Rural Radio Program Becomes Mental Health Outreach to Youth

Greater investment in mental health around the world should have moved well beyond the talking stage by now, said Stan Kutcher, M.D., a professor of psychiatry at Dalhousie University in Halifax, Nova Scotia.

Aaron Levin

Kutcher spoke at a meeting convened in Washington, D.C., by the World Bank Group and the World Health Organization titled “Out of the Shadows,” an effort to make mental health a priority in the global development process.

“The 2001 World Health Organization report took mental illness out of the shadows, so at this point we should not be talking about investing in mental health; we should actually be investing,” said Kutcher.

Putting more into mental health systems, especially those targeted at young people in low- and middle-income countries, is critical, he said. Conditions that at onset among young people are mild to moderate in intensity, like depression and anxiety, respond very well to existing treatments.

“We’re the only branch of medicine that waits until stage 4 to offer intervention,” said Kutcher. “The problem is not that we don’t know what to do; the problem is that we’re not doing what we know.”

As infectious diseases decline as sources of morbidity and mortality in young people, noncommunicable diseases like mental illness will create an increased burden as the population ages without some interventions.

“It’s not good enough to put treatment in clinics,” he said. “Kids don’t wake up in the morning and decide to go to clinics, and they often don’t understand that they have a disorder.”

Kutcher discussed an approach tested in Malawi and Tanzania, where, as in many developing countries, half the population is under 15 years old. In the two African countries, Kutcher and colleagues from Farm Radio International and TeenMentalHealth.org developed an integrated pathway to mental health care and tested it with case-control cohort studies. The first step was the creation of melodramatic radio soap operas aimed at young people. Story lines about depression and other mental health topics were woven into the scripts. “Mental health by stealth,” Kutcher called it.

Listening clubs then were set up in schools where students gathered around a radio set. Teachers were taught to identify children with symptoms of mental illness and to train older children in ways to mentor younger ones. Finally local health care providers were trained in ways to screen, identify, diagnose, and effectively treat illnesses like depression and anxiety.

“The process reached 500,000 people on the radio and 15,000 in schools,” he said. “About 3,000 asked their teachers for help, and 1,000 were referred to community health clinics.”

Pre- and post-testing and comparison with control villages showed increases in knowledge about mental illness, decreases in stigma, enhanced help seeking, and better health care outcomes, he said.

In low- and middle-income countries, such locally delivered interventions can provide a disproportionate population dividend, said Kutcher. Early intervention and effective treatment of youth depression, for instance, can decrease premature mortality by reducing suicide, cardiovascular disease, and diabetes as the population ages. Early intervention also increases labor force participation and workplace productivity, benefiting both individuals and the society in which they live.

His experience in both Africa and Canada have led Kutcher to conclude that developing ways to improve access to mental health care can be assisted from the outside, but not imposed.

“We have to meet young people where they are, using their language and the vernacular of their subculture,” he said. “We also need to meet them in the institutions where they live, starting with schools. Better to invest in schools rather than jails.”

Finally, all community health care providers should have the competency to provide mental health care appropriate to their roles, he said.

“There’s no excuse today for any health care provider not to have the ability to screen, identify, and diagnose mental illness,” he said. “No medical professional should graduate without knowledge of mental health.” ■