Young people's mental health and cash transfer programmes

We argue that programmes in low- and middle-income countries should focus on vulnerable young people, including those with mental health conditions, and address not just their most urgent needs around food security and survival but also longer-term mental health impacts.

Why should we prioritise young people’s mental health during the Covid-19 pandemic?

Young people are particularly vulnerable to the mental health impacts of crises, such as pandemics, especially those living in poverty. They are more likely to be exposed to violence, exploitation, and social isolation, all of which exacerbate existing or create new mental health problems. [1] [2] Young people living in poverty are not only at risk of experiencing extreme poverty during the crises but are also likely to miss out on educational and employment opportunities. [3] [4] For example, after the 2001/2 economic crisis in Argentina, 75% of under 18s were living under the poverty line,[5] and whilst adult employment recovered to pre-crisis levels, youth unemployment only recovered slightly after the economic crisis.[6]

Is this really the time for investing into mental health?

Inevitably during crises, policy makers prioritise the most immediate concerns, such as providing food and medical care. Mental health is typically given lower priority, because of reduced awareness of its impact on mortality and morbidity.

However, crises also present opportunities, and experiences from past emergencies show that mental health can become a priority for system reform.[7] As government departments might have greater incentives to work together on system-wide responses, this also offers new opportunities for promoting long-term economic and mental health resilience in line with the United Nation Sustainable Development Goals.

How might cash transfer programmes improve youth mental health?

Although not always an intentional programme goal, cash transfer programmes can reduce suicide and improve mental health among adults [8] [9] and – if aimed at young people – reduce depression by up to 38 per cent.[10] [11] The ways by which programmes achieve such improvements are not yet well understood but include increased self-confidence, self-worth and hope that come along with being able to go to school and buy and do things they could not afford before.

How can cash transfer programmes integrate mental health?

Informed by evidence from cash transfer programme evaluations and mental health responses to crises and epidemics, we recommend the following five changes:

• Cash Transfer Programmes (CTPs) should specifically target vulnerable young people with or at risk of mental health conditions.
  
  
• CTPs should explore the provision of resources to support mental health and non-stigmatising information about COVID-19.
  
  
• CTPs can be designed to facilitate access to mental health support for young people.
  
  
• Mental health impacts should be considered when making decisions about the amount, duration and administration of CTPs.
  
  
• Evaluations of cash transfer programmes should include an assessment of their mental health impacts

The extent to which recommendations are applicable and can be implemented will depend on contextual factors in countries such as the existing mental health care infrastructure, welfare systems and other sectors such as education, as well as the characteristics and nature of CTPs. Similarly, recommendations apply differently for countries or regions depending on the state of the pandemic they are in.

About the authors

This blog was written by a team of international researchers, including global leaders in mental health and poverty research, who collaborate on a project called CHANCES-6 (http://www.lse.ac.uk/cpec/chances-6).

A detailed version has been published in Lancet Psychiatry and can be found here.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30382-5/fulltext

For more information

Funded by the Economic and Social Research Council and spanning six Latin American and African countries, CHANCES-6 seeks to clarify impacts of cash transfer programmes on young peoples’ mental health and to unpack mechanisms by which cash transfer programmes influence their mental health and life chances. The knowledge gained from CHANCES-6 seeks to inform the design of cash transfer programmes in order to optimise investments in resource or settings and by considering long-term economic and mental health impacts.

For more information contact Annette Bauer (a.bauer@lse.ac.uk) or Sara Evans-Lacko (s.evans-lacko@lse.ac.uk).

References

[1] Lee J. Mental health effects of school closures during COVID-19. The Lancet Child & Adolescent Health 2020; 4(6): 421.

[2] Save the Children. Children at Risk of Lasting Psychological Distress from Coronavirus Lockdown: Save the Children Releases New Survey Results. 2020.

[3] Marcus R and Gavrilovic M. The Impacts of the Economic Crisis on Youth: Review of Evidence. London. Overseas Development Institute, 2010.

[4] WHO. Impact of economic crises on mental health. Copenhagen, Denmark: World Health Organisation, Regional Office for Europe, 2011.

[5] UNICEF. Including Children in Policy Responses to Previous Economic Crises: The Case of Mexico’s 1995 Peso Crisis and Argentina’s 2002 Convertibility Crisis. Social and Economic Policy Working Paper. United Nations Children's Fund, New York, 2010.

[6] United Nations. World Youth Report 2007. Young People’s Transitions to Adulthood. Progress and Challenges. UN Department of Economic and Social Affairs, New York, 2007.

[7] WHO. Building back better: sustainable mental health care after emergencies. Geneva: World Health Organization (WHO), 2013.

[8] Ozer EJ, Fernald LC, Weber A, Flynn EP, VanderWeele TJ. Does alleviating poverty affect mothers’ depressive symptoms? A quasi-experimental investigation of Mexico’s Oportunidades programme. International Journal of Epidemiology 2011; 40(6): 1565-76

[9] Alves FJO, Machado DB, Barreto ML. Effect of the Brazilian cash transfer programme on suicide rates: a longitudinal analysis of the Brazilian municipalities. Soc Psychiatry Psychiatr Epidemiol 2019; 54(5): 599-606.

[10] Kilburn K, Thirumurthy H, Halpern CT, Pettifor A, Handa S. Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya. The Journal of adolescent health: official publication of the Society for Adolescent Medicine 2016; 58(2): 223-9.

[11] Baird SdH, Jocobus; Ozler, Berk. Income shocks and adolescent mental health. Washington D.C.: The World Bank Development Research Group, Poverty and Inequality Team, 2011.