ON MY MIND

This is a review of the short film On My Mind (2021), directed by Martin Stange-Hansen


A TIME FOR LEADERSHIP ON MENTAL HEALTH
Fear. Loneliness. Grief.
As the coronavirus pandemic descended on the world in 2019, these powerful emotions enveloped the lives of many millions of children, young people and families. In the early days especially, many experts feared they would persist, damaging the mental health of a generation.
In truth, it will be years before we can really assess the impact of COVID-19 on our mental health.
For even if the potency of the virus fades, the pandemic's economic and social impact will linger: over the fathers and mothers who thought they had left the worst of times behind them, but are once again struggling to put food in a baby's bowl; over the boy falling behind in school after months of disrupted learning; and the girl dropping out to work on a farm or in a factory. It will hang over the aspirations and lifetime earnings of a generation whose education has been disrupted.
Indeed, the risk is that the aftershocks of this pandemic will chip away at the happiness and well-being of children, adolescents and caregivers for years to come -that they will pose a risk to the foundations of mental health.
For if the pandemic has taught us anything, it is that our mental health is profoundly affected by the world around us. Far from being simply a question of what is going on in a person's mind, the state of each child's or adolescent's mental health is profoundly affected by the circumstances of their lives -their experiences with parents and caregivers, the connections they form with friends and their chances to play, learn and grow. Mental health is also a reflection of the ways their lives are influenced by the poverty, conflict, disease and access to opportunities that exist in their worlds.
If these connections were not clear before the pandemic, they certainly are now. COVID-19 has put the mental health and well-being of an entire generation at risk, but mental health concerns are not new: Indeed, long before the COVID-19 pandemic struck, parents, teachers and many others were voicing growing unease about the mental health of children and adolescents. This is the reality that is at the heart of The State of the World's Children 2021.

A challenge ignored
Indeed, what we have learned is that mental health is positive -an asset: It is about a little girl being able to thrive with the love and support of her family, sharing the ups and downs of daily life. It is about a teenage boy being able to talk and laugh with his friends, supporting them when they are down and being able to turn to them when he is down. It is about a young woman having a sense of purpose in her life and the self-confidence to take on and meet challenges. It is about a mother or father being able to support their child's emotional health and well-being, bonding and attaching.
The links between mental and physical health and well-being, and the importance of mental health in shaping life outcomes, are increasingly being recognized. They are reflected in the connection between mental health and the foundations of a healthy and prosperous world acknowledged in the Sustainable Development Goals. Indeed, that agreement among the nations of the world positioned the promotion and protection of mental health and well-being as key to the global development agenda.
Despite all this, governments and societies are investing far, far too little in promoting, protecting and caring for the mental health of children, young people and their caregivers.

A time for leadership
At the heart of our societies' failure to respond to the mental health needs of children, adolescents and caregivers is an absence of leadership and commitment. We need commitment -especially financial and political commitment, from global, regional and national leaders and from a broad range of stakeholders -that reflects the important role of social and other determinants in helping to shape mental health outcomes. The implications of such an approach are profound. They demand that we set our sights on a clear shared goal of supporting children and adolescents at crucial moments in their development to minimize risk -and maximize protectivefactors.
As well as commitment, we need communication: We need to end stigmas, to break the silence on mental health, and to ensure that young people are heard, especially those with lived experience of mental health conditions. Without their voices being heard and their active participation and engagement, the challenge of developing relevant mental health programmes and initiatives will not be met.
And we need action: We need to better support parents and caregivers so that they can better support their children; we need schools that meet children's social and emotional needs; we need to lift mental health out of its 'silo' in the health system and address the needs of children, adolescents and caregivers across a range of systems, including parenting, education, primary health care, social protection and humanitarian response; and we need to improve data, research and evidence to better understand the prevalence of mental health conditions and to improve responses.

A time for action
The COVID-19 pandemic has upended our world, creating a global crisis unprecedented in our lifetime. It has created serious concerns about the mental health of children and their families during lockdowns, and it has illustrated in the starkest light how events in the wider world can affect the world inside our heads. It has also highlighted the fragility of support systems for mental health in many countries, and it has -once again -underlined how these hardships fall disproportionately on the most disadvantaged communities.
But the pandemic also offers an opportunity to build back better. As this report sets out, we know about the key role of parents and caregivers in shaping mental health in early childhood; we know too about children's and adolescents' need for connection; and we know about the dire impact that poverty, discrimination, marginalization and domestic violence can have on mental health. And while there is still much work to be done in developing responses, we already know the importance of key interventions, such as challenging stigmas, supporting parents, creating caring schools, working across sectors, building robust mental health workforces, and establishing policies that encourage investment and lay a solid foundation for mental health and well-being.
The European Union (EU) institutions should scale up their action to build back better by laying down the foundations for more resilient national health and social protection systems, while centring the recovery on the new generation's well-being with a focus on making mental health services accessible to all who need them.
We have a historic chance to commit, communicate and take action to promote, protect and care for the mental health of a generation. We can provide support for the foundation of a generation equipped to pursue their dreams, reach their potential and contribute to the world.

Prevalence of mental disorders
The prevalence of mental disorders for boys and girls in Europe aged 10-19 is 16.3 per cent, while the global figure for the same age group is 13.2 per cent. This means that 9 million adolescents aged 10-19 in Europe live with a mental disorder.

Estimated prevalence and number of adolescents with mental disorders in Europe, 2019
Note: The number of adolescents with mental disorders are rounded to the nearest 1,000; calculations are based on these disorders: depression, anxiety, bipolar, eating, autism spectrum, conduct, schizophrenia, idiopathic intellectual disability, attention deficit/hyperactivity (ADHD) and a group of personality disorders.
Source: UNICEF analysis based on estimates from the Institute for Health Metrics and Evaluation (IHME), Global Burden of Disease Study, 2019.

Suicide estimates
In Europe, suicide is the second most common cause of death among adolescents aged 15-19. Tragically, almost 1,200 children and adolescents aged 10-19 end their own lives every year -that is an estimated three lives per day lost to suicide in Europe.

Top five causes of death among adolescents aged 15-19 in Europe
Source: UNICEF analysis based on WHO Global Health Estimates, 2019; estimates were calculated using population data from the United Nations Population Division World Population Prospects, 2019. In 2019, anxiety and depression accounted for 55 per cent of mental disorders among adolescents aged 10-19 in Europe.

Estimates of key mental disorders among adolescents in Europe, 2019
Note: The sum of the prevalence of individual disorders exceeds 100 per cent due to the co-morbidity between the disorders; calculations are based on the disorders noted above.
Source: UNICEF analysis based on IHME Global Burden of Disease Estimates, 2019.

Boys and girls aged 10-19
Like his classmates at Gonzaga College, a secondary school in Dublin County, Jude* wants to do well in school but sometimes finds the pressure overwhelming.
"Some of us do need to gain perspective," Jude, 17, said. "I've seen some people having panic attacks before exams; there definitely is a sense of pressure." Besides academic pressure, adolescents also often face peer pressure, social stigma and restrictive stereotypes, which can take a toll on mental health. Indeed, young people identified mental health as one of the top three issues in Ireland's National Youth Strategy in 2015.
MindOut, an evidence-based social and emotional learning programme, aims to address some of these mental health and well-being concerns. The success of the programme can be seen in many of the young people Collazos has worked with over the years in the programme. One example is of a young Moroccan immigrant who had struggled with substance abuse, homelessness and had run-ins with the police and immigration authorities before finding his way to Superacció, where he now remains active as a volunteer, even as he looks for work.
With the support of the Spanish National Committee for UNICEF and local and regional authorities, the Transcultural Mental Health Programme is expected to expand and become integrated into the child protection system in Catalonia. The cost for us all is incalculable.
It does not have to be this way.
And it should not be this way.
Our priorities are -or should be -clear. We may not have all the answers, but we know enough to be able to act now to promote good mental health for every child, protect vulnerable children and care for children facing the greatest challenges.
This report sets out a framework to help the community, governments, schools and other stakeholders in Europe do just that, grounded in three core principles, for every child, everywhere: Commitment from leaders, backed by investment; Communication to break down stigmas and open conversations on mental health; and Action to strengthen the capacity of health, education, social protection and other workforces; better support families, schools, and communities; and greatly improve data and research.

Commitment, Communication, and Action for Mental Health
TO COMMIT means strengthening leadership to set the sights of a diverse range of partners and stakeholders on clear goals and ensuring investment in solutions and people across a range of sectors.

Provide regional leadership.
Building on existing efforts and towards the new health preparedness and resilience mission for the whole of the EU that was recently announced, the EU must lead the way in laying the foundation to ensure that all children have access to mental health services. EU leadership is needed to align stakeholders around clear goals and set priorities to develop financing models that can help bridge the investment gap; to share knowledge and experience on delivering services, building capacity, gathering data and evidence, and providing mental health and psychosocial support in crisis and emergency settings; to develop with relevant partners and stakeholders intervention packages co-created and codesigned with children and young people to promote a holistic and community-based approach to mental health, and crucially, to monitor and evaluate progress. This would position the EU as a champion of children in Europe and worldwide. Prevent suicide. Regional and national suicide prevention programmes can play an important role. The EU should invest and set priorities, providing guidance and exchange of best practices, such as identifying at-risk children and adolescents; restricting access to the means of suicide; providing specialized training for teachers, parents and health workers; encouraging responsible media reporting; and identifying and removing harmful content on social media. Schools should be a crucial partner in suicide prevention, helping to identify atrisk children and providing support.
Strengthen and equip multiple systems and workforces to meet complex challenges. To bring mental health services closer to those who currently cannot access them, services need to be provided not just through health systems but across a wide range of different sectors and delivery platforms, such as education, social protection and community care. The EU should support partner countries to build and strengthen mental health services across different sectors and delivery platforms, strategically using these platforms and the community to bring services closer to most children, adolescents and caregivers who still cannot access such services. Disadvantaged groups require dedicated attention and specific programmes to ensure services meet their needs. Additionally, explore opportunities offered by digital and online technologies to reduce gaps in access to mental health support in order to reach all populations.
Improve data, research and evidence. Lack of data and evidence renders children with mental health conditions invisible and is a major obstacle to policy development and planning. Greater investment is needed across national governments in research on children and adolescents, which should be cross-culturally applicable, adaptable to local realities and capable of capturing diverse experiences and realities. A determined effort is also needed to routinely monitor mental health, developing a consensus-based set of core indicators around child, adolescent and caregiver mental health. Additionally, the EU should increase investment in implementation science, which investigates how a range of factors can impede or accelerate the implementation of policies and interventions.