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

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.

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.