Mental health problems are one of the top public health challenges in Europe, affecting 25% of the population every year (WHO, 2013). Participation in working life is considerably lower among persons with mental health problems than in the general population, and mental health issues constitute the single largest determinant of disability benefits for the OECD member nations (OECD, 2012). The fact that young persons experiencing mental health problems are at greater risk of being excluded from social settings such as school and work than others is one of the greatest challenges facing public health services in European societies (WHO, 2013). For most individuals, about 75%, mental health problems have developed by the age of 25 (McGorry & Goldstone, 2011). Because of the early age onset, mental health problems often have a negative impact on educational attainment and transition into employment (Kessler et al., 2007;
Waghorn et al., 2012). Studies document low levels of secondary education attainment among persons with mental health problems, both internationally and in Norway (Anvik
& Eide, 2011; Esch et al., 2011; Finning et al., 2018; Haynes, 2002; Markussen & Seland, 2012). This is of particular concern, since incomplete secondary education is one of the biggest risk factors for being permanently unemployed (Olsen & Tägtström, 2013).
Studies document a growing tendency towards mental health problems among young persons in Nordic and other European countries, as well as in Asia and the US (Bor, Dean, Najman, & Hayatbaksh, 2014; Collishaw 2015; Sletten & Bakken, 2016). In particular, internalizing mental health problems in which anxiety and symptoms of depression constitute the core seem to have increased (Bor et al., 2014). Ramsdal, Gjærum, and Wynn (2018) found that internalizing mental health problems in combination with a lack of social support is strongly associated with dropping out from school and employment.
Further, the authors found that comprehensive social support plays a major role in improving the ability of young students to cope with school and mental health problems.
Other studies found that long periods out of school might decrease the possibility of re-engagement, because these students also have a higher risk of anxiety and depression (Bjelland et al., 2008; Chazelle et al., 2011; Wang, Smith, & Dewa, 2010). In a study
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investigating social and health-related problems in a Norwegian sample of young adults at risk of early work disability and their self-perceived causes of illness, psychological distress was found to be the most prevalent health problem. The young adults in that sample perceived that the main causes of their illness were relational problems (Sveinsdottir et al., 2018).
The fact that many young persons with mental health problems experience interruptions in school and work participation is of increasing concern for the Nordic countries, as well as for the member countries of the EU (Wulf-Andersen, Follesø & Olsen, 2016).
Collaboration between Nordic countries is encouraged as way to develop knowledge and initiatives that will support young persons at risk of ending up in vulnerable life situations (Kolouh-Söderlund, Lagercrantz, & Göransson, 2016). The Nordic collaboration focuses on the significance of young adults’ possibilities to participate in a variety of settings, such as school and work, as well as to pursue interests and friendships, and the importance of being ‘insiders’ as opposed to ‘outsiders’ in socially valued contexts (Kierkegaard, 2016).
Young persons aged 16-19 in the Nordic countries comprise nearly five million people, or 19-22 percent of the total population in each country1. Most young persons in Nordic countries report that they are doing fine, and their subjective well-being is better than in the other European countries (Olsen, Hyggen, Tägtström, & Kolouh-Söderlund, 2016). At the same time, recent research has revealed an increase of mental health problems among young persons in the Nordic countries (Brage & Thune, 2015; Sletten & Bakken, 2016). Increased mental health problems are stated to be one of the main reasons for dropping out of upper secondary school (Anvik & Gustavsen, 2012; Markussen & Seland, 2012; OECD, 2018). The majority of young persons receiving incapacity-related benefits are granted those benefits for a mental disorder, and almost inevitably, this leads to social exclusion for the rest of their lives (Hultquist, 2015; Olsen & Tägtström, 2013).
Support to young people with mental health problems in the context of participation in school and work is a priority for the Norwegian welfare system, as well as for the other Nordic countries. It is therefore worrying that young persons who are neither studying
1 According to the database of the Nordic Council of Ministers, January 2014.
nor employed and who suffer from mental health problems often experience the absence of the support they need (Anvik & Gustavsen, 2012; Kierkegaard, 2016; Ramsdal, Gjærum, & Wynn, 2018). Research exploring mental health problems and school dropout calls for special attention to how society and health and social services can support these young persons, to enable them to remain in school, work, and other social settings, contributing to the communities in which they live.
The research project ‘Young people in the Nordic region – mental health, work, education’2, led and organized by the Nordic Welfare Centre (NWC) from 2012-2016, examined initiatives that could support young persons with mental health problems with regard to participation in school and work. The study reports that initiatives recognized as supportive were open to multisectoral cooperation, where the needs of the young persons were the controlling factor (Kolouh-Söderlund, Lagercrantz, & Göransson, 2016).
The study demonstrates a need for a major improvement in cooperation, coordination and flexibility among the organizations, sectors, and services involved. In particular, collaboration between schools, health services, social services, and the private sector are important. Further, it is crucial to simplify the bureaucracy that often resembles an impenetrable jungle to the young persons. Young persons in the study highlighted the importance of being listened to and treated with respect. They asked for initiatives to support them in finding a direction in life and to strengthen their belief in themselves and their own abilities.
In 2017, the NWC invited researchers, policy leaders, practitioners, and leaders and young people from youth organizations and civil society organizations to dialogue sessions to discuss how to improve mental health among young people and relevant services. The dialogue sessions were held in six Nordic cities. The summary of the dialogues reveals a need for a more positive and inclusive approach when helping young persons, especially in dealing with mental health issues3. The message from the young persons at the meetings can be summarized as follows: Young people want to be needed
2 All the publications from this project can be found at https://nordicwelfare.org
3 The essence of the dialogues is presented in a video available at https://nordicwelfare.org
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and to be part of a bigger picture. They want people around them who believe in them.
They ask for close collaboration between schools and other sectors (health sector, social sector, and civil society). They need easily accessible support activities for young people who appear unwell but who are not ill enough to receive support from the healthcare system.