15 October 2017

Improving mental health for Mongolia’s young people


As a school physician, Dr Naran regularly holds health lessons for children.
©UNICEFMongolia/2017/AriunzayaDavaa
Dr. Naran works in a school in remote Ulaan-Uul soum in Khuvsgul province, more than 900 km away from the capital, Ulaanbaaatar. As well as looking after the physical well-being of the children under her care, she has recently been trained to provide counselling.

“Once I started counselling, I realized what a high demand there is for it. It’s mostly girls who come asking for advice on reproductive health, like menstrual hygiene, or teenage acne. Ninth or tenth graders usually come for advice on STIs”, says Dr. Naran. “With cases of depression because of peer pressure, teenage crushes or boyfriend/girlfriend problems, our social worker and I work together. More serious cases are handled by a multidisciplinary team. Luckily, we haven’t had any serious cases such as self-harm or suicide.

Ulaan-Uul is a remote soum in Khuvsgul province, more than 900 km away from the capital.
©UNICEFMongolia/2017/AriunzayaDavaa
"I usually tell students about counselling by going into classes, or during physical check-ups”, she says. “I tell them they can approach me in person, or send an email, or write a note. I make sure to tell them that their privacy will be well protected. So the number of children coming for counselling is increasing.” 

Dr. Naran’s students are fortunate. In a country where more than 45 per cent of the population is under the age of 24 – 15 per cent of whom are adolescents – Mongolia is woefully lacking in adolescent mental health services. Yet depression and anxiety among teenagers is a growing problem. A recent study, the Adolescent Situation Analysis 2016, showed that in the last year, more than 21 per cent of young people between the ages of 13 and 15 have seriously considered killing themselves and 9 per cent have actually attempted suicide at least once. Adolescent girls in particular need attention: the 2013 Global School-based Student Health Survey revealed that 32 per cent of girls aged 16 and 17 have seriously considered suicide at some stage and more than 11 per cent have actually attempted suicide in the last 12 months. 

Children playing inside their school yard in Ulaan-Uul soum, Khuvsgul province.
©UNICEFMongolia/2017/AriunzayaDavaa
Though alcoholism, poverty, violence within the family and bullying at school continue to cause mental health problems, sources indicate that online bullying, grooming, sexual abuse, gaming-related mental disorders and drug abuse are now on the rise among adolescents.

Despite the seriousness of the situation, adolescent mental health services are underfunded by the Government, with few services and trained staff, and insufficient monitoring. 

Adolescence – a second window of opportunity

UNICEF recognizes that investing in young people not only benefits the current generation, but also helps to break the inter-generational cycle of poor health, poverty and discrimination. Adolescence also provides a second window of opportunity to reverse vulnerabilities that originated in childhood, including poor mental health.  For these reasons, adolescents are one of UNICEF’s priority target groups. It advocates for adolescents’ rights to health, influencing government policies, improving service delivery and empowering communities, including adolescents themselves.

UNICEF helped to put adolescent mental health on the policy agenda by supporting Mongolia’s first national conference on the topic in 2016. The conference brought together experts from the health and education sectors, children’s organizations, social protection law enforcement agencies, NGOs and academia. Recommendations were made to all relevant ministries and stakeholders to accelerate the process of setting up accessible and friendly services for adolescents in need.  

Counselling in local schools

Because of a dire lack of mental health professionals working directly with young people, UNICEF has also helped to train nearly 130 social workers, teachers, public health specialists and doctors – including Dr. Naran – to deliver mental health services to adolescents in Khuvsgul province and Nalaikh district. The course was based on a module developed by Mongolia’s leading academics, health and adolescent specialists and mental health professionals, with financial and technical support from UNICEF. Subsequently, UNICEF successfully advocated for this module to be embedded into the In-service Teacher Training Institute’s training programme in 2016, benefiting 60 first-year social workers around the country.  The course was also adapted as an interactive on-the-job training module for school social workers.

Dr. Naran first attended a training session in 2013, with a follow-up four years later. “The training taught me that my role as a counselor is not to tell students what to do, but to listen to them and guide them, take their concerns, experiences, and emotions seriously and try to be open and authentic.”

Dr Naran was trained by UNICEF to deliver mental health services to adolescents.
©UNICEFMongolia/2017/AriunzayaDavaa
After the first training course, Dr. Naran asked her school to provide better facilities for counselling sessions. Though the school was able to furnish a spacious office, it did not have the resources for other supplies, so UNICEF provided essential items, including a computer, a model of a human torso with removable organs for training purposes, and a hospital bed.

“We used to take notes by hand. Now that we have a computer, it’s so much easier to document cases and archive students’ records”, says Dr. Naran. “A spacious and comfortable room is also very important for having face-to-face sessions. Children need to feel relaxed and safe. These things matter when you speak to a child – I learned that at the training.”  

Encouraged by the success in Khuvsgul and Nalaikh, UNICEF will continue to train school social workers and doctors to address adolescent mental health issues, as well as high-level policy work to strengthen the legal environment for adolescent reproductive and mental health services. 

Author:
Ariunzaya Davaa
Communication Specialist
UNICEF Mongolia

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