Mental health is important at every stage of life, however, mental health problems at a young age can have serious implications for both present and future health. The Youth Aware of Mental Health (YAM) programme is helping teenagers explore how to protect their own mental health and support those around them. YAM shows promising results – groups that have completed the programme show with significantly reduced levels of moderate to extreme depression, and reductions in suicide attempts and ideation.
By Vladimir Carli and Camilla Wasserman
Mental health stretches from emotional, psychological, social well-being and beyond. It affects h
ow people think, feel, and act. A person’s mental health influences how they cope with stress, relate to others, and make choices. The emotional, medical, and financial costs for individuals, communities, and societies affected by mental health problems are substantial. Unfortunately, adequate support is wanting, particularly for young people.
One of the serious consequences of mental ill health is suicide. Globally, suicide is the second leading cause of death for young people between the ages 15-29. Attempted suicide leaves the individual with psychological scars and at risk of subsequent suicide attempts and death. Extending beyond the individual in distress, the effects on families, friends and the community are profound.
How young people think about mental health influences not only how they approach their own state of being and help-seeking, but also how they support peers going through difficult times. Stigma, discrimination, fear or shame, distrust in the healthcare system, as well as individual and cultural norms and narratives of mental health may all lead to young people shying away from addressing their mental health. Universal school-based initiatives aimed at promoting mental health awareness, decreasing stigma, and empowering youth to attend to their needs can be an important tool in preventing mental ill health in the general population.
Saving and Empowering Young Lives in Europe (SEYLE)
The Saving and Empowering Young Lives in Europe (SEYLE) research project evaluated three school-based programmes for mental health promotion and suicide prevention. In a large multi-centre cluster randomised controlled trial, 168 schools across ten EU countries in both urban and rural areas were randomised to participate in one of three interventions or a control group. A total of 11,110 students with a mean age of 14.9 from Austria, Estonia, France, Germany, Hungary, Ireland, Italy, Romania, Slovenia, and Spain participated.
The three approaches respectively targeted the following key actors in youth mental health: school staff, mental health professionals, and the young people themselves. A gatekeeper training programme, QPR (Question, Persuade, Refer) was used with teachers and school staff. Mental health professionals conducted screenings (Profscreen) identifying youth at risk. The students participated in the Youth Aware of Mental health (YAM) programme.
The SEYLE study showed that YAM was successful in significantly improving mental health compared to the other two approaches and the control group. Compared to the control group, youth who participated in YAM showed a reduction of 50% in new cases of suicide attempts and severe suicidal ideation, while new cases of moderate and severe depression were reduced by about 30% (Wasserman et al., 2015). YAM is not only an effective, but also a cost-effective school-based intervention (Ahern et al., 2018).
What is YAM?
The YAM programme was created for youth between ages 13–17, inviting participants to learn about and discuss mental health in a non-judgmental space. In YAM, young people role-play dilemmas and everyday sticky situations and discuss how these make them feel. Emphasis is placed on peer support and information is given on where to find professional help if needed.
YAM starts with a set of pedagogical materials that include slides, posters, and a booklet for each participant to keep. In five sessions over three weeks, the youth’s voices take centre stage. Young people are listened to and their experiences are valued. Topics of role-play and discussion range from relationships with peers and adults, changes in mood, to feeling sad or facing a stressful situation. As a group, the participants reflect on how they might feel if faced by such events and discuss how to handle challenging real-life circumstances. The adults present do not instruct them on what is considered right or wrong, risky or healthy. The aim is not to identify one-size-fits-all solutions. Instead, the group considers how different people feel, the possible reasons for their actions, and what kinds of support they might need in each situation.
YAM emphasises empathy towards others’ experiences and supporting peers, while encouraging youth to attend to their mental health needs. In interviews with youth after YAM, young people have expressed feeling more confident in supporting a friend in need (Wasserman et al., 2018). They also indicate using skills and strategies acquired through the programme to help them through adverse life events. Perhaps most importantly, YAM helps young people recognise the need for support as they encounter challenges. To meet this need, contact information to local physical and mental health care options as well as youth-serving organisations in their communities is shared with them.
Continued evaluation of YAM
To continue investigating the impacts of YAM, a large randomised controlled trial funded by the Stockholm Region and carried out by the Stockholm Health Care Services in collaboration with Karolinska Institutet is currently ongoing. With the primary aim to adapt YAM to the Swedish context and evaluate its effects, the project also explores additional outcome measures such as coping skills, empathy, help-seeking behaviour, and classroom climate. To recruit 10,000 students in total, all high schools in Stockholm were invited to participate and 150 schools accepted. The project has a waiting list design, meaning that all recruited students will participate in YAM.
YAM worldwide
YAM was created to serve youth worldwide. By relying on each group to bring up topics that are important and relevant to them, the method aims to be relevant to youth worldwide. YAM implementations and evaluations are currently ongoing throughout Europe (Sweden, Austria, France, Norway, and the U.K.), Australia, India, and the United States. To date, more than 100,000 youth have participated in YAM.
YAM is distributed globally through a research and development company, Mental Health in Mind International AB (MHiM), an SME founded by the Karolinska Institute researchers who developed the programme with support from Karolinska Institute Innovations. MHiM collaborates with local young people and youth professionals whenever YAM is brought to a new country or context, to ensure the programme stays appropriate and sensitive to local youth needs.
Vladimir Carli
Vladimir Carli is Senior Lecturer in suicide prevention at Karolinska Institute in Stockholm, Sweden. He splits his time between research and teaching in the field of mental health promotion and suicide prevention.
Camilla Wasserman
Camilla Wasserman is a doctor in Health Sciences with an MA in Anthropology. She aims to be a youth advocate and to uplift the voices of young people in her research and teachings in mental health promotion.