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Applying the 4-S Framework to Address Adolescent Mental Health
The Department of Child and Adolescent Health and Developments 4-S Framework for
strengthening health sector responses to adolescent health and development provides a
strctre for initiatives to improve adolescent mental heath throgh!
"# $athering and sing strategic information
%# Developing spportive& evidence-informed policies
'# Scaling p the provision and tili(ation of health services and commodities
4# Strengthening action and linkages with other government sectors
)* sing mental health as an entr* point for addressing *ong people+s health& there is the
opportnit* for strengthening the response for related health pro,lems of p,lic health
importance# This is ,ecase depression& an-iet* and low self esteem can lead to e-cessive risk-
taking ,ehaviors which are often at the heart of pro,lems sch as ST.s inclding H./0A.DS&
nwanted pregnanc*& eating disorders& s,stance se and a,se& and accidents and in1ries#
2an* of these pro,lems are preventa,le and all are helped ,* ps*chosocial interventions#
1. Strategic nformation
3r aim is to gather the ,est epidemiologic and programme monitoring data related to
mental health pro,lems in adolescents& anal*se these and sed them for polic* formlation and
strateg* development# For this to happen& 2inistries of Health need firstl* to define a set of
indicators in each of the following areas!
Health otcomes! incidence and prevalence of ke* mental health pro,lems in
adolescents
)ehavioral data! risk ,ehaviors that cold contri,te to mental health pro,lems& and
protective ,ehaviors that cold protect adolescents from them and their conse4ences
Determinants! ,io-ps*cho-social factors contri,ting to mental health pro,lems
5rogrammatic data! appropriateness of interventions& and their 4alit* and coverage#
Secondl*& 2inistries of Health need to gather data& aggregated ,* age and se-& throgh
esta,lished health information s*stems& srve*s and stdies# Finall*& the* have to anal*se the
data and appl* these for advocac*& polic* formlation and strateg* development#
6e will spport 2inistries of Health to select the most appropriate indicators& and data
collection and anal*sis methods and tools# 6e will also spport them in data anal*sis and its
se for decision making#
!. S"pporti#e $#idence %ased &olicies
3r aim is that national- mental health policies and strategies& or the mental health
component of overall national health policies and strategies are gided ,* strategic information
and sond evidence# Frther or aim is that there are clear polic* statements calling for actions
,* different sectors to promote mental health& prevent mental health pro,lems and respond to
them if the* occr#
"
6e will spport 2inistries of Health ,* reviewing their polic* and strateg* docments&
and where appropriate helping them to strengthen these#
'. Ser#ices and (ommodities
3r aim that is adolescents with mental health pro,lems are identified in their
commnities and referred to primar* level health facilities where the* get the care and spport
the* need# Those adolescents re4iring speciali(ed care have to ,e referred to secondar* and
tertiar* level health facilities#
For this to happen& 2inistries of Health need to pt in place a continm of services
from the commnit*& throgh the primar* level to the referral level# At the commnit* level&
teachers& social workers and other non-health workers shold ,e ena,led to recogni(e pro,lems
and refer those adolescents who might need help to health services# At the primar* level& health
workers shold detect mental health pro,lems earl* and provide timel* treatment and spport
inclding conselling& cognitive-,ehavioral therap* and where appropriate& ps*chotropic
medication# At the referral level& a mlti-disciplinar* team shold deal with the ,io-ps*cho-
social and reha,ilitation needs of adolescents with serios mental health pro,lems# 3ne ke*
emergenc* service that shold ,e in place is care and spport for adolescents who harm
themselves or are at the risk of doing so#
6e will spport 2inistries of Health ,* providing them training& self learning and desk
reference tools for commnit* mem,ers and health workers# 6e will also provide gidance on
the 6H3 recommended essential medicines and spplies that are needed at the primar* and
referral levels& and on the referral networks that shold ,e pt in place#
4. Strengthening )ther Sectors
3r aim is that other sectors spport the efforts of the health sector to ena,le
adolescents to o,tain the mental health services the* need& and in addition make the important
complementar* contri,tions that the* need to& in order to promote mental health in
adolescents& to prevent pro,lems from arising& and to respond to mental health pro,lems
promptl*& effectivel* and sensitivel*# For this to happen& 2inistries of Health need to!
engage and spport other sectors- in particlar the edcation& social welfare& media&
emplo*ment and *oth and sports sectors - to make the important contri,tions that
the* need to
ensre that their actions are evidence ,ased& carried ot well& reach all adolescents and
especiall* those who are most vlnera,le& and are carried ot colla,orativel* with other
sectors
6e will spport 2inistries of Health in defining the contri,tions that other sectors need to
make& and in ensring that their actions are evidence ,ased# Here are some illstrative
e-amples!
Setting Sector Actions
Home Social welfare services 7dcating parents to help them nderstand the emotional needs of
adolescents and how to respond to these needs8 the natre of
mental health pro,lems that might occr and how to respond to
%
them as well as when and how to seek help#
Spporting vlnera,le adolescents and their families
School School staff )ilding individal assets sch as self esteem and life skills#
Discssing se-al health& in1ries and violence and s,stance se&
and promote health* attitdes and ,ehaviors#
2aking the school a safe environment 9i#e# free from ph*sical and
emotional violence: and a spportive one 9i#e# where stdents and
staff feel valed and spported:#
Training teachers to detect adolescents who might need help&
provide them with conselling spport& and refer those who need
medical help to health facilities#
6orking with social health services to identif* and provide spport
to those adolescents living in difficlt circmstances#
(omm"nity Commnit* leaders
and mem,ers
7ngaging and sensiti(ing commnit* leaders and mem,ers to help
create a caring and spportive environment for adolescents at risk
of mental health pro,lems& those with these pro,lems and their
families#
7ngaging and sensiti(ing commnit* mem,ers to intervene when
there is violence in homes and elsewhere in their commnities#
Training selected commnit* mem,ers to detect and refer those
adolescents who might need help to health services#
Media and new
comm"nication
technologies
2edia personnel Disseminating information on factors contri,ting to mental health
pro,lems in adolescents& on effective wa*s to prevent mental health
pro,lems and respond to them when the* occr& and on s,stance
se and mental health pro,lems#
5reventing glamori(ation of sicides#
'