Peak disease burden for chronic physical health conditions1 typically occurs in an individual’s 50s and 60s, whereas the prevalence of mental and substance use disorders peaks much earlier—in an individual’s 20s or 30s. About half of all mental disorders appear by age 14, and three-quarters by age 24. When left untreated, these conditions can negatively affect lives and livelihoods. That’s why early diagnosis and intervention are critical for adding years to life and life to years for millions of children and adolescents.
As part of the McKinsey Health Institute’s (MHI’s) Conversations on Health series, Erica Coe and Kana Enomoto, coleaders at MHI, discussed this challenge and how to prioritize the mental health needs of children and adolescents with Zeinab Hijazi, PsyD, the global lead on mental health at UNICEF. In this capacity, Dr. Hijazi works with governments and other stakeholders around the world to advocate for policies to address the mental health needs of children, adolescents, and families in humanitarian and development settings. This includes policy, data, research, and advocacy work at UNICEF headquarters. It also includes supporting coordination across sectors to aid country teams and partners, as well as designing and implementing locally relevant and sustainable strategies. Dr. Hijazi has 18 years of experience supporting community-based mental health and psychosocial programs globally.
This interview has been edited for clarity and length.
Erica Coe: “Mental health is a universal human right” was the central theme for the 2023 World Mental Health Day. What does that phrase mean to you?
Zeinab Hijazi: UNICEF has formally identified mental health as a key priority. We have a mandate to work with governments to gain their buy-in on the importance of mental health, and to see that buy-in translated into policy changes. So “mental health is a universal right” is more than just a statement for us; it is a fundamental principle guiding our actions and our commitment to ensure every child has quality, accessible, and affordable mental health services.
Mental health, especially of children and adolescents, has long been stigmatized, overlooked, and underfunded on a global scale. Our mission includes initiating dialogues, taking actionable steps, and investing in communities to enable children to realize their right to mental health.
Neglecting mental health and psychosocial development not only violates children’s rights under the UN Convention on the Rights of the Child,2 but it can also adversely affect their health, learning, and future economic prospects. Incorporating mental health into all policy areas is a cornerstone of our approach.
Furthermore, it is essential to meet young people where they are, by integrating services across health, social services, education, justice, and other entry points in the community. Parents and caregivers play a pivotal role in this model, so we also focus on programs that support the mental health and psychosocial well-being of parents and caregivers—including teachers—and support schools in building social-emotional learning and mental health literacy into the curriculum. We aim to build a supportive ecosystem around children at home, in schools, and in communities.
Importantly, meaningfully and safely engaging young advocates and individuals with lived experiences is central to a mental health human rights strategy. By giving a voice to these young people and caregivers, we not only make our programs more impactful but we also champion a rights-based approach to mental health that is transformative, inclusive, and empowering.
Erica Coe: What issues related to mental health and substance use in adolescence should be top of mind for stakeholders right now?
Zeinab Hijazi: From a UNICEF perspective, our approach to addressing the critical issues surrounding mental health and substance use is rooted in a deep understanding of the unique challenges adolescents face, especially during this sensitive developmental period. First, stakeholders should acknowledge that adolescence is a time when the initiation of substance use and the onset of mental health issues are most pronounced and very often come hand in hand. Adolescence is a pivotal stage in life, and we prioritize the development of targeted prevention programs that cater to the specific needs of adolescents. We also recognize and urge stakeholders to recognize the profound impact of family substance use on children’s mental health and their physical well-being. Our efforts extend to addressing these familial dynamics when appropriate.
The second issue for stakeholders is closing global evidence gaps, particularly regarding the effectiveness of various substance use prevention activities. Much of the available data is drawn from high-income countries and adult populations. We urge governments and the broader stakeholder community to commit with us to bridge these gaps by designing context-specific interventions that consider the unique challenges faced by adolescents in diverse settings.
Recognizing the significance of family dynamics in an adolescent’s life is critical. Our programs need to involve skills building not just for adolescents but also for parents, and encourage positive family interactions as a key component of substance use prevention and mental health support. Furthermore, children spend most of their time in school. Schools play a central role in the lives of adolescents, and we need to advocate for comprehensive school-based prevention programs, counseling services, and early-intervention support to effectively address substance use and mental health challenges within the educational setting. To reiterate my earlier point, it’s about meeting young people where they are in the community and setting up services across that continuum of promotion, prevention, and care.
Kana Enomoto: How do we create the conditions to attain these goals?
Zeinab Hijazi: At UNICEF and other multilateral organizations, we are working globally to incorporate mental health considerations into every area of policymaking. Think of it as a thread that runs through the fabric of all our social structures. It affects not just their psychological well-being but also their learning, their development, and their capacity to connect and contribute to society.
This year’s Global Mental Health Summit in Argentina, with its focus on mental health and policies, was timely and necessary. It afforded us an opportunity to deliver our messaging and requests primarily to a ministerial and government audience, including nonhealth representatives. Our mandate is to work with governments to exert influence and gain their buy-in around the importance of mental health—and to see that buy-in translate into changes in policies that support services for mental health for children, families, and the broader community. Ministries beyond health must be involved in, and accountable for, policymaking about mental health.
At the summit, we heard from countries that are engaging across ministries to inform a comprehensive approach to mental health. We discussed investment strategies, tackling stigma and discrimination, and the need to focus on localized research that addresses specific communities. We also discussed the imperative of including children, youth, and caregivers with lived experiences in a leadership capacity when shaping mental health policies and programs.
Kana Enomoto: What gives you the drive, empowerment, and hope you need to keep fighting for change?
Zeinab Hijazi: What truly gives me hope and inspires me to keep advocating for change is the incredible potential and energy of young people. Every day I become more convinced of the necessity to truly engage young people as cocreators and innovators in mental health. We need to empower them with the skills to ask the right questions and gain the knowledge to answer them effectively, as well as to understand the power of their own voice and the confidence that comes from demanding change as part of a community. The rising generation can really help propel advancements in mental health. I started in this field when I was 21 years old, and I am so humbled and honored to have had mentors who guided me and invested in my career and success. Now it’s our turn, collectively, to do the same for the younger generation.
