Around 90% of the children and adolescents in the world live in lower- and middle-income countries, where they make up around 50% of the population [1]. Studies have suggested that approximately 13% of children and adolescents worldwide suffer with some form of mental health problem or illness [2]. We can see that a large proportion of children living in lower- and middle-income countries do, or will struggle with mental health, so let’s look at why preventing and treating mental health problems is so important.
Why is Mental Health so important?
Mental health has been shown to have long-lasting effects from childhood into adulthood and is a fundamental aspect of having good health and wellbeing [3]. Poorer mental health has been found to be associated with delinquency and substance misuse in adolescents, as well as behavioural problems and social emotional problems in children [4]. Not only this, but mental health has also been shown to have an influence upon a person’s social and economic outcomes across their entire lifespan [4]. This creates a negative cycle. Those living under poverty have an increased risk of developing mental illness, and those living with mental illness are at an increased risk of remaining in, or moving into, poverty [5]. This reinforced the cycle of poverty. WHO Mental Health and Development reported the importance of mental health as a developmental issue for lower- and middle-income countries [6], so what interventions can be done in these countries?
How can Early Childhood Education Programmes benefit Mental Health?
Early Childhood Education (ECE) programmes have been found to benefit mental health in children in many different ways. ECE’s have been shown to aid in developing children’s cognition and language development, which support good mental health and wellbeing during a child’s development [7]. Not only this, but ECE’s also have been shown to help children’s self-regulation, and social-emotional skills. Improving a child’s social and emotional competence has been shown to greatly reduce the likelihood of mental health issues [8]. ECE’s have also been found to help with children’s self-esteem and school behaviour, along with decreasing school drop-out rates, which can lead to positive behaviours and improved academic performance which in turn has a positive effect upon mental health [9][10]. A study looking at ECE’s found that 75% of ECE programmes found short term benefits to child mental health [11].
There are many types of ECE which can be beneficial to mental health, such as:
– Parenting Programmes
– Centre Based Programmes
– Educational Programmes
– School Based Programmes
School-Based Programmes
Improving the teacher-student relationship can have a positive effect in the classroom, along with the mental health of both the teacher and the students. Increasing teacher skills has been shown to reduce anxiety and increase motivation inside the classroom [4]. One example of this is the Irie Classroom Toolbox [12]. The programme aimed to reduce aggression amongst the children within the classroom as well as reducing the violence to children from teachers, in Jamaican preschools. This would lead to both positive peer and positive teacher relations for children, which would be thought to improve mental health [13]. As a result of the programme, a reduce in teacher violence was found, alongside a reduce in class wide child aggression [12]. These benefits were also shown to be sustained for at least one school year.
This suggests that school-based programmes such as the Irie Classroom Toolbox can help the prevention of mental health problems in children, by reducing negative risk factors such as teacher violence, and by promoting positive factors such as social and emotional competence throughout the classroom. The Irie Classroom Toolbox is a low-cost intervention, which means it can be integrated into the school systems of lower- and middle-income countries more easily and gives a higher cost-benefit analysis. This means more children can be reached for a lower cost.
Parenting Programmes
Parenting programmes are hugely important for child mental health interventions, as child-parent relationships can have such a big impact on a child’s emotional and social development [11]. Improving a parent or caregiver’s behaviour in regard to a child can have a large impact upon said child’s mental health. Not only can an improved relationship help the child’s mental health, it can also have a positive impact upon parental mental health, especially maternal, through increased self-confidence and self-efficacy [14]. A trial in Iran looked at the prevention of a negative relationship between mother and child, and therefore the prevention of poor mental health for both [15]. Mother’s of 2 to 6-year olds were taught parenting skills and common mistakes made within parenting, for 2 hours a session, for two weeks. This led to a reduce in parent-child conflict and abuse, as mothers reported an improvement in the children’s behaviour [15]. This kind of preventative intervention which focuses on the mother-child relationship has a positive impact on the mental health of both parties.
Conclusion
In summary, we can clearly see how mental health plays a big role in the wellbeing of children, especially those in lower- and middle-income countries, and why it is so important to protect children’s mental health [16]. It can also be seen how early childhood education programmes can be hugely beneficial to children’s mental health, particularly in lower- and middle-income countries where the cost of interventions is so important. Reducing the risk of mental health issues for a child means that they are less likely to carry those issues into adulthood, and therefore have more chance of breaking the cycle of poverty.
References
[1] Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta‐analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345-365.
[2] Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O., … & Rahman, A. (2011). Child and adolescent mental health worldwide: evidence for action. The Lancet, 378(9801), 1515-1525.
[3] Patel, V., Flisher, A. J., Nikapota, A., & Malhotra, S. (2008). Promoting child and adolescent mental health in low and middle income countries. Journal of child psychology and psychiatry, 49(3), 313-334.
[4] Barry, M. M., Clarke, A. M., Jenkins, R., & Patel, V. (2013). A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC public health, 13(1), 835.
[5] Lund, C., De Silva, M., Plagerson, S., Cooper, S., Chisholm, D., Das, J., … & Patel, V. (2011). Poverty and mental disorders: breaking the cycle in low-income and middle-income countries. The lancet, 378(9801), 1502-1514.
[6] WHO, M. (2010). health and development: Targeting people with mental health conditions as a vulnerable group.
[7] Lister-Sharp, D., Chapman, S., Stewart-Brown, S., & Sowden, A. (1999). Health promoting schools and health promotion in schools: two systematic reviews. In Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. Centre for Reviews and Dissemination (UK).
[8] Tennant, R., Goens, C., Barlow, J., Day, C., & Stewart-Brown, S. (2007). A systematic review of reviews of interventions to promote mental health and prevent mental health problems in children and young people. Journal of Public Mental Health, 6(1), 25.
[9] Weare, K., & Nind, M. (2011). Mental health promotion and problem prevention in schools: what does the evidence say?. Health promotion international, 26(suppl_1), i29-i69.
[10] Berlinski, S., Galiani, S., & Gertler, P. (2009). The effect of pre-primary education on primary school performance. Journal of public Economics, 93(1-2), 219-234.
[11] Baker-Henningham, H. (2014). The role of early childhood education programmes in the promotion of child and adolescent mental health in low-and middle-income countries. International journal of epidemiology, 43(2), 407-433.
[12] Baker-Henningham, H., Vera-Hernández, M., Alderman, H., & Walker, S. (2016). Irie Classroom Toolbox: a study protocol for a cluster-randomised trial of a universal violence prevention programme in Jamaican preschools. BMJ open, 6(5), e012166.
[13] Devries, K. M., Knight, L., Child, J. C., Mirembe, A., Nakuti, J., Jones, R., … & Walakira, E. (2015). The Good School Toolkit for reducing physical violence from school staff to primary school students: a cluster-randomised controlled trial in Uganda. The Lancet Global Health, 3(7), e378-e386.
[14] Cooper, P. J., Tomlinson, M., Swartz, L., Landman, M., Molteno, C., Stein, A., … & Murray, L. (2009). Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial. Bmj, 338, b974.
[15] Oveisi, S., Ardabili, H. E., Dadds, M. R., Majdzadeh, R., Mohammadkhani, P., Rad, J. A., & Shahrivar, Z. (2010). Primary prevention of parent-child conflict and abuse in Iranian mothers: A randomized-controlled trial. Child Abuse & Neglect, 34(3), 206-213.
[16] Grantham-McGregor, S., Cheung, Y. B., Cueto, S., Glewwe, P., Richter, L., Strupp, B., & International Child Development Steering Group. (2007). Developmental potential in the first 5 years for children in developing countries. The lancet, 369(9555), 60-70.
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