It can be quite distressing to experience the life changes occasioned by mental health challenges without an inkling of the root cause or remedial actions to address them. This is true for young adults or their parents. In many cases, the lack of insight into the mental health issues leads to social frictions in relationships between the young person and their families, friends and even the institutions to which they belong. Performance expectation gaps or behavioural shortcomings are easily attributed to a lack of seriousness or deviant behaviour. According to the World Bank, the first incident of most mental health episodes are traceable to the adolescent or young adult ages between 10 and 24 years. However, the symptomatic expressions are attributed to normal physiological and emotional maturation of the individual. The misdiagnosis and lack of attention to the psychosocial needs of the young adult at this stage of development have serious consequences on the future social and economic prospects, and in some cases are disabling to the achievement of an individual’s full potential. Approximately, 14% of all adolescents and young adults experience mental health problems with substance abuse, depression, anxiety and suicide among the leading debilitating health issues (World Bank, 2021).
Adolescent and Young Adult life – A tumultuous life phase
Rapid psychosocial, physiological, and cognitive developments are common with adolescents and young adults. These affects their perception and decision making. It is phase in which people are coming to terms with several changes including puberty; conscious interactions with social units (friends, families, colleagues, workplaces, institutions and governments); inclination to probe the rationale for existing beliefs, practices, institutions and systems; vulnerability to new ideas and influences and increased capacity for risk taking. They are also exploring adult behaviors such as going into romantic relationships and finding a job. The above experiences contextualize the mental health challenges and needs of this young population. People with mental health burden have the potential for increased Disability-adjusted life years (DALY), which denotes the number of years lost due to ill health, disability or early death. The leading causes of DALY in young people include unipolar depressive disorders, alcohol use disorders, self-inflicted injuries, schizophrenia and bipolar affective disorders. Also suicide is among the leading cause of death in young people across many countries. The poor mental health of young people can also be attributed to factors including diminishing influence of family, increased freedom, social media, societal expectations, social pressures, lack of mental health education and increase exposure to drugs and alcohol.
Mental health risk factors in adolescents and young adults
Many factors increase the risk of degeneration of mental health with co-morbidities, which could cause a downward spiral in the wellbeing of a young person. Early identification of these risks will facilitate the needed intervention in order to mitigate their propensity to cause major mental health issues. The risk factors associated with the top adolescents and young adults mental health conditions are highlighted below:
| Mental Health Condition | Biological Risk Factors | Psychological Risk Factors | Social Risk Factors |
| Depressive disorders | Family history and genetics, gender, poor nutrition, medication and substance abuse | History of trauma including emotional, physical and sexual abuse, personality traits, | Chronic stress, family conflict, neglect, unresolved grief or loss, bullying, poverty, migration, discrimination, |
| Substance abuse disorders | Family history of drug or alcohol use disorders | Emotional distress, aggressiveness and difficult temperaments | Early initiation into alcohol or drug use, peer substance use, failure within families to establish acceptable behaviors, poor supervision or monitoring, family conflict or poor relationships, parental tolerance of drug or alcohol use, poor grades in school, lack of commitment to school, drug availability and low cost, cultural values, media influencers, social rejection and economic status |
| Anxiety disorders | Gender, physical and mental health problems | Childhood trauma, negative life events | Education or work related stress, societal pressures |
| Suicide | Poor mental health, substance misuse, poor physical health | Self-harm, adverse childhood experiences | Academic pressures or worries, bullying, social isolation, hostile family environment, bereavement, relationship problems, neglect, deprivation |
| Managing the Risk Factors | 1. Awareness through education
2. Sound physical health 3. Age appropriate exposure to toxins and other harmful substances |
|
1. Open communication
2. Family monitoring and supervision 3. Family attachment 4. Positive reinforcement of achievements 5. Clear protocols in schools for dealing with anti-social behaviors 6. Counselling on academic and personal challenges 7. Education on available support |
Barriers to managing young and adolescent mental health problems in Nigeria
Adolescents and young adults face significant societal challenges in confronting the mental health issues. Stigmatization prevents families from seeking help from qualified mental health practitioners while a preference is shown by families towards attributing mental health challenges to spiritual attacks. It is also usual for sufferers to hide their conditions from friends and families as they present a macho front and mask any vulnerabilities. Educational institutions are also poorly equipped to identify individuals with mental health risk factors while there is a general absence of mental health support in educational institutions.
Medical practices have also hampered the development of a sound mental health environment in the Nigerian health sector. Only about 10% of the 25-30 percent population of Nigerians who suffer mental illness have access to professional services, while dedicated services for adolescents and young adults are rare. Many general practitioners do not have the training and confidence to recognize mental health conditions. Secondly the diagnosis of mental illness requires significant investment of time which many practitioners cannot afford. While there is growing awareness on the availability of care in private mental health institutions, this is not widespread to promote referrals in cases where the primary care provider is unable to manage the patient. It is also not uncommon for non-specialists to dabble into mental health management, leading to poor outcomes and degeneration of the patient.
Public sector investment in mental health has also been weak with only eight federal psychiatric hospitals in Nigeria. With a psychiatrist population of 262 (Association of Psychiatrists in Nigeria, 2024) for a country of over 200 million people, it is no surprise that many people with serious mental illness are unable to access care. Limited care availability has also been exacerbated by the continuous migration of certified psychiatrists to other countries for improved working conditions. In cases where care is available, cost could be an inhibiting factor in accessing it. Many managed care organizations restrict the coverage of mental health conditions because the financial burden could be significant, given the extended care requirement of some of the problems.
Conclusion
The economic wellbeing of the society is heavily dependent on the ability of the population to be productive to cater for themselves and the larger society. Mental health conditions significantly affect the disability-affected-life years (DALY) of individuals and these illnesses can be managed better if recognized during the adolescent and young adult ages, when they first emerge. Trust, communication, close support and care are critical at this stage.
