Profiles

With suicide and self-harm now leading causes of death and injury among young people between 15 to 19 years, UNICEF and WHO are coming together for the first time at the Leading Minds for children conference to tackle the growing scale of mental health disorders among children and young people. On World Mental Health Day (10 October) this interview, extracted from the full podcast, presents a fascinating discussion on this emerging global priority for children and young people.   Dr. Vikram PatelSarah Crowe: As a specialist in mental health over many decades, how do you see the scale of mental health concerns facing children today? How has it evolved over the last 30 years since the convention of the rights of the child? Vikram Patel: Mental health in the global context has been the orphan child of global health, and children's mental health has been the orphan child of global mental health. The real scale of the crisis is that we know so little about mental health problems in children in the global context and that the overwhelming majority of children who are already experiencing mental health problems receive neither the recognition, nor do they receive any form of intervention that we know can transform their lives. If you had to ask me what is the actual proportion of children who suffer this kind of neglect, I would say that in most parts of the world - particularly in low income countries - it is virtually 100 percent of children. I think this is the real scale of the crisis: the complete lack of recognition of the mental health needs of children globally. ...the focus of children's health and well-being has moved from children surviving to children thriving.SC: Is it true to say that for underdeveloped countries or communities, mental illness in children is becoming more apparent? VP: Absolutely. I think that is certainly one reason why children's mental health is emerging as it were from the shadows as the focus of children's health and well-being has moved from children surviving to children thriving. It's becoming very apparent that to thrive one needs to have good mental health and that children's mental health problems become more visible, as childhood mortality and physical causes of sickness become much better controlled. Thankfully, it's emerging from the shadows. SC: Can you take us through the child mental health risk factors? At which points in a child's development do they arise? VP: In the earliest years of childhood, the major concerns are those to do with early-life brain development. Intellectual disability and autism being the examples of what some refer to as developmental disabilities. In middle childhood, you begin to see the emergence of emotional disorders, particularly, anxiety disorders. And in adolescence you see the greatest surge of emotional and behavioral disorders, particularly in post puberty years, where you see the emergence of mood disorders, self-harm behaviors, conduct problems and substance use conditions. So, you see quite different conditions occurring at these broad developmental phases of early childhood, middle childhood and adolescence.   Find out about the World Mental Health Day 2019 "A Day for 40 Seconds of Action Campaign"  SC: What about the growth of gender fluidity, or young people choosing actively to associate themselves with being non-binary or searching and exploring a new identity? Is this influencing adolescent mental health at this vulnerable stage of their lives? VP: I don't think this is necessarily a recent development. I think this has historically always been part of our sexual identity, but that it has been more suppressed by rigid and inflexible social norms for a very long time. And I think we should celebrate the fact that many of those orthodox and rigid social norms are being challenged now. And so that it gives greater freedom of space for young people to reject the binary approach of sexual identity. Obviously, where mental health problems arise is when they encounter continuing rejection of those identities by orthodox social norms. Let's be honest: in most parts of the world, orthodox social norms continue to be a major cause of mental health problems. And this has to do not only to fluid gender identity, but with a variety of other denials of autonomy and freedoms that young people continue to experience in many populations around the world. Rondiney Diniz, 20, looks at his mobile phone, inside his home in the city of Fortaleza, in Northeastern Brazil.SC: Has the digital era created greater burdens, greater levels of toxic stress? VP: I certainly think there are unknown perils to do with the digital world. Particularly in childhood and early adolescence, when the brain is very rapidly developing. It is very plastic, it's responding to the environment in exquisitely sensitive ways. And if that environment is one in which you've replaced interaction with real people with a digital world in which your interactions are with virtual people, it's hard for me to know exactly what that impact might be on the brain, but it's not something that we were evolutionary developed to deal with. I think the jury's out about the exact nature of those risks. SC: You've written a lot about the prevention of mental illness and authoritative parenting. What can teachers, caregivers, parents do to put their children on the right path to mental health, whether it's online or off line? VP: Authoritative parenting, in my mind, is the balance between laissez faire parenting - which says, 'whatever you want to do is fine' - and this is different from authoritarian parenting - which says, 'whatever I want you to do is the only acceptable way to do it'. Authoritative parenting is recognizing the growing needs for autonomy as a child transitions into adolescence and then ultimately into young adulthood. It is really a fine art. There isn't necessarily a set of rules that one can apply to identify when a child is entitled to be making more and more decisions of their own. In terms of what parents, children and teachers can do, one most important thing is that we know about children's mental health. While all mental health problems will finally involve some biological dysfunction in the brain, we also know that the most profound influences on brain development and mental health are in the environment. A single way of describing what promotes good mental health is that the environments are nurturing and that they provide a secure space for young people and children to express themselves and be heard. Clcik the image to hear the full interview with Dr. Patel covering a wide range of key issues on global child and youth mental health.SC: How helpful do you think the Convention of the Rights of the Child has been in prompting action against the worst side of stigma, which often leads to horrendous abuses committed by states, communities, families? VP: I think the convention's been a singularly important tool to enshrine the right for a child to live in an environment which is free of fear, of abuse, of neglect and of violence. I think it has been the foundation for many legislations in countries around the world that protect children. However, it would also be fair for me to say that in most of these countries, the actual implementation of these aspirations in the real world has been marred by a number of different barriers. Not least, the fact that most states are unable to in fact see the child as being autonomous from their parents and it is the home environment, especially in early childhood, when so much of the neglect experiences occur. SC: And can you share examples that show these violations up for what they are? Could you give us something you might have seen or experienced or heard from young people? VP: The most important violation is growing up in extreme poverty, in circumstances where parents are unable to provide their children with the necessary emotional nurturing that is so essential to their development and well-being. So, this is not about parent blaming: I want to really stress that. I want to emphasize that families are caught in a vicious trap of poverty, and the failure of the state and of society more generally to recognize children's needs in those extremely marginal settings is what I consider the single biggest threat to well-being in the global context. SC: If we could look forward what are the trends that you see unfolding? What makes you most optimistic about the prevention, care and treatment of mental illness? VP: What gives me greatest hope is the recognition of mental health more generally and children’s mental health more specifically. Mental health is being seen as a global priority. This is not something I witnessed 20 years ago and the very fact that UNICEF, for example, is championing children's mental health, is a sufficient indicator of that transformation. I also see a wonderful opportunity because of the science that we have, of neurodevelopment, clinical and public health interventions for children. We are not working in a vacuum of knowledge. We actually have a lot of things we know can be transformative. I think the real challenge is delivering what we know can be transformative. Another major challenge of course is the continuing stigma attached to the discussions around mental health and well-being. Adolescents don't like to see doctors for any condition, not least for their mental health. Because of a very narrow medical approach to child mental health it is rejected by most children and adolescents. We need to put them front and center in thinking how that should be done. SC: “Nothing about us, without us” is the way forward and we hope to be able to take this on very seriously, going forward to Leading Minds 2019.   Dr. Vikram Patel,  professor of global health at the Harvard University School of medicine and co-founder of Sangath Foundation in India . His work over the past two decades has focused on reducing the treatment gap for mental disorders in low resource countries.  Dr. Patel will be a keynote speaker at the first Leading Minds 2019  conference at the UNICEF Office of Research – Innocenti in Florence, Italy.    

“The intergovernmental negotiations on the Global Compact for Safe, Orderly and Regular Migration recently concluded by upholding the best interests of the child and emphasizing the importance of family unity for children on the move. UNICEF’s Executive Director hailed it saying it should help equip Member States with tools to prevent deaths of children, protect them from abuse and exploitation, avoid the trauma of family separation, detention or forced removal.One of the critical issues it will tackle is how best to support children like those stranded in Niger which has effectively become the southern frontier of Europe. With the latest agreement on the EU disembarkation platforms and processing centres, Africa’s role is set to become all the more important.”  Agadez, Niger - Nothing could be further than from the gates of paradise than this scorching, unearthly wasteland stretching out as far as the eye can see and beyond. And yet this is it. Hidden in the ghettos, scattered on the outskirts of this ancient turmeric-coloured city, milling about in centres are hundreds of migrants, stranded, with dashed hopes and unfulfilled dreams. They’re on the move to or from neighbouring nations or beyond. Some, but surprisingly perhaps not most, have an eye on the ultimate prize of making it across the burning sands of the Sahara and on to what is fast becoming the elusive Eldorado - Europe. Many children travelling alone or separated, nursing mothers, newborns, and throngs of young men angry that their quest had been cut short. Agadez was once the migration capital of Africa, a crossroads for people on the move, a bustling business hub for smugglers, roadside shops selling masks, and sunglasses for the daunting journey, traffickers awaiting their human trade. Authorities would turn a blind eye then. Now, as Europe and North Africa tighten their borders and close their ports creating drama on the high seas in a general clampdown on migration – this unlikely has become effectively Europe’s new frontier. Arrivals into Italy from January to early June this year were down by two thirds compared to the same period last year when 60,000 crossed over from North Africa. Since November last year, more than 8,000 West Africans, including 2,000 children, have been returned to Niger from Algeria, with another 900 refugees and asylum seekers from East Africa transferred from Libya awaiting cumbersome and slow resettlement or family reunification processes to determine their future. Niger is one of the poorest countries in the world yet is bearing the brunt of the ‘out-of-sight, out-of-mind’ policies by richer countries.Hastily stitched together agreements between one country to the next – EU-Turkey; EU-Libya; France-Niger; Algeria- Niger - are making migration someone else’s problem, pushing migrants from pillar to post, farther south. Children pay the highest price with little or no proper structures to keep them safe. The pushbacks have meant the stakes are higher and the routes riskier. In the flurry of a dust storm, of flesh-baking heat, we met a young Guinean furious for being dumped over the border from Algeria where he was scrapping out a living on the streets doing odd jobs. He went on a wildly gesticulating tirade but his words were as wise as they were distressing: “The desert has become a cemetery for our African brothers and nobody cares.” He was among those returned from Algeria, left in a nowhere land of the desert in temperatures of 48 degrees celsius miles from the Niger border, forced to walk until they could find transport and shelter. Many came from within Niger, the impoverished county of Kantche state in Zinder with its long-held reliance on income from begging. Ironically when the migrants are brought to Agadez onto a bone-dry open plain with a few threadbare tents, local children circle around with plastic begging bowls - begging from the returned beggars.It’s a motley bag – some could even classify as refugees. I met Liberians who fled their country during the Ebola crisis, Guineans fleeing hard times, Nigerians fleeing Boko Haram and others fleeing the torment and hardships in Libya.  Three UN agencies – UNHCR, IOM and UNICEF – have stepped up the response in Niger  yet too many fall through the cracks as they’re bundled up and off in this vast migrant heartland. One young mother nursing her 2-week-old baby was embarrassed that she had not yet managed to shave the new-born’s thick head of hair according to tradition. “The enforcing of the anti-migration law has changed the dynamics in the country. We’re seeing a huge spike in unaccompanied and separated children, and those involved are using routes where they cannot be tracked, and it’s far, far more dangerous.” Said Dan Rono, a child protection officer with UNICEF “It’s a tough journey for an adult, so you can imagine for an 11-year-old, it’s almost impossible for that child.” In April alone there was an increase of 14 per cent over the previous month in people transiting through Niger with around a third children, exhausted and traumatized. The true figure is likely to be higher as many children go undetected or hide. Omar, a 14-year-old from Sierra Leone, was one of those hidden statistics. He’s a gangly, awkward early teen in a Yankees cap, sleeveless vest, baggy shorts and flip flops, pretty much all he owns.  He is under the radar in a place they call the ‘Ghetto’ outside Agadez, waiting for the chance to cross. He left home because his father was not paying for his school fees. “I have made my decision to go to Libya, or to go to Europe to have a good life. May God save and guide me I will not go back home until I make it, to become a good boy so I can support the family behind,” said Omar. “For now, if I stay home I won’t be serious ok? I’ll become a bad boy. I will smoke, drink... So, I don’t want that life ok? I don’t want to become a bad boy. But if I go Europe I will continue my school. I will continue playing football again”. UNICEF has found in studies that although most children on the move stay within Africa and have no desire to go to Europe, of those who say they do want to, like Omar, around a third say it is for an education.A former smuggler, Dan Ader, who’s seen his lucrative business crumbled into the desert dust since the clampdown, told us: “There are so many deaths because there are thousands of routes. Now if your GPS has a little glitch you’re finished! You will not find your way again.” According to UNICEF estimates between January and May some 120 children drowned at sea between January and May. At sea there are at least coastguards. No one patrols the vast and deadly sea of sand. It doesn’t stop them trying. Desperation and dreams turn them into philosophers and poets like the scratchings on a prison cell, the graffiti on the grim ghetto walls, tells their stories scrawled in large charcoal: “Europe ou rien. Dieu est là! Europe or bust. God is there.” “Il vaut mieux mourir en mer que de mourir devant sa mère – sans rien.” (i.e. “Europe or bust, God is there! It is better to die at sea than to die in front of your mother—with nothing.”) Migration is as old as humanity itself here – a rite of passage for many boys into manhood, and simply a way of life in search of a better life – and closed ports and closed borders are not likely to stop this. Africa is the youngest and fastest growing population in the world, the north is ageing. Some say ‘Africa is sitting with its bags packed.’ The scrawling on the wall of the filthy ghetto in Agadez is a stark reminder of one of the reasons: “L’Afrique est riche mais ses enfants quittent à cause de mauvais gouvernements,”  (Africa is rich, but it’s children are leaving because of bad governments.)Yet only some 15 percent of those on the move in Africa, express any interest in going to Europe. So managing migration is truly global and now as the Global Compacts on Migration and Refugees are being finalized, the EU and other bodies really need to seize this moment to put the needs of children uprooted before national interests; commit to predictable cross-region action to keep children safe and families together and invest in countries like Niger and others in the Global South that take in far more refugees and migrants in a month than the Global North now does in an entire year. For most the true paradise lost, is being uprooted from a homes and loved ones – especially for children alone. Refugee and migrant children look now to powerful member states, to the European Union and to the African Union to put in place a proper migration system – promised in the Global Migration Compact - that doesn’t dismiss them like the wind that carried them to foreign shores.     You can find more about UNICEF Innocenti research on Children and migration: rights, advocacy and resilience   Sarah Crowe, is senior UNICEF communications specialist on migration and recently visited Niger   * Total arrivals (1 Jan - 03 Jun 2018): 13,706 Total arrivals (1 Jan - 03 Jun 2017): 60,394     

What lies ahead for getting COVID under control? WHO’s Special Envoy Dr David Nabarro and the African Union’s Special Envoy Strive Masiyiwa discuss this question on Leading Minds. Both are spearheading global efforts to bridge the growing chasm between the vaccinated and the unvaccinated. We will explore the latest on what this all means for tackling new variants as one corner of the world’s population moves on to third jabs while another corner has yet to receive their first.

The pandemic sparked the biggest increase in history in digital learning and living, but what does it mean for this generation of children and the next? Is the future already inevitably written in computer code? What does this mean for the millions of children who simply cannot get online? Are today’s tweens and teens the canaries down the coal mine of this mass human online experiment?Join us in our new Leading Minds Online series* as we put these questions and more to our two experts –  a Japanese-American academic Cultural Anthropologist Dr. Mizuko Ito, Director Connected Learning Lab, University of California, Irvine, and student  Zulaikha Patel, a South African youth activist.

Time is fast ticking for a looming debt crisis that threatens to decimate decades of progress for children.The debt crisis is likely to hit two-thirds of the world’s population. Even before the pandemic 1 in 8 countries spent more on debt than on education, health and social spending combined. And African countries are already spending three times more on debt repayments to banks and private lenders than it would cost to vaccinate the entire continent against Covid-19.So how can this ticking time bomb be defused?To coincide with the release of an important policy brief from UNICEF on the debt crisis, Leading Minds will ask the expert panelists:How do we stop mortgaging children’s futures?Can debt relief measures turn this tide?

UNICEF convened its inaugural Leading Minds conference this year, taking the pressing issue of mental health of children and young people as its theme. The purpose of the annual Leading Minds conference series is to bring attention to a theme pertinent to the present and future wellbeing of the world’s children and young people by convening some of the world’s leading minds to examine available evidence and solutions and contribute to accelerating progress on solutions and breakthroughs.