Youth mental health is a pressing global concern that transcends borders and economic divisions. We spoke to youth in Nigeria and Bolivia about the barriers they face in accessing mental health support and their aspirations for a future where mental health is prioritised and adequately addressed.
Young people in low and middle-income countries (LMICs) struggle with mental health, and stigma is hindering progress. Photo: Muhammad-Taha Ibrahim
In low- and middle-income countries (LMICs), where limited access to mental health services is combined with economic and environmental challenges, addressing youth mental health is paramount. Beyond the impacts of climate change, recent global economic and political crises have forced many young people into adulthood prematurely. The pervasive influence of social media exacerbates these issues, fostering a sense of shame regarding income and social status.
Access to mental health care and mental health professionals remains minimal in LMICs; alarmingly, only one in 27 people with depressive disorders in LMICs receive adequate treatment. Comprehensive national mental health policies and programs are urgently needed, but to effectively reach youth it is essential to have an understanding of their diverse experiences within their specific contexts.
“We are moving from childhood to adulthood, we are struggling a lot, trying to be social, trying to be present, dealing with school. We need to make major decisions with our career and everything and that is why we are in a moment where our mental health is vulnerable.” —Young Nigerian influencer
Stigma and other social and cultural factors still very much influence how people speak about mental health issues. For many young people, mental health is closely linked to spiritual or psychological afflictions. This deep-seated belief often prevents them from openly discussing their struggles or seeking professional help due to the fear of stigmatisation. In Nigeria and Bolivia, mental health challenges are often viewed as spiritual issues that can be addressed through prayer, or as severe psychiatric disorders afflicting only a few members of the community. This outlook discourages young people from seeking help and pushes them towards unhealthy coping mechanisms.
“When you ask your family and you’re coming out to them about the condition, families would turn you to spiritual homes and traditional groups,” said a Nigerian mental health professional and influencer.
Just because you speak, does not mean you are heard
While destigmatising mental health challenges might be a first step, another barrier facing youth is the ability to be or feel heard. Cultural norms that frequently dismiss emotions leave young people feeling ashamed of their feelings or hesitant to reach out for help. Both Nigerian and Bolivian youth told us how they often struggle to recognise their feelings and emotions.
This difficulty is compounded by daily challenges related to livelihood, demanding family expectations, and the complex experience of exploring their sexuality. In societies where sexual diversity is taboo, youth often feel isolated and unable to discuss these topics with adults, forcing them to process their feelings alone. This lack of support leads to poor understanding of their emotions, creating additional stress and confusion that overshadow their mental wellbeing.
“If a young person exhibits sad behaviour, they are usually taunted. ‘What have you seen in life to be tormented with the world’s burden?’ Mental health burden is not acknowledged in young people.” —UNICEF Nigeria health specialist
This challenge remains severely unaddressed. In Nigeria, local youth known as community brothers and sisters often take on the role of supporting their peers and helping them navigate their mental health. Inspired by this emergent community model, Education as a Vaccine (EVA) utilises peer groups as an integral part of its approach to promoting health and wellbeing among the youth. These peer groups are structured to provide a supportive environment where young people can discuss and learn about various health topics, including sexual and reproductive health, mental health, and gender equality. The peer groups typically consist of young individuals who are equipped and trained as peer educators or facilitators. Their role involves engaging with their peers through interactive sessions, workshops, and community outreach activities.
“It’s a fundamental principle for us and our counsellors that we are not judgmental; you just address their issues not from your personal bias but from the information they need to have,” explains an EVA representative. “We train our counsellors to provide age-appropriate information.”
Lack of support and trusted relationships strain the system
While friends and informal groups have become preferred sources of support, they are often ill-equipped to provide sustained, specialised assistance when it is required most. Young people experience loneliness during the transition from childhood to adulthood, facing challenges that parents, family members, and teachers often cannot relate to. Informal support groups made up of community brothers and sisters and friends fill gaps in national systems but may not address deeper emotional trauma.
Many young people lack trusted relationships and people to confide in. Photo: Muhammad-Taha Ibrahim
Even in more established health centres, many young people stop seeking support due to concerns about potential judgment and reprimands from staff. Confidentiality breaches are common, and inadequate training to provide mental health assistance to this demographic compound the challenges. As a result, their trust is eroded, and they are less likely to return to these facilities for any type of support.
“Adolescents want somebody they can trust; a friend [within the healthcare system], not just a mother,” according to the head of adolescent health at Nigeria’s Ministry of Health. “The attitude of health workers is not something that can work with adolescents; they lack empathy and therefore the adolescents turn away from health professionals.”
Nevertheless, teachers and religious leaders are in a unique position to bridge the gaps in the fragmented system by serving as key touchpoints to counsel and support young people, while also promoting mental health education among families. It does, however, require appropriate training and building back trust with youth.
The Mentally Aware Nigeria Initiative (MANI), which has implemented a comprehensive mental health program that harnesses youth engagement and community involvement, is one initiative that tries to address these challenges. The program provides extensive mental health training and workshops for schools, communities, and workplaces to destigmatise mental health and enhance literacy. Through counselling services, awareness campaigns, and peer support networks, MANI has successfully reached over 45,000 predominantly young people. Their efforts have cultivated a supportive environment where youth feel empowered to openly discuss mental health challenges and seek assistance without fear of discrimination.
MANI’s school- and work-based programs have fostered supportive environments, enabling young people to proactively address mental health issues within their communities. This approach not only bolsters resilience among youth but also fosters broader community understanding and support for mental health initiatives.
“What makes MANI more effective is that they are an organisation for young people; they are allowing youth to be at the forefront of their projects.” explains a young founder of a student mental health advocates program who is inspired by the MANI program.
Access to relevant and culturally attuned knowledge remains limited
Knowledge and awareness about mental health remain a privilege, largely determined by factors such as geographic location, family income, religious and cultural backgrounds, gender, sexual orientation, and community attitudes. Even though youth rely on social media for information, much of the content and services available seem distant from local realities, culture, language, and traditions, deeming them in most cases irrelevant.
The rich diversity underscores the importance of crafting adaptable interventions that resonate with specific local contexts, harnessing both offline and online approaches.
In settings with limited access to online resources, low-tech and no-tech initiatives have shown promise. In Bolivia, for example, the Familia Segura program—a free helpline offering psychological support—connects young people with trained psychologists who provide accurate mental health information, support, and rapid interventions for youth at risk of violence, in coordination with local authorities.
Initially launched by UNICEF’s protection office as an emergency response at the onset of the pandemic, Familia Segura has since become a permanent program. Its free helpline works even in rural areas or areas with low connectivity, so young people can reach professionals by phone. It employs human-centred design and community-based strategies to improve services and extend its reach to more rural areas.
This approach demonstrates that low-tech solutions can effectively address mental health needs, especially when they are integrated with community-based support systems. Such initiatives provide valuable lessons for developing similar programs in other LMICs, ensuring that mental health support is accessible to all youth regardless of their socioeconomic status or access to technology.
A path forward for a youth-centred mental health system
The young people we spoke with in both countries envision a robust and thriving mental health system. They envision a system that involves their communities, fosters their sense of value, creates reliable support networks, actively engages with them, equips them to effectively aid themselves and their peers, and encourages their leadership in influencing their mental wellbeing.
Crucial to this vision is the expansion of support beyond mental health professionals to include parents, teachers, community leaders, and even social media influencers. These figures can help young people recognise mental health concerns and develop strong social and emotional skills required to tackle daily challenges. While digital platforms hold promise in strengthening this support system, it is vital to actively engage young people in designing these services, addressing potential harms and inequities through a youth-centred approach.
Acknowledging that youth mental health is intertwined with our society’s fabric underscores its significance. This issue impacts not only their wellbeing but also has far-reaching implications for the future of our planet, particularly in LMICs, where these concerns often remain hidden.
Creating a support system that enables young people to feel valued and equipped to handle adult life is not just an act of compassion; it’s a matter of upholding their fundamental human rights.
*Sources have been anonymised
The opinions expressed are those of the author and do not necessarily reflect the position of Re:solve Global Health.
More information on the studies that informed this op-ed can be found in Dalberg Design’s work for UNICEF Innovation: Transforming Mental Health for Youth in Nigeria and UNICEF Bolivia: Diseño Centrado en Personas para el desarrollo de estrategias para Familia Segura.
María Alejandra Sandoval (Male), originally from Colombia, brings a unique perspective and global expertise to her position as design director at Dalberg Design. With over a decade of experience spanning service design, visual design, creative facilitation, and human-centred design, Male specialises in conducting research and crafting solutions at the intersection of climate resilience, rural livelihoods, and financial justice.
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