Mental health is a state of mental wellbeing that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. Our mental health is determined by a range of individual, social, economic, geopolitical and environmental factors, including emotional skills, substance use, genetics, socioeconomic status, exposure to violence, inequality and environmental deprivation. Mental health is an essential and integral component of health and wellbeing, and it is crucial to personal, community and socio-economic development. For this reason, the 66th World Health Assembly of 194 Member States adopted the WHO’s Comprehensive Mental Health Action Plan 2013-2020, and extended it until 2030 at the 72nd World Health Assembly, in order to achieve more effective leadership and governance for mental health; the provision of comprehensive, integrated mental health and social care services in community-based settings; implementation of strategies for promotion and prevention; and strengthened information systems, evidence and research.
Psychosocial distress and poor mental health impacts children, young people and their caregivers across the world. These past few years have shed light on and brought to fore the gravity of the mental health crisis, exacerbated by the unique stresses of the Covid-19 pandemic, the isolation of continued lockdown, limited opportunities to socialize and connect with peers, increased unemployment and poverty in families, increased exposure to social media and the internet, increase in physical and online violence, abuse and exploitation, and lack of access to protection services, in addition to the risks posed by conflict, natural disasters, migration and protracted economic adversity. During childhood, which is a developmentally sensitive period, the impact of exposure to risk factors for poor mental health outcomes is particularly negative. Children who have live in humanitarian and fragile settings and children from marginalized groups who are at higher risk of discrimination are at higher risk for mental health conditions.
According to a UNICEF report, 89 million adolescent boys aged 10–19 and 77 million adolescent girls aged 10–19 around the world live with a mental disorder, as defined by the WHO. Anxiety and depression make up about 40% of these diagnosed mental disorders, with a median of 19% of 15- to 24-year-olds in 21 countries self-reporting in 2021 that they often feel depressed or have little interest in doing things.
“It’d be so much easier for my parents if I wasn’t here…”
A 13-year-old girl began a live chat by explaining to the counsellor that she was really struggling due to financial worries, as her family faced being evicted from their home. Alongside this, she explained that she was trying to manage anxiety and panic attacks, which she found particularly hard to deal with as she shared her bedroom with her younger sister and therefore didn’t have a safe space. The girl felt she was unable to talk to her parents about her situation, as they were working hard to support her brother, who required additional support due to ASD. They were also dealing with the stress of being evicted. “I can’t stop thinking that if I wasn’t around, everything would be easier for my parents, I feel guilty for existing.”
The counsellor encouraged the girl to call the helpline to have a chat. However, this wasn’t possible due to a lack of privacy at the girl’s home. Together with the counsellor, they worked on being open about the girl’s suicidal thoughts and talked about how she might be able to share these feelings with her parents so that they could try to offer her some support. The counsellor shared some other services that might be helpful for the girl in order to gain the support she needed for her anxiety and panic attacks. After their conversation, which had been very intense for the girl, the counsellor also helped her make a plan for looking after herself for the rest of the evening, which included watching Netflix so that she could try to relax.
As a most grave impact, suicide is the fifth most prevalent cause of death for adolescents aged 10–19, with an estimated 45,800 adolescents dying from suicide each year. Regionally, Europe and Central Asia have some of the world’s largest adolescent suicide rates, particularly for boys and the LGBTQI community. The latter tend to face a greater amount of violence, discrimination and rejection in society. According to the WHO, one key approach to suicide prevention is electronic media strategies for online suicide prevention, including self-help programmes and professionals engaging in chats or therapy with suicidal individuals. Furthermore, crisis helplines are specifically mentioned as a service to turn to when social support or other professional care is unavailable, making child helplines a key resource in child and adolescent suicide prevention.
“I feel hopeless … I sniff glue to cope with the challenges of street life …”
A 13-year-old boy was brought to the child helpline by a peer who had previously received support. He had been living on the streets and had developed a substance addiction. He expressed feelings of hopelessness and a belief that his current lifestyle was inescapable. He used substances – such as sniffing glue – to cope with the challenges of street life.
The child helpline counsellor built up a rapport with him and provided a safe, non-judgmental space in which to share his experiences. Recognizing the severity of his addiction and mental health issues, the counsellor coordinated the boy’s admission to a local rehabilitation centre for detoxification and treatment. The counsellor also arranged therapy sessions with a mental health professional specializing in trauma and substance abuse, and collaborated with local NGOs to find a safe living environment for the boy after rehabilitation, including enrolling him in an educational programme.
Despite the serious cost of inaction and wide prevalence, mental health is fraught with stigma, misunderstanding, lack of data, inadequate recognition of child helplines in mental health promotion, lack of investment in services, lack of support for parents and caregivers, and inadequate consideration of compounding factors such as poverty, gender and social norms, humanitarian crises and disabilities. The global median for government expenditure on mental health is only 2.1% of the median government expenditure on health, and in some of the world’s poorest countries, governments spend less than USD1 per person treating mental health conditions.
A Gallup survey for UNICEF reports that more than 80% of young and older people across 21 countries see sharing experiences with other people and seeking support as the better way to address mental health issues, rather than treating it as a personal matter to be handled alone. This is a positive trend, and indicates that investments in support services, such as child helplines, may greatly benefit children and young people by providing safe, accessible and quality ways to effectively deal with their mental health issues.
“It’s against the family’s rules, and it’s breaking my heart…”
A 16-year-old girl called the child helpline, feeling overwhelmed and that she had nobody to talk to. She didn’t have any specific child protection or safety issues but nevertheless she was asking for help. She explained that she was in a relationship, which was against family rules, and she was scared that her father would find out about it and make her bring it to an end. She said her heart was breaking, and she asked for advice on how to handle the situation.
The counsellor suggested doing things that made her happy and which she enjoyed, such as dancing, exercising, doing schoolwork and reading. The counsellor also recommended holding her breath and counting to five whenever she felt anxious about her father finding out about her relationship. She was encouraged to take things one step at a time. The counsellor reassured her that, while it might take time for her heart to heal, she wouldn’t feel sad forever. She was also advised to follow her father’s rules in order to protect herself.
The girl was thankful and expressed her gratitude for having space to talk without feeling judged. She said she had felt embarrassed about calling and felt like she might “explode” with emotion, but the conversation had instead helped her understand her feelings better, and she had been given some useful suggestions. She said she would write down the counsellor’s name in her diary in case she needed any more help.
Child Helpline Data on Mental Health
Child helplines have expertise in child mental health and psychosocial support, providing counselling to over 700,000 mental-health related contacts worldwide annually. This is equivalent to one in four of all counselling contacts fielded by our network. Globally and over time, mental health is either the most or second-most common reason for contacting a child helpline after violence. However, when looking at the number of contacts across the 3-year period, it is important to note that Europe is the only region where mental health contacts exceed violence-related contacts. All other regions have either a few more violence contacts (Asia-Pacific and MENA), or more than double that (Africa and the Americas and Caribbean regions).
Emotional distress was the most common mental health-related reason for contacting child helplines in 2022, whether related to mood problems or anxiety problems. It accounted for around two in every five mental health-related contacts. Almost as frequent as the two different types of emotional distress concerns were contacts related to suicidal thoughts and suicide attempts.
Girls contacted child helplines significantly more than boys with all issues related to emotional distress (anger, fear and anxiety, mood). This was also true for suicidal thoughts and suicide attempts, concerns about the self, self-harming behaviours and problems with eating behaviour. Boys contacted child helplines more with issues related to addiction, and they were just as likely as girls to contact with issues related to behavioural problems and traumatic distress.
In Africa, the most common mental health-related issues that affect children and young people vary from year to year. In the Americas and Caribbean region, suicide and emotional distress (both mood and anxiety) are consistently the most common mental-health-related concerns affecting children and young people. In Asia-Pacific, similarly to the overall global pattern, the most common mental health issues are emotional distress (mood and anxiety), and suicidal thoughts and suicide attempts. In Europe, the three most common reasons for contact within the mental health category are again emotional distress (mood and anxiety) and suicidal thoughts and suicide attempts. In the Middle East and Northern Africa, relatively few contacts concern mental health. This means drawing any conclusions about the longitudinal trends is challenging. Indeed, the common types of mental health issues vary on a yearly basis.
Mental health is increasingly gaining attention as a child rights issue, beyond public health. While there are some positive developments in acknowledging the scope of the issues, mental health remains fraught with stigma, misunderstanding, lack of data, lack of investment in services, lack of support of and for parents and caregivers, and inadequate consideration of compounding factors such as poverty, gender and social norms, humanitarian crises and disabilities. The role of child helplines in mental health promotion cannot be understated, and must be fully recognized.
Ronja Ulvfot
Regional Manager, Europe
Anastasia Shuster
Data & Research Manager
