Precision Mental Health Support = When exactly to Intervene to save Most Young People from Deeper Anxiety and Depression

Peer-support has existed in the form of good #friends since the beginning of time. In this article, we will review these informal relationships based on context and society, with the aim to optimize friendships between peers to better the mental wellbeing of youths (aged 13-25)

In such an instance, while friends abound and peers are many, we are focusing on a specific type of peer-support. Someone who is psychologically trained, a first aid responder, and a partner in the journey of youth mental health, as well as being a participant in that same journey and challenge of mental wellbeing themselves. The peer-supporter is then both the participant and provider.

This is Article 1: WHEN (1/3 Articles in a Series)

1. When to peer-support
2. Who are the peer-supporters and the context of peer-supporting
3. How to peer-support on a Digital Platform?

WHEN

Precision: Self Care to Critical Care

In Precision Medicine, the dosage and the timing matters to the success of the treatment of an individual. As such, I am highlighting that in order to be more effective with fewer peer-supporters and their limited volunteer time, the trained psychological view would be to place emphasis on training peer-supporters for CRITICAL INCIDENCES and to identify possible PERSONAL DISPOSITIONS in peer-users for more effective interventions based on needs analysis.?

Mental Health in the World Today:

“Half of all mental health conditions start by 14 years of age, but most cases are undetected and untreated,” according to the World Health Organization, which also says suicide is the fourth leading cause of death among teens aged 15 and 19 worldwide.

In China, an estimated 24.6% of the country’s teenagers live with some form of depression, according to the latest report on mental health published by the Institute of Psychology under the Chinese Academy of Sciences. As many as 7.41 million children aged between 4 and 16 are said to suffer from mental or behavioral conditions, according to media reports citing a survey, while a separate report published in 2019 estimated that nearly 100,000 minors died from suicide annually.

In the United Arab Emirates, neuropsychiatric disorders contribute an estimated 19.9% of the burden of disease. Seventy-five per cent of these psychological conditions are associated with depression and anxiety. The burden of mental illness in the UAE is exacerbated by risk factors associated with a young population and the increasing burden of non-communicable diseases (NCDs).

In 2019, the American Academy of Pediatrics issued a report noting that “mental health disorders have surpassed physical conditions” as the most common issues causing “impairment and limitation” among adolescents. In December, the U.S. Surgeon General, in a rare public advisory, warned of a “devastating” mental health crisis among American teens. But the medical system has failed to keep up, and the transformation has increasingly put emergency rooms and pediatricians at the forefront of mental health care. Community doctors now routinely deal with complex psychiatric issues, making tough diagnoses after brief visits and prescribing powerful psychiatric medications for lack of better alternatives. “Pediatricians need to take on a larger role in addressing mental health problems,” the 2019 A.A.P. report concluded. “Yet, the majority of pediatricians do not feel prepared to do so.” Dr. Dennison, 62, has adapted. Two decades ago, she routinely prescribed antibiotics and saw patients with “strep throat, earaches and wheezing,” she said. “And no one heard of A.D.H.D.,” she said, referring to attention deficit hyperactivity disorder. She estimated that, back then, 1 percent of her cases related to mental and behavioral health; now at least 50 percent do.

The causes of this crisis are not fully understood. Experts point to many possible factors. Lifestyle changes have led to declines in sleep, physical activity and other healthful activities among adolescents. This generation professes to feeling particularly lonely, a major factor in depression and suicide. Social media is often blamed for these changes, but there is a shortage of data establishing it firmly as a cause.

“We need to see mental health through a prevention lens and stop seeing physical health as different than mental health.”

Proposed THEORY OF CHANGE MODEL: Based on Critical Incidences Intervention and Pre-Critical Incidence Peer Support

The intervention points are commonly acknowledged eg.? O Levels (a major examinatio for Commonwealth countries) results day - Singapore teachers in some schools are posted to patrol the top floors of schools to ensure no student jumps off post poor results.

For the purposes of understanding the life span of peer-support, this author purports a maximum of two critical incidences within a developmental stage for the average person.?

If the model above is accepted, then the peer-user and the peer-support team (peer-supporter, peer-support moderator, peer-support leaders, supervision team) would have been trained for critical incidences prior to the incidence occurring. A good comparison would be like preparing for an? “Emotional/Life Incidence Fire Drill”.

The peer-support provides the peer-user life skills to deal with future crises, even if the life stage is different. This author purports there is an underlying set of resilience skills that can cut across different types of critical incidences’' points.

(to be continued in Article 2: Who?)

APPENDIX:

Glossary of Terms:

Disposition

- n. a recurrent behavioral, cognitive, or affective tendency that distinguishes an individual from others.

Personal disposition

- Gordon W. Allport’s term for a personality trait: any of a number of enduring characteristics that describe or determine an individual’s behavior across a variety of situations and that are peculiar to and uniquely expressed by that individual. Personal dispositions are divided into three categories according to their degree of influence on the behavior of the person possessing them. Cardinal dispositions (or cardinal traits), such as a thirst for power, are so pervasive that they influence virtually every behavior of that person; central dispositions (or central traits), such as friendliness, are less pervasive but nonetheless generally influential and easy to identify; and secondary dispositions (or secondary traits), such as a tendency to keep a neat desk, are much more narrowly expressed and situation specific.

Critical incidence

(Author's Acting definition) -? a period of crisis in a life stage that could present a mental health challenge for that stage of life (e.g. O-level exams at 16, poor results could lead to attempts at self-harm)

Peer support

- Peer support is defined as “the linking of people living with chronic conditions, e.g. diabetes. People with a common illness are able to share knowledge and experiences, including some that many health workers do not have.” [Definition from In-Health MOHT.]?

My variation for Youth Peer Support:? “the linking of 13-25 year olds with a common shared history and current context (eg Students, Mental Health Conditions, Grief, Children of Addicts) who? are able to share knowledge and experiences, for self awareness and self management through the stressors of life.

Intervention

- n. generally, any action intended to interfere with and stop or modify a process, as in treatment undertaken to halt, manage, or alter the course of the pathological process of a disease or disorder.

Tech Solutions for Peer Support Training

myPAL was created for the Ministry of Health Transformation office with the vision to help Singaporean youths (aged 13 - 25) be better peer-supports to each other and in doing so, ease the burden of burnout in counsellors,?#therapists ?,?#socialworkers , and?#healthcare ?leaders. Young people prefer to ask peers for help in times of confusion and crisis. However, expecting young people to be a peer-support to another person without the right psychological and self-care skills is unfair and challenging. They will likely be overwhelmed and withdraw from being peer-supporters.?

Thus, myPAL seeks to address mental health with a prevention lens, by providing digital and scalable professional training to peer-supporters. Peer-supporters and peer-users will be able to converse anonymously, with personalised on-the-job training and improvement provided for each peer-supporter by identifying gaps in their skills, as well as an e-learning curriculum for all. The e-learning is essential to scaling peer-support by a) improving and raising standards in peer- support conversations and b) increasing numbers of trained peer-supporters internationally to meet the mental health needs of youths.

The anticipated pilot will be with undergraduate nurses and medical students from the National University of Singapore. We will be using the?I’m Friendly Co ?platform and lessons from?Clanbeat ?eg.?Video lesson on Worry and Anxiety - Clanbeat

If you’d like to help transform myPAL to reality or simply learn more about the project, please contact Marion at?[email protected] .