Impact: Implementation of a multisectoral programme to improve Indigenous adolescent mental health in Brazil and Dominica

Lead Research Organisation: King's College London
Department Name: Health Service and Population Research


Abstract developed by Indigenous youths consulted for the proposal.

WHY WE NEED THIS STUDY: Many Indigenous people live in Latin America and the Caribbean, most in a situation of poverty.
Mental health problems are frequent, including suicide and drug use among teenagers, which we are very concerned about. So for us
it is necessary to carry out studies that help adolescents with mental health problems but also respect the Indigenous culture.
Adolescence is a complicated life stage, especially for Indigenous people who also experience many problems such as violence,
discrimination and less resources. For these reasons it is common for Indigenous adolescents to have mental health problems, and
this is why it is important that Indigenous health professionals, and other people in the village, are trained to help adolescents who are
facing problems.

WHY THIS PROJECT IS DIFFERENT: Researchers often present ready-made research to the village and this generates insecurity in
us, due to our lack of knowledge, or because researchers want to impose their knowledge without considering ours, sometimes with a
certain contempt, which generates deep dissatisfaction. Therefore, we are pleased that this research has involved us since the project
was created and that the project will be carried out with us by a team that has already worked in projects with Indigenous people.

WHAT THIS STUDY IS PROPOSING: The work in this study will take place in two Indigenous settings in two countries, Brazil and
Dominica, in four work streams. About 1500 adolescents in 13 schools will take part. In the first work stream, researchers and people of the village, and adolescents, will co-develop mental health promotion messages, to be discussed in conversation circles during school activities.
They will also amend a tool that has already been used to help adolescents with mental health problems. In the second work stream, they will train teachers, Indigenous health workers, village Chiefs and other community leaders to incorporate these messages into our school and
community activities. They will train teachers and health workers to identify and manage common adolescent mental health problems.
In the third work stream, they will train Indigenous young people like ourselves in how to do research, to understand how the programme worked, whether it helped adolescents and how it can be improved. In the fourth work stream, researchers will support Indigenous adolescents and older youths to write and present results of the study to our community, nationally and across the region. Together, we will also organize events on how findings can strengthen the capacity of our schools and health systems to respond to Indigenous adolescent health.

WHO WILL BENEFIT: Many will benefit from this study including adolescents and all those who will be trained to implement and evaluate the
programme. There are also important wider and longer-term benefits of raising awareness of the health and well-being of Indigenous
communities across the region.

Technical Summary

The Latin American and Caribbean region is home to ~55 million Indigenous people who experience high levels of poverty due to historic structural discrimination. An urgent concern is the higher rates of mental health (MH) problems among Indigenous compared with non-Indigenous people, including higher rates of substance use and suicide among adolescents. There is a pressing need for culturally responsive MH programmes for Indigenous adolescents. We aim to work in partnership with trained Indigenous people from their communities, to implement and evaluate a culturally adapted evidence-based multisectoral programme (Indigenous leaders requested the word 'intervention' to be replaced by 'programme' as 'intervention' was felt to have an authoritarian emphasis) to improve Indigenous adolescent (10-18 years) MH in Brazil and Dominica.

Our study includes 4 Work Packages (WP): WP1: Partnership: Establish an Indigenous Adolescent Stakeholder Group (ASG) and a Stakeholder Implementation Group (SIG) at each site; co-develop culturally adapted evidence-based positive messages to be promoted during school and village activities; co-adapt the WHO's Mental Health Gap Action Plan - Intervention Guides (mhGAP-IG) integrating culturally centred knowledge and customs. WP2: Training Implementors: Train teachers, Indigenous community health workers (ICHWs) and community champions to embed the MH promotion messages in community activities; use the adapted mhGAP-IG to train ICHWs and primary health care (PHC) practitioners to identify and manage common adolescent MH problems. WP3: Programme evaluation: Include ~1400 pupils in schools, local community clubs and PHC Centres and conduct mixed-method case studies to gain in-depth understanding of context and linkages affecting processes and outcomes. WP4: Impact: Support Indigenous adolescents to contribute to multi-media dissemination; support ASG and SIG on using findings for strengthening the responsiveness of their schools and PHC.


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