Overview

Children and adolescents are thinking and feeling beings with a degree of mentalcomplexity that is only now being recognized. While it has long been accepted thatphysical health can be affected by traumas, genetic disturbances, toxins and illness, ithas only recently been understood that these same stressors can affect mental health,and have long-lasting repercussions. When risk factors and vulnerabilities outweigh orovercome factors that are protective or that increase resilience, mental disorder canresult. Child and adolescent mental disorders manifest themselves in many domainsand in different ways. It is now understood that mental disturbances at a young agecan lead to continuing impairment in adult life.

Child and adolescent mental health includes a sense of identity and self-worth; soundfamily and peer relationships; an ability to be productive and to learn; and a capacity touse developmental challenges and cultural resources to maximize development (Daweset al., 1997). Good mental health in childhood is a prerequisite for optimal psychologicaldevelopment, productive social relationships, effective learning, an ability to care forself, good physical health and effective economic participation as adults.

However, a proportion of children and adolescents suffer from overt mental healthdisorders. A mental illness or disorder is diagnosed when a pattern of signs andsymptoms is identified that is associated with impairment of psychological and socialfunctioning, and that meets criteria for disorder under an accepted system ofclassification such as the International Classification of Disease, version 10 (ICD-10,WHO, 1992) or the Diagnostic and Statistical Manual IV (DSM-IV, American PsychiatricAssociation, 1994).3Examples include: mood disorders, stress-related and somatoformdisorders, and mental and behavioural disorders due to psychoactive substance use.Community-based studies have revealed an overall prevalence rate for such disordersof about 20% in several national and cultural contexts (Bird, 1996; Verhulst, 1995).

Some children and adolescents are in difficult circumstances; for example, they mightexperience physical, emotional and/or sexual abuse, experience or witness violence orwarfare, suffer from intellectual disability, slavery or homelessness, migrate from rural tourban areas, live in poverty, engage in sex work, be addicted to substances such asalcohol and cannabis, or be infected or affected by HIV/AIDS. Difficult circumstancesand mental health problems can be interrelated in a number of ways. They could, forexample, serve as risk factors for mental health problems, such as post-traumaticstress disorder in a child who has been sexually abused. Alternatively, mental healthproblems could serve as risk factors in difficult circumstances; for example, when anadolescent uses alcohol or drugs to deal with depressive feelings. Whatever the natureof the relationship between mental health problems and difficult circumstances, specificintervention strategies are necessary to address children’s and adolescents’ needs.