Two pillars have been identified by the United Nations (UN) as the basis for guaranteeing the right to mental health. First, there is no health without mental health, and, second, good mental health means much more than the absence of mental disorders.

In this respect, mental health is one of the major concerns and problems of young people. According to WHO, one in seven children between the ages of 10 and 19 experiences a mental disorder. Mental health problems such as anxiety and depression are the result of the increasingly rapid changes in society, uncertainty about their future careers, peer pressure and the constant tensions in the education system. In addition, COVID-19 has destabilised young people's social interactions. For many of them, they are a way of distracting themselves from the reality they face at home. Overnight, young people's social lives were severely curtailed by the quarantine and other restrictions that were still in place in most countries a year after the pandemic began.

Isolation has been linked to a wide range of mental health problems. These include increased anxiety, depression and suicidal thoughts. It also particularly affects vulnerable young people, including LGBTQI+ young people and others already affected by intersecting social determinants of health. Overall, social issues such as popularity and peer pressure play an important role among adolescents. Therefore, public health interventions designed to limit face-to-face contact may have had a protective effect in terms of the spread of the COVID-19 virus. However, they may have had an impact on the social factors that have developed among young people during the pandemic and the role they have played in substance use behaviours.

Tackling isolation, stigmatisation and criminalisation
Young people are more likely than adults to be in contact with others and to have more informal social gatherings. They tend to share their lifestyles and hobbies with their peers. Some of these activities, lifestyles and hobbies may be the source of more delinquent or disobedient behaviours. Negative behavioural responses by the public to a pandemic (e.g. not staying at home when they have flu-like symptoms) could significantly increase the negative public health impact of the pandemic. Conversely, positive behavioural responses could limit the negative public health impact of a pandemic. Young people are at increased risk of spreading a virus because of their extensive social networks and frequent contact with peers and adults.

For young people with mental health problems, the onset of a pandemic may exacerbate the problem. This may lead to non-adherence to health-promoting interventions as young people make less effort to stay healthy. In addition, young people with mental health problems may experience stress in complying with preventive measures, which may exacerbate their mental health issues. This can create further barriers to compliance and prevention.

Adolescents who comply with social distancing measures are less depressed, less distrustful of others, more resilient, natural leaders and more proactive in dealing with problems, according to studies in China and the Netherlands. This suggests that, in order to promote and maintain safe habits during future crises, future health education programmes could be designed to improve knowledge of social distancing measures and their effectiveness during pandemics.

Finally, young people with mental health problems are particularly vulnerable to social exclusion, discrimination, stigma (which affects willingness to seek help), educational difficulties, risky behaviour, physical illness and human rights violations. An engaged society that addresses these issues will therefore be better able to control the spread of the virus. Aspects such as family cohesion, involvement in extracurricular activities and the presence of protective agents such as teachers or coaches have been identified as contributing to positive mental health outcomes in adolescents. Thus, protective and supportive family, school and community environments are even more important for their overall mental health in stressful situations such as a global pandemic.

How can a human rights-based approach address the impact on adolescents' mental health?
The United Nations Educational, Scientific and Cultural Organisation (UNESCO) concluded that during COVID-19 approximately 862 million children and adolescents were affected by school closures. This is an estimated half of the world's school population. In June 2016 the former UN Special Rapporteur on the Right to Health, Dainius Pūras, highlighted the importance of this stage in a person's life and the need to invest in adolescents' resilience. Adolescents can have an appropriate future in society if they are supported in exercising their rights. Targeted measures for young people, such as the protection of their human rights, social protection and investment in employment, are needed to strengthen young people's voices and actions.

There is no good mental health without a human rights-based approach. Positive implementations, such as the inclusion of mental health in the 2030 Agenda for Sustainable Development, show initiatives that are making progress in promoting and preventing adverse mental health outcomes among young people. Unfortunately, despite these promising trends, in April 2020 the former UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Dainius Pūras, highlighted a global failure of the status quo to address human rights violations in mental health care systems.

In this rapidly changing world, there is a need to rethink the right to mental health from a human rights perspective and redefine the social and political structures that can help children and adolescents manage their mental health. The biassed use of biomedical models can lead to policies and practices that may be unfamiliar or inaccessible to young people.

An evidence-based medical perspective on young people's mental health, rather than a biomedical perspective, could help to improve the situation of young people. Accepting or acknowledging that many factors can affect their mental health and the need to seek help or take action to reduce the impact of these factors is often embarrassing for young people. According to a UN study, nearly one in five adolescents is ‘probably affected’ by anxiety or depression, with the lowest levels of ‘mental well-being’ recorded among young women and younger adolescents aged 18-24.

A human rights-based approach to COVID-19 requires strong health systems and accessible mental health treatment for all. Vulnerable groups, such as young people with mental disorders and those living in marginalised situations, must be protected. There is an urgent need to rethink our approach to young people's mental health in light of the COVID-19 pandemic. In designing future strategies to support and restore the mental health of this group, states should adopt human rights standards and principles and ensure that their voices are heard. As the aforementioned UN Special Rapporteur pointed out, many of the root causes of poor mental and physical health stem from violations of other human rights, such as restrictions on the rights to freedom of association and movement. Therefore, investing in good mental health and emotional well-being in early childhood through effective public health, psychosocial and psycho-educational interventions should not be considered a luxury but a necessity.

It is essential to create better tools to support the mental health of young people, which will have a positive impact on their behaviour and a more inclusive view of young people in future pandemics. Research into the behaviour of young people during pandemics will ensure that responses to current or future epidemics can meet their needs. In addition, the successful implementation of these precautions, including (limited) adherence among young people, can be facilitated by research findings. By working directly with them to contribute to mental health strategies, future generations of young people may be less affected by mental health crises.

Cite as: Katz Rotnitzky, David. "Young people’s mental health at stake: Have we forgotten the COVID-19 pandemic? Consequences, risks and human rights", GC Human Rights Preparedness, 7 September 2023, https://gchumanrights.org/preparedness-children/article-detail/young-peoples-mental-health-at-stake-have-we-forgotten-the-covid-19-pandemic-consequences-risks-and-human-rights.html