1. Introduction
1. On 11 February 2021, I tabled,
together with 29 other members of the Assembly, a motion for a resolution
entitled “Taking into consideration the impact of the fight against
the Covid-19 pandemic on the mental health of minors and young adults”
(
Doc. 15223). The motion called on the Parliamentary Assembly to study
the link between the health measures taken during the pandemic and
the increase in psychological disorders among children, adolescents
and young adults and to advise States on the proportionality of restrictive
measures in relation to mental health consequences. The motion was
referred to the Committee on Social Affairs, Health and Sustainable
Development (the committee) for report and I was appointed rapporteur on
12 April 2021.
2. The motion was tabled during a period with strict measures
in place to contain the spread of the virus, and which consequently
had a large impact on the mental health and well-being of people
across the world. However, challenges to the mental health and well-being
of adolescents and young adults were already present before the
pandemic, such as the global financial crisis and its repercussions
(including misguided austerity measures), rising inequalities, high
expectations from society with regard to education, career and establishing
a family, pressure from social media and peers, but also wars, conflicts
and natural disasters. These have all contributed to significant
uncertainties about the future young people and unborn generations can
expect.
Despite pressure from society, the
many crises and turbulent events which have unfolded, there are
few studies on their impact on the mental health and well-being
of young people in general. In fact, the last report adopted by
the Assembly on the issue of mental health and well-being was adopted
in 2005. Thus, I propose to change the title of the report to better
reflect the enlarged focus of the report and the challenges we are
dealing with today.
3. There is no clear age definition of “youth”, but the United
Nations, for statistical purposes defines those persons between
15 and 24 years old as youth, without prejudice to other definitions
by member States. Some specialised agencies include persons up to
the age of 32 in their statistics. The European Steering Committee for
Youth (CDEJ) and the Advisory Council on Youth (CCJ) of the Council
of Europe include persons up to the age of 30. For the purpose of
this report, I have decided to focus on the age group between 15
and 32 years old, an age group that is often forgotten and which
has suffered through a series of turbulent events during critical
years for their development, as described above.
4. In November 2022, I undertook a fact-finding visit to Oslo
(Norway) to learn more about the country’s efforts to lower barriers
to access mental health care, but also the challenges young people
in Norway face with the current system. During the visit, I had
the pleasure to meet with representatives of NGOs, local mental health
care services, the Norwegian Ministry of Health and Care Services,
and the Norwegian Public Health Institute. I also met with two of
colleagues from the Norwegian Delegation to the Assembly, Ms Lisa
Marie Ness Klungland (ALDE) and Mr Morten Wold (EC/DA), for an interesting
exchange of views on the topic. I would like to express my sincere
gratitude to the Secretariat of the Norwegian Delegation who helped
organise my fact-finding visit in short timeframe.
5. On 24 January 2023, the committee held an exchange of views
with Anna Knobbout, member of the CCJ. Anna Knobbout highlighted
the mental health struggles of many peers, in particular trans youth,
who had to wait several years only to have a first session with
a psychologist, also noted that while problems of youth and their
needs were increasing, waiting lists were getting longer, and worried
that this could lead to suicidal thoughts. It was noted that prevention
and including mental health in school curricula was very important, including
by having trauma-informed schools, both for refugees and for youth
in general. Although public acceptance of mental health issues had
improved, Anna Knobbout regretted that mental health was still not considered
on an equal footing with physical health.
6. I believe it is urgent that the Council of Europe member States
address the fault-lines in their health systems and the way they
think about mental health and accelerate efforts to improve the
mental health and well-being of minors and young adults. With the
present report, I aim to formulate some practical policy recommendations
to member States as to how that can be done.
2. The right to mental health
7. Mental health is an integral
and essential component of health. The World Health Organization
(WHO) recognises health as a state of complete physical, mental,
and social well-being. Moreover, it is more than just the absence
of mental health disorders or disabilities. Mental health is “a
state of mental well-being that enables people to cope with the
stresses of life, realise their abilities, learn well and work well
and contribute to their community”.
The increased acknowledgement that
there is no health without mental health, indicates a shift in how
“the right to a standard of living adequate for the health and well-being...”
as enshrined in the Universal Declaration of Human Rights, which
was adopted 75 years ago, is now understood.
8. The International Covenant on Economic, Social and Cultural
Rights provides a legally binding framework for the right of everyone
to the enjoyment of the highest attainable standard of [physical
and] mental health in its Article 12.1. This is complemented by
other United Nations (UN) legal standards, including the Convention
on the Rights of Persons with Disabilities, the Convention on the
Elimination of All Forms of Discrimination against Women, and the
Convention on the Rights of the Child. At the regional level, the
right to protection of health is recognised in Article 11 of the
European Social Charter (ETS No. 35). Consequently, States parties
have an obligation to “respect, protect and fulfil the right to
mental health in national laws, regulations, policies, budgetary
measures, programmes and other initiatives.”
9. The right to mental health is moreover understood as the belief
that all individuals should have access to appropriate and effective
mental health care and support, regardless of their socioeconomic
status or other factors. The Office of the United Nations High Commissioner
for Human Rights (OHCHR) emphasises that the right to mental health
includes access to timely and appropriate mental health care and
treatment. “Good mental health must be defined by the creation of
environments where people can live their lives in dignity in the equitable
pursuit of their full potential.”
It is fundamental to our collective
and individual ability to think, emote, interact with each other,
earn a living, and enjoy life. On this basis, WHO underlines that
the promotion, protection and restoration of mental health should
be regarded as a vital concern of individuals, communities and societies
throughout the world.
10. This new and holistic approach to mental health emerged at
the end of the 20th century and contains
a critical mass of new evidence on the importance of mental health
and the effectiveness of integrated approaches.
The former UN Special Rapporteur
on the right of everyone to the enjoyment of the highest attainable
standard of physical and mental health, Dainius Pūras noted that
we are standing before a unique momentum and opportunity to advance
with regard to improving mental health. Recent efforts by the WHO
and other influential global actors are proof that mental health
is emerging at the international level as a human rights development
imperative. This is supported by the 2030 Agenda for Sustainable
Development where most of the development goals implicate mental
health.
3. Challenges
to the mental health and well-being of adolescents and young adults
3.1. An
age of uncertainties
11. Young people face a world with
multiple crises and much uncertainty. Adolescence is a crucial period for
the development of social and emotional habits that are important
for mental health and well-being. Half of all mental health disorders
in adulthood start by age 14, but most cases are undetected and
untreated.
The consequences of not addressing
adolescent mental health conditions extend to adulthood, impairing
both physical and mental health and limiting opportunities to lead
fulfilling lives as adults. One such challenge can be developmental
changes, as the transition into adulthood can be a time of significant
physical, emotional, and cognitive changes, which can be both overwhelming
and stressful.
12. Adolescents and young adults face a variety of challenges
to their mental health and well-being. The more risk factors young
people are exposed to, the greater the potential impact on mental
health. According to WHO, factors that can contribute to stress
during adolescence include exposure to adversity, pressure to conform
with peers and exploration of identity. Moreover, media influence
and gender norms can exacerbate the disparity between an adolescent’s
lived reality and their perceptions or aspirations for the future.
Difficult living conditions, stigma, discrimination or exclusion,
or lack of access to support and services can negatively impact
the mental health and well-being of young people. These include
young people living in humanitarian emergencies and fragile settings;
young people with chronic illness, autism spectrum disorder, an
intellectual disability or other neurological condition; pregnant
adolescents, adolescent parents, or those in early or forced marriages;
orphans; asylum seekers, refugees, and immigrant children and young
people from minority ethnic or sexual backgrounds or other discriminated
groups.
13. Compared to older generations, young people report more negative
feelings such as losing purpose and motivation in life, often caused
by having to meet never-ending high expectations from society related
to education, work and career path, amongst other things. Moreover,
the lack of involvement of young people in critical decision-making
processes amplifies these feelings. Issues like climate change,
LGBTQI+ rights, socioeconomic inequalities, and racial justice deeply
resonate with them, yet they often find themselves side-lined from
the discussions that shape their own future.
14. Children and young adults in Europe are reported to suffer
more from mental health disorders than their peers in other continents.
In Europe, suicide is sadly the
second leading cause of death among young people. Despite alarming
trends on their mental health and well-being, there are few studies
on the state of mental health specifically for the age group of
15-32 years in our region. In 2021, UNICEF published a report titled
“The State of the World’s Children 2021: On My Mind”
. The report finds that depression
and anxiety are two of the leading causes of illness and disability
among adolescents in Europe. Almost one in five European boys aged
15 to 19 suffer from mental disorders, followed by more than 16%
of girls the same age. However, mental health disorders among children
and young people are often under-reported, due to the stigma around mental
health issues. It is not clear why, in the high-income continent
of Europe, mental disorders contribute a greater percentage to overall
burden, despite evidence-based interventions and comparatively greater financial
capacity to address these issues.
15. There is evidence to suggest that capitalism may be associated
with poor mental health outcomes and that it exacerbates inequities.
Some argue that the competitive
and individualistic nature of capitalism as such can lead to high
levels of stress, anxiety, and depression. The pressure to constantly
strive for success and material wealth can create a sense of never-ending
dissatisfaction and can lead to feelings of inadequacy and failure.
Additionally, the emphasis on individualism and self-sufficiency
within capitalist societies can make it difficult for individuals
to ask for help or support, which can exacerbate mental health issues.
Furthermore, the focus on consumerism and material possessions can
make it difficult for individuals to find meaning and fulfilment
in life, which can lead to feelings of loneliness. Consumerism has
also been linked with increased feelings of depression and anxiety,
emotional and behavioural problems, lower self-esteem, and parent-child conflicts.
16. Studies have also reported on the correlation between the
use of social media and poor mental health. Notably, prolonged daily
usage of social media has been associated with a higher risk of
developing anxiety and depression, as well as body image issues,
disordered eating behaviours, attention problems, feelings of exclusion,
and poor quality of sleep. Additionally, while there is currently
no available medical diagnosis of it, some researchers believe that
excessive social media exposure can lead to brain changes comparable
to an addiction.
17. Use of social media also increases the possibility of young
people being exposed to inappropriate or harmful content, and of
being subjected to cyberbullying or predatory behaviours. Vulnerable
categories of young persons – such as racial or ethnic minorities,
persons with disabilities or members of the LGBTQI+ community –
are also more susceptible to being targeted or accidentally coming
across hate-based content, which can significantly affect their
mental health.
18. Lack of access to affordable healthcare, job insecurity and
poverty can also contribute to poor mental health. Studies show
that young people are over-represented in these statistics. Negative
trends on the labour market disproportionately affect young people,
including by reducing their opportunities for part-time work and work-based
learning for students. Many recent graduates (and students who are
soon to graduate) face difficulties finding and maintaining jobs,
which negatively impacts their well-being and puts them at increased risk
of developing mental health issues throughout the course of their
lives.
19. The climate crisis is another contributing factor to increased
levels of anxiety among young people today. Climate anxiety, or
eco-anxiety, is distress related to worries about the effects of
climate change.
It is not a mental illness, but rather
anxiety rooted in uncertainty about the future and reactions to
a vision of a better future in jeopardy. Nevertheless, its detrimental
effects should not be overlooked – climate anxiety may lead to rumination
and difficulty in sleeping, and have adverse impacts on work, study,
and family relationships.
Additionally, high levels of climate
anxiety are often correlated with high clinical symptoms of depression
and anxiety.
A survey published in the Lancet
Planetary Health in 2021
, revealed that among 10 000 children across
10 countries, more than 50% of them reported feeling sad, anxious,
angry, powerless, helpless, and guilty about climate change. As
many as 45% of the respondents indicated that their feelings regarding
climate change have a negative impact on their daily life and functioning.
20. The impact that the climate crisis may have on young persons’
mental health transcends past climate anxiety: the effects of environmental
disasters increase the already-high levels of uncertainty. Climate
change can affect children’s physical environment, such as their
home or school; parents’ or young adults’ places of work may also
be damaged, as well as livestock and crops, thus leading to economic
instability and, in turn, to a decrease in mental well-being. In
the most nefarious of cases, climate disasters may lead to the forced migration
of families, putting young persons at a higher risk of developing
mental health issues.
Additionally, living
through an environmental disaster is a traumatic experience, which
may leave long-term mental scars on young people.
3.2. The
impact of Covid-19 on the mental health and well-being of adolescents
and young adults
21. According to WHO, in the first
year of the Covid-19 pandemic, global prevalence of anxiety and depression
increased by 25%.
Young people and women were the most
affected. Concerns about mental health conditions have already prompted
90% of countries surveyed to include mental health and psychosocial support
in their Covid-19 response plans, but major gaps remain.
22. A report on the “Impact of Covid-19 on young people in the
EU”, indicates that young people were more likely than older groups
to experience job loss, financial insecurity, and mental health
problems due to the Covid-19 pandemic. Moreover, young people reported
reduced life satisfaction and mental well-being associated with
requirements to stay at home, and disruptions in education.
Overall, the Covid-19 pandemic had
a disproportionate impact on young people’s life satisfaction and
their mental well-being, compared to older groups.
23. At least one in seven children globally have been directly
affected by lockdowns. Key findings from a study conducted by UNICEF
suggest that the pandemic had a substantial negative effect on child
and adolescent mental health, mostly because of rising anxiety related
both to the disease itself and the restrictive public health measures
that were put in place to contain the virus.
Social isolation, disruptions in
daily life, family grief, and uncertainty about the future in the
context of Covid-19 are all factors that put children and adolescents
at higher risk for depression.
24. The economic and social impacts of the pandemic will have
profound consequences for many years to come, resulting in a setback
for the UN Sustainable Development Goals. Findings from a report
by Save the Children show a correlation between income loss and
decreased psychological well-being.
The pandemic tends to
magnify pre-existing social inequalities with respect to access
to quality education, health care, and other services, resulting
in an unequal impact on children and young adults from different
socio-economic backgrounds.
Children living in poverty are more
likely to experience stress due to loss of income in the family.
Unsurprisingly, children living in households that had lost more
than half of their income since the outbreak of Covid-19 reported
a higher level in the increase of negative feelings compared to
children from other households.
25. Moreover, the Covid-19 pandemic has had a devastating effect
on young people with a history of mental health needs, who reported
aggravation of their condition and more difficulties when searching
for help.
The Norwegian Ministry of Health
and Care Services, and the Norwegian Public Health Institute, whose
mission is to produce, summarise and disseminate knowledge to support
good health efforts and healthcare, have observed similar tendencies.
The foundations of lifelong mental health are built in early childhood.
This period is known by the increase in prevalence of many psychological
symptoms and the emergence for the first time of psychological problems.
The hardships of the pandemic severely undermined those foundations.
26. However, not all children and young adults have the same experience
of the pandemic, and thus its impact on their mental health is different.
For example, some young people have reported certain positive aspects
of the pandemic alongside the negative ones, including discovering
oneself, deepening family relationships, and sharing life at a distance.
In
particular, the amount of parental engagement during lockdown has
made a significant impact on children’s wellbeing.
However, the negative impacts of
the pandemic clearly outweigh its positive aspects for most children
and young adults.
27. Studies indicate that alcohol and substance abuse among adolescents
and young people increased during the pandemic. Moreover, this was
found to be associated with other negative mental health issues. Containment
measures such as lockdowns and subsequent social isolation were
found to be a risk factor for alcohol consumption.
4. Some
challenges and good-practice examples to take away from the fact-finding
visit to Norway
28. The Norwegian health system
offers a high level of social and financial protection. Population
coverage is universal (although regrettably with some exemptions
such as undocumented migrants and persons whose asylum applications
have been rejected) and includes essential mental health care. Public
financing accounts for the majority (85%) of health expenditure.
Various mechanisms, including exemptions and ceilings on out-of-pocket
payments, limit the financial burden of care on individuals. For
2023, the ceiling for annual out-of-pocket user fees is 3 040 NOK
(approximately 285 EUR). Once someone has reached this ceiling,
they will receive an exemption card, and will not have to pay user
fees for the remainder of the calendar year.
29. In Norway, health care policy is controlled centrally. However,
responsibility for the provision of health care is decentralised.
Primary mental health care services are financed and organised by
local authorities at municipal level, and according to local demand.
Specialised mental health services, on the other hand, are the responsibility
of the regional health authorities. They are provided in highly
specialised mental hospitals, community mental health centres, and
in outpatient setting (treatment by privately practicing psychiatrists
and psychologists under contract with the regional health authorities).
30. User fees for treatments by psychologists that specialise
in clinical psychology, and have funding contracts with regional
health authorities, count towards the ceiling for out-of-pocket
fees and the exemption card for health services. Children and adolescents
up to 18 years old do not have to pay any user fees for treatment
by a psychologist. Patients need a referral either from a doctor,
psychologist, or child welfare officer. However, the number of psychologists
with funding contracts is limited. This has resulted in long waiting
times, in extreme cases up to two years
(although patients
with urgent needs will normally skip the line and receive care faster).
In 2020, nearly one in four patients with a referral were declined
by the specialised mental health services.
Patients who are
declined by the specialised mental health services, or who find
the waiting lists to be too long, will have to bear the full cost
of private psychologists, without any reimbursement.
31. Local municipalities often have a wide range of mental health
services available, depending on the demand and capacity. Municipalities
are required to employ psychologists within their health and social
care services. The municipality psychologists provide free short-term
treatment for mild to moderate mental illnesses and disorders.
32. During my visit to Oslo, I met with representatives of “Health
Clinics for Adolescents” (HFU), “UNG Arena” and “FACT Ung”. Health
Clinics for Adolescents are free services for young people that
offer help and advice from nurses, doctors, and psychologists. My
interlocutors informed me that young people often come to them with
questions regarding sexual and reproductive health, as well as mental
health issues, ranging from school refusals and heartbreak to more
serious problems that need long-term care. If the HFU finds that
the latter is the case, they will often refer the person to UNG
Arena, for follow-up on mental health. UNG Arena is a low-threshold
mental health service offered to young people aged between 12 and
25 years old that was built together with young people and offers
peer-support. FACT, which stands for Flexible Assertive Community Treatment,
and draws inspiration from the Netherlands, aims to provide a holistic
and co-ordinated service to young people with more serious mental
health problems and disorders. It targets young people who should normally
receive treatment within the specialised mental health services,
but who for various reasons do not fit in, and thus try to accommodate
their individual needs.
33. All three care services experienced a sharp increase of young
people struggling with poor mental health both during the first
stages of the outbreak of the pandemic, and post-confinement. Moreover,
Gamle Oslo, the district where the three care services are located,
has one of the highest percentages of children growing up in poverty
in Norway, including a lot of refugees and immigrant children, who
are often at increased risk of mental health problems, marginalisation,
and stigma. My interlocutors were worried that despite the very
high increase of young people seeking care, they were not able to
reach out to some of the most vulnerable groups.
34. Another low-threshold treatment service that is provided by
the municipality is “Urgent Mental Health Care”. It is offered to
persons over 16 years old who are experiencing various types of
anxiety together with mild or moderate depression. This service
can also help with sleeping difficulties and incipient substance misuse
problems.
The service is free and provides
direct assistance without the need for referral from a doctor. The
aim is to ensure that young people can access support within one
to two weeks so that the condition does not become more severe.
35. The NGOs that I met with in Oslo drew my attention to several
other critical issues for vulnerable groups in Norway. In particular,
the Norwegian Organisation for Asylum Seekers, pointed out that
there is no vulnerability screening of asylum seekers and that immigration
authorities are not trained in detecting mental health problems
and disorders, which has resulted in fatal consequences for some
individuals. On one occasion, it was detected long after the asylum
interview that the asylum seeker, whose legal age was 24 years old,
had an intellectual disability and had the intellectual level of
a 12-year-old. Moreover, undocumented migrants and asylum seekers
whose applications have been rejected, are only able to receive
immediate assistance and healthcare which is absolutely necessary
and cannot wait, despite the many traumas they may have lived through.
36. Queer Youth represents another group vulnerable to mental
health problems. The mental health of many of their members has
deteriorated since the mass shooting at locations associated with
Oslo Pride, on 25 June 2022, with many receiving death threats and
feeling unsafe. They underlined the need to decentralise health care
services so that queer people could get adequate health care and
support in their local communities. Queer Youth has phone and chat
services that risk being defunded by the government. They experienced
an increase in calls concerning suicide prevention in 2020 and 2021,
and noted that people calling are getting younger, with 8 out of
10 being under 18 years old.
37. Lastly, Mental Health Carers Norway, an advocacy group solely
working for the well-being and needs of mental health carers, underlined
the importance of including carers and other family members in national strategies
concerning mental health and well-being. I have integrated the additional
learnings and good practice examples from my fact-finding visit
to Norway in the chapter below.
5. Practical
recommendations to member States
38. In a report to the UN Human
Rights Council, the Special Rapporteur on the right of everyone
to the enjoyment of the highest attainable standard of physical
and mental health notes that “the right to mental health includes
both immediate obligations and requirements to take deliberate,
concrete and targeted action to progressively realize other obligations”.
States
are urged to use appropriate indicators and benchmarks to monitor
progress, with indicators disaggregated by sex, age, race, ethnicity,
disability and socio-economic status. Below, I will include some
policy proposals that member States should consider in order to
improve the mental health and well-being of young people.
39. In many member States, waiting lists have hit all-time highs
and critical mental health services have been disrupted or halted
in 93% of countries worldwide.
The pandemic has highlighted the
fragility of support systems for mental health in many countries
and underlined how these hardships fall disproportionately on the most
disadvantaged communities.
Many member States have
been forced to divert already overstretched health system resources
away from mental health needs and towards the fight against the
virus. In March 2022, the Director General of WHO, Dr Tedros Adhanom
Ghebreyesus, warned that the numbers should serve as a wake-up call
to all countries to step up mental health services and support.
40. After three years of pandemic disruption, it is time for governments
to urgently allocate the necessary funding and take other steps
to build stronger health systems. First of all, States must increase
funding for mental health. This may include funding for community-based
services, but also funding for research and training for mental
health professionals. Despite the recognition that mental health
is an integral and essential component of health, it has been continuously
underfunded in all of our member States. In fact, spending on mental
health stands at less than 10% of spending on physical health.
41. In 2023, the United Nations will hold a high-level meeting
on Universal Health Coverage. Universal health coverage means that
everyone, everywhere, should be able to access health services they
need without suffering financial hardship. Regrettably, in many
countries, there are high coverage gaps of care and services for
common mental health conditions, such as depression and anxiety.
Even when services are available, they are not necessarily rights-based,
accessible and cost-effective.
42. The need for universal health coverage has never been clearer,
and it is pivotal that mental health is an integral part of this.
If we want to ensure the full success of the implementation of universal
health coverage
, mental health
must be integrated into health systems, especially primary and community-based
health services.
There are several studies that suggest
that integration of mental health in physical health programmes
will improve the mental health outcomes of populations, as well
as support the effective delivery of physical and mental health.
This corresponds well with the understanding of WHO that there is
no health without mental health. In fact, when integrated, the combined
physical and mental health treatment contributes to better overall
outcomes. Moreover, from a financial perspective, the overall care
may also cost less.
43. Another important measure is to expand access to mental health
care and treatment, to anyone within a State’s territory, regardless
of legal status, and have in place targeted and holistic measures
that meet the needs of underserved communities. Having mental health
as an integral part of universal health coverage will increase access
to mental health services by removing financial barriers, such as
high out-of-pocket costs which may prevent individuals from seeking
help. This is an important step to ensure that vulnerable groups, who
are often disproportionally affected by crises, and in general may
have poorer health, have easier access to necessary care and treatment.
44. Early detection and treatment are pivotal to addressing the
challenges to the mental health and well-being of minors and young
people. Member States can increase focus on mental health promotion
and prevention by providing education and resources to help children,
their carers, and young people maintain good mental health. Integrating
mental health into universal health coverage would also increase
early identification and treatment of mental health conditions.
Moreover, having mental health and well-being as part of the school curriculum
will help foster well-being and develop resilience, and may include
talking about emotions, recognising signs of mental health illnesses,
and practicing self-care.
45. Reducing stigma and shame associated with mental health problems
is another critical step. We have a long way to go with regard to
acceptance of mental health and well-being and treating it as equal
to physical health in all population groups. However, there is no
denying that mental health problems are more stigmatised in certain
population groups. Member States could reduce stigma by improving
the overall health literacy within the population and organising
targeted campaigns towards certain groups by reaching out and collaborating with
trusted organisations/people in their respective local communities.
Moreover, universal health coverage can help reduce stigma associated
with mental health problems by treating mental health as equal to
physical health. This would also help reduce discrimination and
marginalisation of people with mental health problems.
46. Finally, universal health coverage would provide a more holistic
health care service overall. A holistic approach to healthcare focuses
on treating the whole person, rather than just their physical symptoms,
and includes addressing mental health, as well as social, economic,
and environmental factors that can impact a person's overall well-being.
Following the good practice example from Norway, where seven ministries
are working together on a new escalation plan on mental health,
a cross-sectoral approach that integrates mental health into other
policy areas is necessary for the success of national strategies.
For instance, education and access to meaningful work that is conducive
to the mental health and well-being of young people, requires a multisectoral
approach.
47. Offering a wide range of multisectoral and low-threshold care
services will contribute to lowering barriers to seek help for mental
health issues. Building on the good practice examples from Norway,
this could include drop-in-centres, community-based outreach programmes,
peer support and phone and chat services. It is an excellent way
to reduce pressure on health systems, through early detection and
prevention, so that people get the help they need before their condition
develops into something more serious. Such services are also beneficial
because they are less stigmatising than traditional mental health
services and are more accessible to people who may not have the
resources or support to access more traditional services. However,
it cannot replace specialised mental health services.
48. Member States should also simplify administrative procedures
and bureaucratic processes to make them more user-friendly and provide
better information to users on their rights. Navigating complex bureaucratic
systems can be overwhelming and confusing, leading to feelings of
frustration, helplessness, and stress. All the NGOs I met with during
my fact-finding visit highlighted that dealing with administrative procedures
can be time-consuming and require a significant amount of paperwork,
which can be burdensome and increase stress levels. Moreover, dealing
with administrative procedures can be costly for people who may have
financial difficulties, which can add to their stress levels.
49. Although priority should be given to children and young adults,
the mental health of parents and other caregivers is pivotal for
the well-being of the younger generations as well, as underlined
by the advocacy group for mental health carers in Norway. The stress
experienced by parents and caregivers can affect their ability to meet
the children’s needs. It can also be transferred to younger generations
and have a negative effect on their mental health.
50. As for the pandemic, disruptions in education had a negative
impact on the mental health of children and young adults, and disproportionately
affected the most vulnerable and marginalised within our communities. Many
lacked access to internet and/or necessary equipment, as well as
adult support and supervision. As pointed out by UNESCO, the pandemic
and the following restrictive measures exacerbated already existing disparities
within the education system.
For this reason, UNICEF, UNESCO
and WHO recommend that if and when restrictions are imposed to decrease
transmission and control the spread of the virus, schools should
be the last places to close and the first to reopen.
51. The pandemic has had a negative impact on the fulfilment of
children’s rights and the transition into adulthood. As pointed
out by my colleague, Mr Stefan Schennach (Austria, SOC), in his
report on “Beating Covid-19 pandemic with public health measures”
(
Doc. 15444), it is of utmost importance that governments and decision
makers are transparent and open on the reasons for imposing restrictive
measures. In addition to ensuring that measures fulfil a legitimate
aim and that they are proportionate, decision makers must assess and
determine the best interests of the child, as well as consult children
and young adults in all cases concerning them, in line with
Resolution 2414 (2022) “The right to be heard – Child participation: a foundation for
democratic societies”.
6. Conclusions
52. Mental health and well-being
are fundamental components of a child’s healthy development and
future. Failing to address mental health needs among youth can have
profound consequences and extend into adulthood, including limiting
young people’s opportunities to lead fulfilling lives, as well as
societies’ pathways for upward growth.
Young people with mental health
conditions often face disproportionate challenges if they do not
receive adequate support. They are more vulnerable to social exclusion,
discrimination, stigma (which may affect their readiness to seek
help), poor physical health and human rights violations. This may
lead to the inability to continue education, unemployment, troubles
with criminal justice systems, substance abuse, self-harm and suicide,
and poor quality of life.
53. Despite the fact that mental health is increasingly acknowledged
as a key component to children and young people’s development, greater
recognition and promotion of mental health and well-being are needed. Social
and cultural stigma attached to mental health still need to be addressed.
Promotion, prevention, and early intervention strategies may produce
the greatest impact. Recognising that mental and physical health
are equally important for the well-being of children and young adults,
more resources are needed for timely, integrated, and multidisciplinary
interventions. This would limit the risk of poor long-term outcome,
with potential benefits for health-care system costs.
54. It is urgent to ensure that mental health care services are
free and accessible to everyone, regardless of socioeconomic status,
sexual orientation and gender identity, legal status, ethnic background,
disability, and other factors that may put minors and young people
at increased risk of poor mental health and well-being.
55. I firmly believe that as parliamentarians, we have a responsibility
towards children and young people to include them in policy-making
processes and ensure their voices are heard on issues that matter
to them. By incorporating young voices into legislative processes,
we promote a more inclusive and representative democracy, which
helps ensure that our policies are well-rounded and reflective of
the diverse needs and interests of the entire population. By creating
spaces for dialogue and collaboration in parliaments, we as parliamentarians
can foster an environment where young people feel valued and understood.
This in turn will lead to increased civic engagement and a stronger
sense of belonging within a society.