Poverty reduction, mental health and the chances of young people: understanding mechanisms through analyses from 6 low- and middle-income countries

Lead Research Organisation: London School of Economics & Pol Sci
Department Name: Personal Social Services Research Unit

Abstract

Poverty and mental health are closely linked. In low- and middle-income countries (LMICs), young people in poverty have a high risk of developing or maintaining mental health problems. The stress and environmental conditions associated with poverty increase the risk of mental health problems. Additionally, the disability and high costs faced by people with mental illness can maintain poverty.

Currently, most evaluations of antipoverty interventions focus on socioeconomic or general well-being outcomes, but rarely examine the effects on mental health. At the same time, the main focus in the field of global mental health has been to improve access to treatment, but with little focus on the impact of interventions on future life chances and poverty.

This study aims to (1) understand the mental health impact of antipoverty policies and (2) how mental health interventions influence the life chances and risk of poverty amongst young people. To do this, we will use multiple interdisciplinary methods to understand the costs and the impact of potential interventions and associated pathways to improved life chances. We will analyse seven different datasets from six low- and middle-income countries.

We will also collect qualitative data from interviews and focus groups with young people from economically deprived circumstances. Qualitative data will provide information on: (i) experiences and meaning of poverty and mental health problems, (ii) personal experiences of being involved in antipoverty programmes or receiving mental health interventions, (iii) challenges or barriers to engaging with the antipoverty and mental health interventions and (iv) ideas for future interventions.

Additionally, from the start of the project, we will work together with community members: young people from deprived circumstances, service users, health practitioners and policymakers. Workshops will help us to gather insights into how our findings can be used to develop and test new interventions, for example by combining mental health and poverty programmes.

Mental health problems are common among young people from economically deprived circumstances in LMICs and it is known that experience of poverty and mental health problems can have long lasting effects into adulthood. Providing more effective intervention during this period could be help reduce the impact of poverty and / or prevent mental health problems early in life, thus increasing future life chances, including opportunities for education and employment.

Planned Impact

Who will benefit from this research?

The main intended beneficiaries of this research include two broad groups:
1. Policy makers and youth policy advocates concerned with the social, economic and health circumstances of young people in LMICs (intermediate beneficiaries).
2. Young people from economically deprived circumstances in low and middle-income countries who stand to benefit from improved programming and life chances as a result of receiving these interventions (ultimate beneficiaries).

We will work together with stakeholders to develop a theory of change map which sets out the pathways by which we propose these two main beneficiary groups will engage with and use research generated by our project. Although the two groups are separated temporally (i.e., policymakers are intermediate and young people ultimate beneficiaries), we believe it is essential that both are consulted early in the research process. For example, to develop interventions and programmes suited to young people, it is vital that beneficiaries are consulted from the outset in the design and evaluation of the interventions and programmes. If funded, our project will, during the first year, engage with young people in Brazil, Colombia and South Africa through focus groups and individual interviews. We will elicit young people's views on the project, potential interventions, and their evaluation in a collaborative, respectful manner. We will then consult with the same groups in the final year, to present findings and to obtain feedback on how these might be used and taken up in policy and practice.

We have extensive experience working with policy partners and advocates in this collaborative manner. For example CL is currently CEO of PRIME, which engaged actively and early with policy partners in Ministries of Health in 5 countries at the start of the programme in 2011, setting the stage for a fruitful, long term partnership which is still ongoing (Lund et al., 2012). In Brazil, CP works closely with the national ministry of health to promote youth mental health priority setting and AM plays a key role in youth advocacy organisations. In Colombia, PH has excellent links with policymakers, especially in relation to antipoverty programmes through the evaluation of the national pensions programme.

How will they benefit from this research?

Policymakers and youth policy advocates will benefit by receiving new knowledge on costs and likely impacts of poverty alleviation and mental health interventions on life chances of young people in 6 diverse LMICs. However, there are a number of assumptions regarding this process, which we will need to manage. First is the assumption that the research will generate knowledge that is relevant to the local context; second that policymakers and youth advocates will have the necessary skills and motivation to use findings; third that if it is used that the interventions that are subsequently developed and delivered will be appropriate for the local setting; and fourth that if relevant, used and appropriate, that these interventions will yield concrete benefits for the second major beneficiary group, namely young people living in LMICs. To address each assumption we will first consult early with policy partners in Brazil, Colombia and South Africa, as well as our international Scientific Advisory panel regarding the policy needs and questions relevant for these countries; second we will during this process conduct a needs assessment regarding the capacity of policymakers and youth advocates to utilise and implement the products of the proposed research; third during the course of the current research we will not develop or evaluate any new interventions, but will use findings to develop proposals for new interventions in future grants, for example integrating mental health and antipoverty interventions, based on the knowledge we generate in this study regarding likely mechanisms and context-specific constraints.

Publications

10 25 50
 
Description We find that cash transfer programmes are an important policy opportunity to reduce poverty and improve youth mental health, increasing future opportunities and life chances; however, cash transfers on their own are likely insufficient for improving mental health and life chances of youth. This is based on a systematic review of the literature, and quantitative analysis and qualitative analysis from our own study. It is likely that improving youth mental health and life chances, involves complex pathways and mechanisms, including, for example, through reductions in household stress, maternal and paternal mental health problems, domestic violence, community violence, etc. Thus, there is clearly room for optimisim. Our findings suggest that it is important to try to understand how to potentiate their benefits for youth mental health alongside anti-poverty initiatives. In this vein, it is important to consider how we might incoporate youth mental health promotion, prevention and treatment interventions to complement cash transfer programmes and more specifically target youth mental health and associated mechanisms.
Exploitation Route We have already shared findings with local and national stakeholders in each of the participating sites and we are further planning a large public event including participation from global organisations such as the World Bank, WHO and UNICEF. We believe that our findings could be used in further planning of mental health policy and also planning around social protection and anti-poverty programmes and in particular how these areas might be better integrated in practical and policy terms. Moreover, the research findings will also inform further (ongoing and planned) research programmes, in particular around intervention development and piloting.
Sectors Education,Healthcare

URL https://www.lse.ac.uk/cpec/chances-6
 
Description The project is benefiting from building on existing partnerships and developing new partnerships across countries and with global agencies. Partners have engaged with stakeholders through facilitated workshops organised as part of the CHANCES-6 project. Partners also engaged with wider activities around youth mental health and the role of poverty, for example in community outreach events, in meetings with policy-makers and through radio and TV interviews, and newspaper interviews and features. For example, in Brazil and South Africa, partners organised two policy workshops at the beginning of the project to introduce the research and the end of the project to present the results and receive feedback from research experts and policy-makers. Findings from the CHANCES-6 project were presented at a number of conferences including the World Psychiatric Association annual meeting, International Early Psychosis Association meeting (2021), Population Association of America's Annual meeting (2022), IPA Annual Research Gathering (2021), Psychology and Economics of Poverty Convening (2022), and presentations to the UN Human Development Report Office (2021), the Chinese University of Hong Kong Institute (2021) of Health Equity Webinar (2021) and the Indonesia World Mental Health Day Webinar (Oct 2021). Partners also presented on CHANCES-6, at other related project meetings on related topics to discuss synergies and exchange knowledge more broadly. This has already led to some important collaborations, which are expected to be developed and strengthened over the coming years. This includes collaborations with the Bertha Centre for Social Innovation and Entrepreneurship in South Africa, where researchers from CHANCES-6 were invited to be part of the Youth Innovation programmes Psychosocial Support Advocacy campaign in Cape Town. As mentioned, country teams have also organised launch events to publicise the project and engage stakeholders early in the project. In South Africa and Brazil, final stakeholder events were held in late 2021 and early 2022 and provided an opportunity to discuss and reflect on research findings and discuss future policy implications. In South Africa, this included stakeholders from Ministries of Health, Social Development, Basic Education, as well as stakeholders from the Centre for Social Development in Africa and the South African Social Security Agency. In Brazil this included stakeholders from the Ministries of Health, Local (São Paulo) Social, Health and Law Departments, as well as researcher and young people representatives. In terms of youth engagement, young people living in poverty have been invited to share their personal stories and views about the project. Films have been produced, which are currently shared on the CHANCES-6 website and via social media. They are powerful stories of the views of young people, whose voices are rarely heard, around mental health, poverty and their life chances, highlighting the many interconnections and the importance of addressing them together. We plan to continue sharing these stories as they link with ongoing research projects and also at relevant meetings and conferences, to ensure long-term impact. New Wellcome Trust funding for the Alive project which follows on from CHANCES has a strong youth engagement component which also follows on from the CHANCES-6 work. Alive is building on the CHANCES-6 work to continue engaging with youth in an ongoing way, including through establishing Adolescent Advisory Groups in each participating country. There have also been impacts on early career researchers and students who are linked with the project, including students from the London School of Economics and Political Science, the University of los Andes in Colombia and Mackenzie Presbyterian University. Students at these universities were interested in approaches to measure the impact of poverty on youth mental health and becoming involved in CHANCES-6 research. They worked on project outputs including impact-related activities such as through supporting organising stakeholder events, producing the films, writing blogs and articles, conducting interviews and supporting the analysis of interpreting research findings. As part of the CHANCES-6 final cross-country event, we have invited leaders from the World Bank, World Health Organization, and also youth beneficiaries to reflect on the findings of CHANCES-6 from their differing perspectives. Steps have been taken to sustain and build on CHANCES-6 impacts through follow-up research projects in youth mental health and poverty. The ALIVE project, led by the South African partner at University of Cape Town, is a large research study which, building on the knowledge gained from CHANCES-6, together with other knowledge and evidence, will develop a mental health intervention for young people living in poverty spanning Colombia, Nepal and South Africa. The research also benefits from youth involvement structures or knowledge that was developed as part of CHANCES-6 by the London School of Economics and Political Science, the University of los Andes and the University of Cape Town. In Brazil, a new Research Center (Mackenzie Center for Research about Children and Adolescents) will be launched in the following months that will support follow-up projects linked with CHANCES-6, including youth engagement. Opportunities to engage with the development of national policies plans are being taken in Colombia and South Africa, where country partners have been engaging in policy discussions relevant to CHANCES-6. For example, colleagues have been joining discussions as part of national policy meetings. Through the contacts with the government due to the CHANCES-6 project, the Colombian research team was actively involved in the drafting of the first comprehensive government strategy for mental health, approved in 2021. In South Africa, members of the CHANCES-6 team have contributed to a national investment case for mental health, and findings from CHANCES-6 will be used to inform the development of a new national Mental Health Policy, as the current mental health policy framework (2013-2020) has now lapsed. Findings around the need to address social determinants of mental health and to link mental health interventions with poverty reduction strategies such as the Child Support Grant will be included in recommendations to the new policy development process in South Africa. Various social media and regular media work has been used to support the wider promotion of CHANCES-6 and the dissemination of findings. This includes a website, which provides various information and resources about the project and about youth mental health and poverty. A film has been produced by the research team which explains the project. A Twitter account has been created for the project from the outset and used to share project updates and relevant resources, and to connect with stakeholders who are active in the field. Several blogs and commentary papers have been written to channel some of the messages of CHANCES-6 and the importance of addressing the relationships between mental health and poverty among young people. A commentary was written and published in Lancet Psychiatry which discussed the relevance of CHANCES-6, particularly during the Covid-19 pandemic. Other outputs included blogs and papers read by non-academic audiences, including in-house journals and websites of London School of Economics and Political Science, Mackenzie Presbyterian University, Universidad de los Andes and the University of Cape Town. As a research project, CHANCES-6 responded swiftly to the new pressures caused by the Covid-19 pandemic, for example changing from in-person to online meetings and research activities. Cash transfer programmes were expanded during the pandemic and we used channels such as the Lancet Psychiatry commentary to highlight possibilities for using policy changes to address youth mental health. We also pivoted to add exploration of the impacts of COVID-19 on the mental health and life chances of young people in our qualitative research.
First Year Of Impact 2022
Sector Communities and Social Services/Policy,Healthcare
Impact Types Societal,Policy & public services

 
Description Active participation and Inputs to drafting of "Colombian National Mental Health Strategy"
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact We were able to directly influence the Colombian government in changing three key aspects of the national policy for mental health: 1) The original draft document did frame mental health disorders primarily as a disease being the consequence of individuals' exposure to traumatic events. This implies that preventing and treating mental health disorders is primarily the responsibility of individuals, rather than the society at large. Over the course of several months we were able to convince the representatives of the government that mental health should be considered not as an individual pathology, but as a phenomena that is socially embedded and affected directly by the social and economic context (e.g. it is well established that phenomena such as violent conflict and economic crises have a direct effect on mental health). This change in the overall framing on mental health which was reflected in the introductory chapters of the national mental health policy has important implications since it shifts the responsibility for preventing and treating from the individual to the society at large. 2) The original draft of the policy did not make any reference to socioeconomic inequalities in mental health. However, given our ongoing work on this topic, we did successfully lobby the government to explicitly make reference to this issue in various chapters of the national policy. This has important implications for the distribution of resources in the future and provides a key reference for advocating improvements in mental healthcare for disadvantaged individuals and communities. 3) We did successfully convince the government of the importance to explicitly mention the economic case for investing in mental healthcare, i.e. due to increased productivity of individuals with better mental health. According to several members of the task force this argument was important in the negotiations with the different ministries in negotiating concrete financial commitments from each sector, including transport and finance, for the mental health strategy that are mentioned in the national strategy.
URL https://colaboracion.dnp.gov.co/CDT/Conpes/Econ%C3%B3micos/3992.pdf
 
Description ALIVE: Improving Adolescent mentaL health by reducing the Impact of poVErty
Amount £2,010,416 (GBP)
Funding ID 221940/Z/20/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 06/2021 
End 06/2026
 
Description Improving mental health and human capital: developing a mental health intervention for 'Youth in Action' programme in post-conflict areas in Colombia
Amount £338,045 (GBP)
Funding ID ES/V013173/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 02/2021 
End 02/2024
 
Description Blog 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This blog was written to reach wider audience for the commentary we published in Lancet Psychiatry which analyses the role of cash tranfer programmes in addressing youth mental health and poverty during the COVID-19 pandemic, and provides policy, practice and research recommendations.
Year(s) Of Engagement Activity 2021
URL https://www2.lse.ac.uk/News/Latest-news-from-LSE/2021/b-Feb-21/Direct-cash-payments-to-young-people-...
 
Description Blog on extending COVID-related reform to improve life chances of young people in Colombia 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This blog was written to highlight the importance of CHANCES-6 topic i.e. addressing youth mental health and poverty together to improve life chances, in the context of the pandemic and its aftermath in Colombia.
Year(s) Of Engagement Activity 2021
URL https://blogs.lse.ac.uk/latamcaribbean/2021/05/10/extending-covid-related-reforms-to-conditional-cas...
 
Description CHANCES-6 Newsletter (1st edition) 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact We provided a summary of the stakeholder workshops to those who attended the stakeholder workshops; the aim is that they feel their contribution to the CHANCES-6 project is recognised, that they want to contribute further to the project, that they forward the newsletter to other people interested in the project; the aim is also to encourage international exchange between the countries in which we are working
Year(s) Of Engagement Activity 2020
URL https://mailchi.mp/42bada11aebf/chances6-newsletter-dec19-12197289
 
Description Film about CHANCES-6 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The aim of developing the film was to raise awareness of the project, and produce and outup that can be shared via organisational websites - including LSE, UCT, Kings' Collge, MacKenzie, Uniandes websites - and that attracts a wider audience
Year(s) Of Engagement Activity 2020
URL https://www.youtube.com/watch?v=wFKjr8eOy4o&feature=emb_logo
 
Description Film with young people 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Each of the country partners (Brazil, Colombia and South Africa) made film in which young people tell their story about how they experience mental health, poverty and how is is affecting their life chances. Films have been circulated by country partners. A cross country film has been prepared that will be disseminated via the CHANCES-6 website and at the final conferences of Chances-6.
Year(s) Of Engagement Activity 2021,2022
URL https://www.lse.ac.uk/cpec/chances-6
 
Description Podcast: Discussion with director for cash transfer programs of Colombian government about the results of CHANCES-6 in the context of the COVID-19 pandemic 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact We did a podcast (via Soundcloud and Facebook) with the director for cash transfer programs of Colombian government about the results of CHANCES-6 in the context of the COVID-19 pandemic.
Year(s) Of Engagement Activity 2021
URL https://soundcloud.com/escuela-de-gobierno-universidad-de-los-andes/transferencias-monetarias-condic...
 
Description Stakeholder workshop South Africa 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact We were holding stakeholder workshops in Colombia, Brazil and South Africa to introduce the research to policy makers and influencers, professionals working in the filed and other researchers, and discuss with them the opportunities for using the research to inform policy, practice and research
Year(s) Of Engagement Activity 2019
 
Description Stakeholder workshop in Brazil 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Almost 20 representatives of the municipality of São Paulo, NGOs and mental health institutions came together in August 2019 to discuss CHANCES-6 and opportunities for linking the national cash transfer programme Bolsa Famila with mental health support for young people.

For most attendees the event was a real eye opener because they had "never thought of a link between the Bolsa Familia Program and mental health". At the same time the issue resonated strongly with their own experiences of the benefits of Bolsa Familia: "We see improvements in the education of these young people [who attend the program] and I think this is because of mental health benefits". They thought that young people's mental health also improved because "their mothers were less distressed".

They discussed the urgent need to have programmes for young people that specifically addressed the mental health impact of poverty-related factors such as crises, drug use and homelessness. They were particularly keen to see the findings from the economic analyses of CHANCES-6 on the cost-effectiveness of programmes. They felt that this would convince governments to invest into programmes.

Attendees, who were from various departments and disciplines - social welfare, mental health, community and culture to criminal justice - were particularly enthusiastic about future collaborations on these issues, and about staying involved in CHANCES-6.
Year(s) Of Engagement Activity 2019
URL https://www.lse.ac.uk/cpec/chances-6/engagement
 
Description Stakeholder workshops at end of project in Brazil and South Africa 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Workshops were held to present the findings of the research and discuss implications for future policy, practice and research.
Year(s) Of Engagement Activity 2021,2022