Interventions to mitigate psychosocial distress from a gender norms perspective

Meeting the psychosocial-related needs of adolescents 

There is growing awareness of the challenges facing adolescents in relation to mental ill-health and psychosocial distress, alongside greater awareness of the need to address mental health challenges more generally. One example is the welcome addition to the Sustainable Development Goals (SDGs) of the need to strengthen mental health by promoting ‘physical and mental health and well-being…for all’ with specific targets on mental health: 3.4, 3.5, and 3.8. There is also the WHO Mental Health Gap Action Plan, which aims to scale up national services for mental, neurological and substance use disorders, particularly in low- and middle-income countries (LMICS). 

Despite greater awareness, however, the needs of adolescents in this area are largely unmet, particularly in LMICS, with programmes often age and gender blind. Some countries may have some infrastructure and capacity (as well as appropriate policies) to address severe mental health disorders that are relatively recognisable, such as autism, schizophrenia or, epilepsy. Yet less severe forms of mental ill-health, including depression, anxiety and stress, often go unreported and untreated because they are more difficult to diagnose, are less visible, and because people may be unwilling to come forward because of the associated stigma, preferring rather to deal with it either at home or alone, as highlighted in Samuels et al. (2018). 

Programmes to address the underlying drivers of mental ill-health and psychosocial distress should include efforts to unpack and address the discriminatory gender norms that contribute to these challenges. Programmes to tackle early marriage, for example, should include discussion on how norms around the sexual purity of girls and restrictions of their mobility and freedoms can lead to isolation, depression, anxiety and fear. Ways to mitigate the impact need to be front and centre. 

A cadre of service providers with social work or psychology backgrounds is also critical to address these less severe forms of mental ill-health and psychosocial distress – a cadre that is often missing in many LMIC contexts. Similarly, there is a clear need for capacity building and for services that are tailored to the specific needs of adolescents, and indeed other age groups, as well as being gender sensitive. For example, adolescent girls are often fearful of, or unable to access, reproductive health services often because providers are male and may display patronising attitudes. 

More generally, service provision should be informed by an understanding of the prevailing gender norms that underpin much of the mental ill-health and psychosocial distress endured by adolescents, particularly girls, and that influence the extent to which they are able and willing to access services.