Sangath, Porvorim, Goa, India.
Vrije University, Amsterdam, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 2019 Apr;54(4):405-414. doi: 10.1007/s00127-018-1647-2. Epub 2019 Jan 3.
PURPOSE: Mental health problems and suicide are the leading cause of mortality in young people globally. India is home to the largest number of adolescents in the world. This study was undertaken to assess the policy environment for addressing adolescent mental health in India. METHODS: We conducted a review of 6 policies and programs and 11 in-depth interviews with key stakeholders. The findings were analyzed using the policy triangle analysis framework (i.e., context, content, actors and process). RESULTS: There is no conformity of the age ranges addressed by these documents nor are vulnerable groups explicitly recognized. Stress, anxiety and depression were commonly identified as mental health concerns and diverse platforms such as community, family, school, digital and health facility were recommended to deliver preventive and treatment interventions. Some interventions specifically targeted some social determinants (like safe and supportive schools) but many others (like social norms) were not addressed. Preventive interventions were recommended for delivery through peers and other non-specialist providers while treatment interventions were recommended for delivery in healthcare facilities by specialist health professionals. There was very little engagement of young people in the development of these policies or in their implementation, except for peer educators mentioned in one policy. Stakeholders identified several major challenges in implementing these policies, notably the lack of inter-sectoral coordination and fragmentation of governance; budgetary constraints; and scanty human resources. CONCLUSIONS: Although there are now several policy instruments testifying to a comprehensive approach on adolescent mental health, there are gaps in the extent of engagement of young people and how these will be operationalized that may limit their impact on addressing the burden of mental health problems in young people in India.
目的:心理健康问题和自杀是全球年轻人死亡的主要原因。印度是世界上青少年数量最多的国家。本研究旨在评估印度解决青少年心理健康问题的政策环境。
方法:我们对 6 项政策和计划以及 11 名利益相关者进行了深入访谈。使用政策三角分析框架(即背景、内容、行为体和过程)对研究结果进行了分析。
结果:这些文件所涉及的年龄范围没有一致性,也没有明确承认弱势群体。压力、焦虑和抑郁通常被认为是心理健康问题,建议通过社区、家庭、学校、数字和医疗保健设施等多种平台提供预防和治疗干预措施。一些干预措施专门针对一些社会决定因素(如安全和支持性学校),但许多其他因素(如社会规范)没有得到解决。预防干预措施建议通过同伴和其他非专业提供者提供,而治疗干预措施则建议由专业卫生专业人员在医疗保健设施中提供。在这些政策的制定或实施过程中,年轻人的参与非常有限,除了一项政策中提到的同伴教育者。利益相关者确定了实施这些政策的几个主要挑战,主要是缺乏部门间协调和治理碎片化;预算限制;人力资源匮乏。
结论:尽管现在有几个政策文书证明了青少年心理健康的综合方法,但在年轻人的参与程度以及如何实施这些政策方面存在差距,这可能限制了它们在解决印度年轻人心理健康问题负担方面的影响。
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