt that worst situation is still yet to come so there is a lot of fear and anxiety and this fear and anxiety is affecting them in many ways as we see in the graph on the right hand um children are feeling lonely because of not being able to meet with their fears they are feeling nervous they are feeling restless they are irritable and they have a difficulty in concentrating next slide please and when we asked young people directly as to what concerns them most about the uh this pandemic ongoing pendant they had concerns about physical health and housing and education and everything but most important thing which they highlighted was their mental health they themselves reported that they were most concerned about their own mental health next slide please so this is the situation and what will happen if we don’t do anything the consequences of not taking action are really huge uh we already know that the global economic burden of non-communicable diseases are huge so 35 of the burden is because of mental health um so if we don’t take action right now if we don’t support children and adolescents we expect reduced learning capacity um and future work disability future lost in earnings time of work reduced productivity both in studies and working um we know that a suicide date in people with depression and anxiety is higher so we kind you can lose lives and further psychological hardship and carer burden uh burden on health sector due to increased health care cost of physical and mental health care increased cost of social welfare and disability costs and we know that young people with the mental health issues are eight times more likely to have contact with criminal criminal and justice services so not only is increased service costs but but also likelihood of children getting involved into trouble for various reasons next slide please so what we need to do is mental health for all we need to ensure greater investment greater access for everyone and everywhere we need to ask what we are doing to support young people we need to make investment to change challenges into opportunity because we know that there is a high cost of not taking action and we need to uh and we know that return on investment for every uh uh uh seven and seven point five dollar is for every dollar especially if you spend one dollar we get the return of seven point five dollars uh i’m turning off my video because i’m hearing that the audio is not very great might be due to internet issues next slide please so when we hear voices of young people uh people tell what they are going through and what they want so children tell us that i’m sick and tired of having to wish them to understand anything to stop cutting funding and they’re talking about funding from mental health which which is they’re asking for further investment in mental health children are seeing that i wish they understood how important mental health is during and after this time so not just during this time but we need to continue supporting our young people all the way next slide please you have five minutes dr fatima yeah that’s why i’m not reading all the comments uh so there are a lot of comments that we know so we have a lot of resources for children and adolescents that we have developed from who and in partnership with unicef that can be used by uh it’s currently used heavily by our partners and member states so we have resources like doing what matters in time of the stress it’s an illustrative guide which has even audios of relaxations available very helpful for young people and adolescents we have questions and answers for adolescents youth and young people we have fact sheets small tip sheets my hero is use a very popular study uh story story which has been translated almost like so um every country in the world like almost so many countries in the world it’s available in braille it’s available in digital it’s available in video format so it has been widely very widely used and we have many guidelines also available next slide please so we have provided framework for reopening schools so that the schools can be made safe and secure for the young children we have provided tip sheets and guidelines for the parents and teachers how they can support children and it’s how children can be protected thanks next slide please we are also developing ease which is early dollars and skills for emotions target population is young adult since 10 to 14 years and it is for children who are highly distressed and have some impaired functioning this can be used by caregivers and uh it’s a community-based manualized psychosocial intervention and trained and supervised non-specialists can use it over a weekly session and it has been it’s been currently tested in jordan lebanon pakistan and tanzania and will soon be available for wider use for other countries as well next slide please we are also developing uh stars which is sustainable technology for adolescents to reduce the stress so this care this is uh technology based uh artificial intelligence has been used so adolescence young children can use it by themselves they don’t have to go anywhere it will be available easily on their parts um so that’s the effort so that in countries where there are not many service providers available internet is available so young people and adolescents can use it next slide please uh who and unicef has uh recently developed and provided head products uh which which includes guidelines on mental health promoter and preventive interventions uh had tweeted a teacher’s guide and a story a magnification me and friends which is the first comic and there will be further comics coming up uh which is uh which can be used by teachers in their schools very easy to use comics based it’s very interesting next slide please so the strategies mentioned in the helping community actually works around all the various factors around individual family community and societies and provides guidance for countries and people working on it to implement an enforcement policies and laws provide environment to promote and protect adolescent mental health provide caregiver support and adolescent psychosocial interventions to enhance programming for adolescent mental health promotion and protection so this is a very useful uh dollars and five toolkit which i would suggest countries to look at and use it for the to help the prevention and promotion and reducing the risk factors for children and the policies next slide please so these are a few resources but i would really encourage you to look at our website both nsf and whoa uh websites we have tons of resources available and we are continuously engaging with young people uh and developing further our products for the comic guides so within this brief time period i can only uh share these indeed really happy to take questions and share further about these things thank you for your efforts that you are making thanks everyone thank you so much uh for that uh presentation there was a little buzz in your mic but i think we could follow your key messages very well so um we will get back to you later in the question and answer session so thank you very much i think this really provides a fantastic context for our first presentation so now we’re going to travel to iran and i’m really pleased to introduce to you dr amahab hajabi he is he has been acting as the director general of the department for mental health and substance abuse in the ministry of health since 2013 and has a very very outstanding trajectory in these issues so uh we are really eager to hear from you dr hajeri you have the floor thank you uh hello everyone uh um in this session i would like uh to introduce some of the activities uh of the mental health department for children and adolescents in ministry of health in iran basically had the maintenance and promotion of the mental health of children and adolescents has always been considered as one of the main field of work in the department for mental health and this department has always been performing various activities in this field the kobe 19 pandemic which started in march 2020 highlighted the necessity of paying attention to this issue evidence shows that children and adolescents in emergency situations such as this pandemic are more vulnerable regarding mental health issues a few activities have been designed in our department and have been integrated in primary health care system these programs are routinely reviewed and sometimes redesigned according to the emerging needs of the target groups for instance parenting skills training program for parents of children and adolescents life skills training program tailored to target age group program for prevention and management of child men treatment which has been integrated in the primary health care system and we have also implemented some activities in collaboration with other sectors of ministry of health and other governmental organizations such as the ministry of education one of these programs is the school mental health program in this program we are trying to promote and maintain the mental health of students in school sitting parenting a business slide and parenting a skills uh training program are the group of activities uh that uh strengthening the existing parenting abilities and promote the development of new competencies so that parents have the knowledge and skills needed to carry out child rearing support responsibilities and provide their children with experiences and opportunities that promote child learning in our system this group of interventions consist of parenting skills training for children two to twelve years old parenting skills for adolescents 12 to 17 years old parenting is listening for high risk adolescents aged 12 to 17 years old and parenting counseling in the covet 19 pandemic situation as you know uh the covet 19 pandemic led to an increase in the times that children spend at home with their parents this poses a risk for more conflicts or problems between them and in this program we aim to enhance the skills of parents for the management of emotional and behavioral reactions of children and adolescents uh in this program the counselor tries to create a positive relationship with parents and assess the reasons for attendance and then offer counseling and recommendation and if needed the counselors refer the cases to emergency settings please next slide a life skills training forum programs are another group of activities that seek to build capacity of individuals to make decision and take actions that positively impacted their lives and the lives of those around them and in our field uh these programs include uh life skills training for children six to twelve years old life is concerning for a dollar since 13 to 18 years and behavioral counseling for lowering risk in adolescence the last program in this slide i mean behavioral counseling for lowering risk in adolescence has some objectives such as screening and detection of risky behaviors determining different level of risk and preventing of risky behavior and vulnerable abundances and finally eliminating of risky behavior in adolescence please next child mal treatment prevention is another program which has been integrated in primary health care system and the main activities performed in this program are initial screening of all children who are receiving the routine health care services as such as vaccination and if the initial assessment be positive the complimentary screening for child maltreatment uh is being done by the mental health staff in our system the mental health staff is a clinical psychologist with a master degree other interventions include providing psychological services for families providing medical services for traumatized children if needed assessment of the parents by the general practitioners for any possible mental disorders and also providing medical treatment in case of diagnosis of any psychiatric disorders please next the esco mental health program is another intervention one a year prior to the beginning of the covet 19 pandemic a joint program was designed between the ministry of health and the ministry of education uh with the primary objective of maintaining and promoting the mental health of students in school setting in this pilot program the main target as was increasing teachers knowledge on psychological aspects of a child development and also we try to improve that identification of mental health problems among students and differentiate them from normal range behavior and effective initial intervention for a variety of mental health problems with emphasis on preventing in current in current interventions by teachers and a referral of cases with psychiatric disorders for especially interventions and identifications of emergencies such as suicide among school children until here i have given a brief presentation about the activities related to mental health of children and adolescents in the previous slide and now i wanted to point out the two of the challenges we faced during the cubit 19 pandemic one of the main challenges was the temporary cessation of some of the integrated mental health program related to children and adolescents and the other challenge was related to the school mental health pilot program regarding the integrated mental health programs we face the following challenges such as in the health system parents children and adolescents who were the target group of these programs did not go to health centers uh due to anxiety and warwick house by the whites training services which were mainly group training sessions were either not held or the frequency of sessions was significantly reduced their routine established method of service delivery has been somewhat disrupted next please doctor you have five minutes please continue we designed some activities to overcome these challenges for example various tuning packages were developed for capacity building among the mental health staff in the primary health care system to provide psychosocial support for the general population and in this way needs of children and adolescents and also their parents in the kobit 19 pandemic were considered as one of the main issues in this regard the 4030 helpline a four-digit helpline was launched to provide remote counseling services uh for appropriate uh for approaching the mental health needs of target groups after the establishment of the health line parent could receive remote counseling regarding the mental health of the child such as dealing with anxiety or behavioral problems uh for getting over the challenges that the kuwait 19 pandemic brawled about and for facilitating the capacity building and also easy access to of target groups to training sessions we focus on the new method of training in the new training model the mental health staff who are target group for capacity building is trained using online platform and multimedia tools on the other hand the parents children and adolescents also receive their educational services with the use of a variety of multimedia packages such as short films motion graphics clips and animations next please changing the model of uh capacity building and service provision has been started recently but we predict after the complete establishment of these models it means facilitating public as access of the target groups to the multimedia package we will have some achievements such as the level of service coverage will increase significantly quality of training will be enhanced because in the traditional method face-to-face training and holding qot workshop for training service provider had led to decreased quality of training and some endpoint of training and a service recipient in these new methods can have access to learning packages at any time convenient for them without having no to attend the health centers again and again so the need for booster training sessions will decrease to a great extent and in addition we guess multimedia training packages be more attractive and possibly have the ability to capture more audience the situation in the pre-snakes the situation in the context of uh covet 19 uh led to problem in providing services in the escude mental health pilot project other than that the elimination of the school environment also led to a negative impacts in their children’s mental health and behavior therefore we faced more problems in our students in this regards most challenges were due to the non-attendance of the students and teachers in schools the emergence of online teaching platforms replacing classrooms was also a challenge face to face teaching has been eliminated temporarily and teachers remain unaware of most of the children’s behavior problems and also underprivileged students face financial problem in buying some devices such as tablets and smartphones for continuous of care we changed the mode of intervention in the pilot implementation of school mental health program as follow online training of teachers phone based interventions providing online information cages and a telephone follow-up please next slide and next i don’t have enough time and i uh and the last slide this is the last slide uh okay after you did this using these changes we had some achievement in this adaptive activities such as increased sensitivity of a school staff on mental health issue because mental health became an important topic on top of the mind of school principals and other staff increase awareness of parents towards mental health issue of children parents started to speak about mental health problem of their children and receive consultation uh indeed raising parents awareness reinforced their help-seeking behaviors and uh identification of a student with mental problems or mental disorders uh we faced because it caused a percent of the cases identified in escos to be having mental problems or complain were able to receive psychological and psychiatric services at the end of my presentation i would like to thank a unicef representative in islamic republic of iran for its supportive support and there is a very good collaboration between unicef representative in iran and all of the related stakeholders thank you so much great thank you dr thank you so much for sharing the details of your experience in the in iran i am i i appreciate you know the the results of your policies that you highlighted at the at the end so let’s move uh we’re going now to another part of the world and the this is uh we’re going to go now to dr diliana and sisa and she will make her presentation in spanish so you can have access to the english channel la doctora in argentina in the province of chaco it’s a province that i know really well and she will share with us some of her experiences in her province regarding this topic please remember that you can uh click on the interpretation uh button to listen to the interpretation into english doctor and she said you have 15 minutes and i will remind you when you have five minutes left uh dr and sisa thank you very much and thank you for the space to share um here with you it is a pleasure to be able to share with you uh the lessons learned and the uh experiences in the province of el chaco and the inter-sectoral approach and the impact and the work we did in the case of impact of suicide in adolescence the percentage of um deaths due to external causes in argentina says that uh 10 uh that the second cause of death in adolescence between 10 and 19 years of age is suicide in argentina and the province of el chaco this is also true and it affects mostly males the rate uh the death rate is 16.4 per 100 000 and in el chaco it’s 4.2 we will see in particular that this is a province in the north of argentina where specifically we see the locality where we have been working where we have indigenous populations mostly and there is a large population of a different indigenous group so we have the asp which is the acronym in spanish meaning mandatory preventive social isolation and this was implemented in argentina back in march 2020 and it was to prioritize the care of patients suspected of contracting covet 19 and there were two suicides in a couple a male and female a girl who was not indigenous and a young man who was from the calm indigenous population this was a big impact in the community and the press managed this with great sensationalism and um this was a shock for our community in the town of mina flores which is small 8 000 inhabitants so the because of the mandatory social distances and ice and isolation we had very many marked restrictions uh classes were suspended this generated a negative impact on communication with adolescents on regarding daily nutrition education loss of schools ability to convene and also there was a difficulty by the teachers to maintain communication with the students they also didn’t have their physical activities that they didn’t have communication with the different ethnic languages so what were the responses by the government first of all there was an inter-ministerial working group established with different sectors health education rights protection organizations justice human rights and and also the groups that protect the rights of boys girls and adolescents we were able to establish a working dynamic based on this group given that children weren’t being able to go to class also many of them live in remote locations and they have no internet connection in many cases and this makes difficult any access to by the adolescents there were other suicide attempts there was a great deal of anguish and anxiety given the context and also in these very remote locations mental health services do not exist in the locations themselves in addition there is also the issue of interculturality and the fact that they different indigenous groups speak their own languages and if interpreters are essential to work with some of these indigenous populations and they are not always available so next on the one hand centralized responses were established this is a very important issue to be able to generate an organization in such a large territory so we established uh meetings um with eight months of uh follow-up uh with community leaders we had a meetings um weekly and the meetings would last one and a half hours and also our purpose was to take care of the caretakers we had to obtain consent we had to also obtain participation from the whole community especially led by the teachers so we needed to have a community engagement we also did a joint mapping of training spaces for the treatment of the situation and um we worked with adolescent to the extent that the mandatory isolation policy allowed it and also there was training giving on myths and prejudices relating to a suicide and we received help from experts from other provinces um neighboring provinces of the country who were able to provide their knowledge and generate more community engagement we worked with the teachers i repeat as long as isolation measures were respected and teenagers worked in preparing a form of communication they made a video uh which used um the two languages spanish and com language we also established emergency devices and this is for the communities because they didn’t have mental health services that could be provided so we had comprehensive adolescent health advisor with a community engagement as well the plan is called enia we also had interpreters community interpreters who made sure that all the calm language people could understand and we had um [Music] bi weekly attendance of the population’s mental health requirements in person but whenever they couldn’t attend then they could be supported remotely and we kept on listening to the community the highlights of the achievements uh and what is the progress we’ve had to date so we were able to establish the um object the subjective um risks among the uh adult lessons and so there was the subjective urgency um that needed to be established in times of pandemic when there would be a self-harm and suicide attempts in adolescent we need risk assessment um within the pandemic and we had the dialogue through the work that we did which was through the ad hoc group to develop strategies and factors for community resilience and again we took into account multi-linguism and um the language interpretation for the com language speakers so we established an intersectorial program we had centralized responses but we developed tools to work on prevention and care and in post care so what were the lessons learned from the different tools we used and both the centralized work and the contingency emergency approaches we were able to uh create a set of criteria for centralized responses doing interventions and having a follow-up then developing emergency tools and forms of help also we had ongoing evaluation we had a training based on gender rights and interco culturality and we also had a radio program um in com language and the program was called our hope and here they could speak about their weekly problems talking talking among the community having questions and answers having interviews with key people not only from the community but also guests from outside the community and some experts who came and supported and provide help during the situation so these were the kinds of tools that we have developed that were community centered for communication so the experiences of south-south cooperation and learning with other countries were very important this was very pertinent and there was a collaboration between el chaco province and unicef and an official document was prepared for the province and so it included the recommendations that emerged from the program and we can talk about three major aspects continue with evidence-based work with permanent training transdisciplinary approaches with engagement by the community determining contingencies of emergency throughout the territory and support uh for everyone and um this is um with a view to follow up always thank you very much thank you very much doctor and cecil for your presentation and for sharing your experience in the province of el chaco in argentina now i’m going to switch back to english so we continue and now this time we’re going to travel to china and i am very pleased to introduce to you mr su yanong who joined the youth league committee of education bureau district in beijing in 1989 and since then has quite a very uh interesting trajectory uh which will make uh his presentation very appealing uh to us uh so without further ado i will give the floor to mrs he will be speaking in chinese and we can listen to the interpretation by clicking the icon on interpretation on your foreign good morning good evening mental health worker in china hello is according to data released by the chinese minister of education in august 2020 has two hundred and thirteen thousand education schools one point fifty four million students mental health workers to reduce the adverse effect of the pancreatic adolescence my organization youth legal and mental health service center has long been [Music] and emotional problems represented by anxiety sources of negative emotion pressure from exams [Music] usage of young people and middle school students increased during their home study period somebody managers have helped you with their family members because of playing other games and phones and some students will use school online class online entertainment resulting in lower learning efficiency and from their perspective during that period right now 90 percent of lower grade students are more methods of senior students are more diverse to their parents they also contain mental support through communication teachers mental health experts and counselors to characterize adolescent mental health and good action based on the family for those who made it possible for you more young people to acquire in a timely manner thirdly we provide providing professional assistance to mental health workers in areas severely impacted by the kovis outbreaks and fourth our organization [Music] [Music] [Music] um um more than 10 million chinese youth at the same time during the most severe period of the pandemic in china 3.5 hundred questions and answers are used by the customer was published uh one two three five help desk in 20 provinces across the from january to july 2020 central organized nine minutes individually through one two three five youth mountains across the country provided more than one million times of nervousness and their parents on the internet and telephone also broadcasted mental knowledge to cope with patients in a temporary shelter hospital and we also actively shared an experience theoretical and practical guidance for professional mental health workers in part in the environment offices our center provided more than development specific groups for young people under the pandemic the toolkit toolkit provides detailed methods for identifying and entertaining [Music] um of the people across the country so as the professional mental health institution our constantly closely cooperated with government departments such as the youth league the health commission and the civil affairs ministry work not only our emergency management capacity but also our professional accumulated therefore the training practices into professional foundations are very important and regular school finishing out of the education plays an important role 66.77 percent survey responded this is in line with the general priority on mental health education levels in recent years in china and mental adjustment skills yeah business young people at home study period kind of internet excessively professional mental health workers lack effective study like balanced advice platform to share is and provide technical support especially in the country and i think that young people can attend time and information and services out their mental needs like the president put forward the initiative community to make positive contributions to the fight in the province and promote development and adolescent mental health thank you all thank you very much and for the presentation uh the examples much appreciated um so i think we have some time from questions and i encourage you to place your questions by clicking on the question and answer box and we will try to take it back to the panelists so um i have a couple of questions that have come up and what i’m going to do to the panelists is i am going to present the questions uh slowly to all of you and then i will give you a a couple of minutes to address the question that you feel is more a pertinent to you and so the first uh question and [Music] this coming is uh um on the the definition of a mental health um how do you actually make this definition if it’s with one question or more than one question and i think there could be it would be interesting to hear from countries as well the second question um is how a can we make sure that we are reaching the hardest to reach children and you know and then um of course this can also be a different experience we still have the chinese microphone open thank you very much so the second question is your own thoughts on how can we reach the most vulnerable children for example children that are out of school and so any ideas on how and to reach the hardest to reach are valuably welcome some of the answers have been typed as well in the question and answer but some reflections are useful a third question is on the help lines so um in the case of ha dr hajevi you made a reference to the helpline and in our last presentation from dr shuja noong we also heard about the service help desk and i the question is you’re your reflections on how these helplines are being affected in addressing uh issues of mental health so let me go with these three questions back to the panelists and then we can take it from there so i’m just going to go quickly through the panelists to see what their reflections are and then after that we will see if there are more questions and answers and continue with our final one so i’m going to go exactly in the order of the presentations that we heard so i will begin first with a dr fatima for your initial reflections a couple of minutes dr fatim thank you dr andres um so let’s start with the definition of mental health um so we know that meant what who says that any illness or mental health is not just absence of disease so how we look at mental health is about the individual being comfortable with oneself and being able to realize one potential so it’s it includes emotional health sociological health environmental health so it includes a person’s ability to utilize one’s own potential feel comfortable with oneself and being able to enjoy life being able to pursue goals so it’s not just not having depression or not not just having anxiety but able to use the resources and the potentials a person has and the environment that the society offers to use it for the betterment of society and for the betterment of themselves so it’s kind of a broad application the second question was related to how we can reach hard to reach uh population uh it’s a very important question and it’s uh as you say it’s hard to reach population so because we know that school-based children we reach to the schools and we find them and you know we work and work with them but the children who are not in the schools and other well-known children we need to work through uh community-based societies ngos societies which are working in the communities um so any organizations and community based uh activities that are happening through that we usually work because they usually are able to reach better who are locally working within the communities and they are able to better reach and we sometimes need to develop and provide platform for these children now where they could come and you know stay and spend some time have some social activities uh so engaging them through support they respond to these activities or some other recreational activities so where we can gather them and reach them and provide them some psycho education or other information or services um to develop their social emotional health etc while developing their skills um so that is important yes they are hard to reach but it’s not impossible to reach another uh difficult population which really needs our is the increasing number of migraine population or children in emergencies and humanitarian conflict the numbers are increasing day by day and these children are even more in need because they are uh a lot of them are traumatized already so their mental health is really advanced so we need to reach them into the organizations which are working with them already so we engage with those organizations and to them we release them and provide them the services that that is uh possible for us to provide um can you do a third question i’m sorry i’m missing that no the last question was on the helplines but i think that is more referred to the country experiences right right unless you want to make a comment to it please go ahead uh yeah i mean helplines are definitely helpful for a lot of people especially those who are not able to you know go to the clinics and services uh and they don’t know where to go so helplines and especially in the kind of emergencies specifically for people who are really in the highest stress archery cycle etc so these helplines are really life-saving uh in a lot of cases of abuse so there are a lot of case studies and evidence available that shows a really good utility of these services so i would really encourage countries to provide services where possible thank you okay thank you so let’s go to uh dr hajevi and dr hajevi maybe you can comment you can make a comment of course on the helpline and there would be a there’s also a question in the chat which is a what is the impact of the adolescent mental health on the economies and maybe you can say something in the context of covet 19 in the context of iran so dr hajemi some comments from you thank you first of all i would like to explain some key points about the health line helpline about three weeks after the uh beginning of quit 19 pandemic we started to design a health line with a four-digit uh helpline uh four zero three zero uh for uh better access for all of the people we try to train some clinical psychologists we selected the clinical psychologists uh who had enough experiences for providing counseling for in their experiences in the past and we selected them we trained uh this counselor with some specific packages that we had more frequent complaints from the clients the callers and but when we go ahead we could uh promote our services because our services was dynamic and we change our services based on the requests and requests of the colors and during the time after two or three months we could settle down the most of the complaints we could answer to most of the companies of the colors after about two months and we had the change from anxiety and stress to depression during the time after two months because at the first most of the people face awake and ambiguous phenomenon and as you know this kind of concern cause anxiety and steroids after two or three months most of the people had complained about their depression because they had cancer about the financial problems uh in two or three months we could we had uh in some days uh more than uh ten thousands uh uh contact with the helpline and i think it was a very good uh experiences and after six months we [Music] had an evaluation on the effectiveness and satisfaction of the callers to the health line it was a qualitative research and we did this research and we could get some results and based on these results we could change our services based on the request of the colors thank you very much uh dr khadevi for your answers to this question let me move quickly to dr insisa i think because of the characteristics of el chaco maybe you can also address the question of reaching the unreachable children and then i will move a quickly to dr yano there’s a specific question for him we have about four minutes so i will encourage you doctor and sister to be very succinct thank you very much when we work with multiple sectors we can get to know those organizations that are in remote areas and that are also familiar with the population and they always organize in one way or the other so it is important to respect the organizational dynamics of the population and have clear contact points within the territory so that we can actually reach out to those adolescents that are the most vulnerable let me offer an example we were unable because of communication issues because these individuals did not have cell phones we couldn’t reach to them but the teachers were familiar with that group of adolescents with more than 200 of them who lived in rural areas in they were able to reach out to those adolescents that were in remote areas and they were also able to offer counseling to have a dialogue and that was extremely useful to later on create information that we then took to our weekly discussion tables so we need to supplement working tables so that in turn we can [Music] have those that are in far remote areas to see that they always have a help context and that we can always generate new strategies based on their own needs excellent thank you very much for the answer question for mr chu and there’s a question about the mental health support services for students in school just because school students are back in school and the question is is there any extension of the ad hoc mental health support network after the pandemic so i will give you the floor and you have a couple of minutes so dr shoe foreign thank you very much and thank you for the succinct summary colleagues we’re coming to an end and i think we should now give the floor to our wrap-up speaker we will of course uh answer other questions in writing to colleagues i think we cover them most but those that we didn’t we will make sure that we answer them properly i am very pleased to introduce introduce doctor also who is the director of the department of non-communicable diseases and mental health at paho so dr hennis you have the floor for a final wrap-up and i think we’re totally on time which is actually very good thank you so much um andres franco thank you and um i will keep to time i would like to thank unicef for organizing this important exchange in addition to who um the international policy center for inclusive growth and also for the colleagues from who shared their country experiences from iran dr hajevi argentina doctor and sisa and from china mr jiangnang and for sharing a valuable invaluable experiences now as we have heard um sorry as we have heard um child and adolescent mental health is an issue of critical importance in the region of the americas as it is in the entire world adolescents and youth make up a sizable 30 percent of the population of latin america and the caribbean yet mental health services for this group remains neglected depression and anxiety are among the six leading causes of years of life loss due to disability among young people in the latin american and caribbean sub-region and alcohol and substance use is one of the leading risk factors for disability in recent years the overall adolescent mortality rate in the region has increased with suicide being among the leading causes and in fact suicide is the third highest cause of death among young people aged between 20 and 24 years of age in latin america and the caribbean despite the high burden of child and adolescent mental health problems financial and human resources for child and adolescent mental health are lacking in the americas only around 50 percent of paho countries and territories report having a plan or strategy for child and or adolescent mental health and community and school-based mental health services for children and adolescents are woefully inadequate the covert 19 pandemic has had serious adverse impacts on the mental health and well-being of many people worldwide and in the americas as we have heard we’ve learned about the impacted disruptions to services we learned about the immediate impacts in terms of psychological distress anxiety and depression among others and you also heard about the potential for future consequences and of course the vast gap in terms of servicing needs high rates of stress depression and anxiety have been documented in numerous countries globally as well as in the region of the americas but children and adolescents in particular for whom this time in their lives is characterized by significant physical cognitive and social and emotional growth and development have suffered in unique and profound ways large gaps in learning health care and socialization combined with added risk factors for instability and conflict at home including higher likelihood of domestic violence make the mental health of children and adolescents precarious studies from the region of the americas demonstrate the current mental health struggles that young people are experiencing for example a 2020 unicef pool of more than 8 000 adolescents and young people in latin america in the caribbean found that 27 percent reported feeling anxiety and depression in the previous seven days while the long-term effects of the pandemic and mental health remain to be seen it is likely that even after the cover 19 pandemic is behind us we will be coping with its repercussions on child and adolescent mental health for years to come countries are taking action to address the increased demand for mental health and substance use services during the pandemic but they continue to face barriers particularly related to disruptions in service provision for example 62 percent of countries in the americas reported disruptions services for children and adolescents with mental health conditions or disabilities and 70 reported disruptions to school mental health programs south-south cooperation is an essential tool to effectively and sustainably address shared health challenges achieve common targets and tackle issues of health equity within and across all countries it represents an important opportunity to advance mental health and more specifically child and adolescent health an air which has historically been neglected by traditional development assistance for health now more than ever we must continue to advocate for and strengthen souls cooperation among our countries in order to meet the increased need for mental health services for children and adolescents during and after the pandemic we can also support each other in building back stronger more resilient mental health systems future crises and threats to child and adolescent mental health such as climate change paho is committed to facilitating and fostering south cooperation in child adolescent mental health across sectors and entities as part of the unicef and who joint program paho unicef are currently exploring opportunities to collaborate in the mental health and psychosocial support well-being and development of children and adolescents in the americas this work builds upon recent joint actions on the topic among them they developed a school mental health literacy curriculum for primary school teachers a virtual course in mental health literacy for high school teachers joint webinars as well as youth hangout sessions and the my formula campaign where youth talk about their formula for managing corporate 19. a promising project with pajo colombia and unicef will pilot a minimum mental health and psychosocial support package in humanitarian context which includes intervention for child adolescence the corporate 19 pandemic poses unprecedented threats mental health and well-being of children adolescents if we do not collectively address this crisis no we risk our youth becoming a lost generation held back at a long-term impacts of the pandemic under education physical health and mental health and future economic and social opportunities together we must work together and learn from each other to ensure that all young people make it through this pandemic safely through south and south collaboration and that future generations recover on a health and resilient thank you so much thank you so much for those concluding remarks which really bring full circle to a the the tour we’ve been going through so uh much appreciated i think uh just from my uh perspective a couple of a couple of thoughts and one is that this really tells a story about how um from country to country some of the opportunities and the challenges to address mental health issues adolescents have a number of similarities and this justice provides the justification for more events like the one we’ve done today where we can compare and where we can learn from experiences from failures from things that we can do differently across countries adolescents are adolescents wherever you put them it doesn’t matter where they are and the way of working with them um we can learn from country to country i also think that uh just having uh our colleagues from who empower provide this overall uh picture really puts the right framework for the country by country experiences that we got so i really want to thank all of you for having participated today thank you so much to the organizers and the partners who brought us together you will reserve receive a survey after the webinar just take a couple of minutes and tell us a how we did and how we can do it differently to uh make sure that these are really truly learning experiences for all so um on behalf of all colleagues i just want to wish you a fantastic rest of the day and thank you so much for your participation er today very much thank you to the interpreters who did a fantastic job it’s always hard but well done


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Leveraging South-South and triangular cooperation in Advancing Child and Adolescent Mental Health
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