2022

Strengthening Mental Health and Psychosocial

Support (MHPSS) System and Services for
Children and Adolescents in the East Asia
and Pacific Region
An infographic to complement the country report

MHPSS 2022
Table of Contents
2 Table of Contents

4 Overview of MHPSS

5 Overview of Project Approach

6 Package of Priority MHPSS Actions

i
MHPSS 2022 2
 10 Recommended Sectoral Roles and
Responsibilities

13 Priority Actions: Short Term, Mid Term and

Long Term Priority of Actions

16 Recommendations for Strengthening the

Multi-Sectoral Mental Health System

MHPSS 2022 3
 OVERVIEW OF
MHPSS
The AIM of this project was to identify how MHPSS can be implemented for children and
adolescents aged 0-18 years in the East Asia and Pacific region.

01 — A tiered and multi-sectoral package of

services
Required for child and adolescent mental health and
psychosocial wellbeing

02 — The systems, structures and

resources needed
To deliver these services

03 — Multi-sectoral roles and responsibilities

Health, social welfare, justice and education – and the role
of other relevant ministries/agencies, NGOs, young people
and youth organisations, communities and the private sector Funded by
UNICEF
04 — The legislative, policy, institutional, capacity
building steps
Required to ensure a multi-sectoral mental health system

Involved 4
Thailand
Countries
Philippines

Malaysia

Papua New Guinea

MHPSS 2022 4
OVERVIEW OF PROJECT APPROACH
1 Development of the conceptual framework
Aim: To define priority actions and potential sectoral roles.

2 Country level analysis

Aim: Identify the support needed to strengthen a multi-
sectoral mental health system.

a Desk-based review: Current b Consultation workshops:

situation for children and Stakeholder
adolescents
To prioritise actions and propose
Articles were Articles were removed
2054 1204 sectorial roles
retrieved for eligibility
Participants:-
Articles were
Articles were included Government
659 removed for 191 for literature review =72 Non-government organisations
duplication (NGOs, youth and deaf youths)

c Key informant interviews d

with stakeholders Translational workshop

To explore roles, recommendations for

Refine the recommendations following
implementation and actions to strengthen
key findings
multi-sectoral system
Participants:-
Participants from country TAG and
=25
Health sector
Education sector
=27 other key sectorial stakeholders
Social welfare sector
Justice sectors

3 Consolidated country and regional guidance

and recommendations for implementations

MHPSS 2022 5
 PACKAGE OF PRIORITY MHPSS ACTIONS
FOR CHILDREN AND ADOLESCENTS

01 Accessible and
responsive
services for
mental health
conditions

02 Prevention of 03 Mental health

promotion:
mental health ensuring an
conditions in the enabling and safe
immediate social environment
context

MHPSS 2022 6
 PACKAGE OF PRIORITY MHPSS ACTIONS FOR
CHILDREN AND ADOLESCENTS

01 Accessible and Responsive Services for

Mental Health Conditions

SCREENING EARLY IDENTIFICATION OF MENTAL SCREENING HIGHER RISK

AND EARLY
HEALTH CONDITIONS CHILDREN AND ADOLESCENTS

IDENTIFICATION Train and sensitize school-based

counsellors, social workers, frontline
and community-based health workers
Strengthen screening of
to identify, support, refer children and
children/adolescents with high risk
adolescents with mental health needs
behaviours and high-risk exposures
Strengthen screening of pregnant
Refer
and postpartum adolescent girls

STRONG REFERRAL PATHWAYS

Establish referral criteria

Strengthen self-referral Integrate mental
and mechanisms both
through helplines/ health into physical
within the health system
and sectors hotlines/online health services

MANAGEMENT OF RESPONSIVE CARE FOR SUB- RESPONSIVE CARE FOR MENTAL

CLINICAL AND
CLINICAL CONDITIONS HEALTH DISORDERS
Establish child and Establish:

SUB-CLINICAL
adolescent:

MENTAL HEALTH
CONDITIONS
Specialist Therapy
support
Establish specialist Provide mental
Specialized services clinic for mental health residential
and support for health treatment rehabilitation
and care services
Case management families

ACCESSIBLE AND INCLUSIVE MENTAL HEALTH SERVICES

Establish inclusive child, Deliver community-based and mobile
adolescent and family-friendly services for under served children and
services adolescents

CONTINUING CONTINUING CARE FOR THOSE WITH MENTAL HEALTH CONDITIONS

Provide person-centred

CARE
Ensure ongoing Provide education
care to support
participation in and support for
recovery and
education parents
rehabilitation

MHPSS 2022 7
 PACKAGE OF PRIORITY MHPSS ACTIONS FOR
CHILDREN AND ADOLESCENTS

02 Prevention of Mental Health Conditions

in the Immediate Social Context

BUILD
SOCIAL AND EMOTIONAL LEARNING,
TARGETED INTERVENTIONS FOR CHILDREN AND
RESILIENCE, AND PROBLEM-SOLVING
ADOLESCENTS AT RISK

INDIVIDUAL
SKILLS
Implement universal approaches in

ASSETS OF
multi-settings that focus on:
social and emotional

CHILDREN AND
learning
positive behaviors
social connectedness Deliver intensive programs with Provide guidance and

ADOLESCENTS
effective problem counselling and referral to support to schools on
solving Provide
services guidanceand
for screening and support to effective
schools on interventions
effective interventions following
help-seeking behaviour further care. following crisis
crisis (including suicide in the community)

BUILD PSYCHOSOCIAL SAFE, STABLE PARENTING AND ATTACHMENT

COMPETENCE OF Implement programs to raise awareness about: Identify and address

PARENTS AND CARERS

Positive mental health needs of
Nurturing
Non-violence parents / guardians /
Care Parenting carers

STRENGTHEN POSITIVE PEER RELATIONSHIPS ADDRESS PEER-VICTIMISATION

POSITIVE PEER
SUPPORT,
INCLUDING ONLINE
SOCIAL PLATFORM Establish and Integrate Implement school policies
Develop or that :-
education on
support peer-to- strengthen online Promote respectful
digital civility and peer relationships
peer groups and social networks that Address peer-to-peer
literacy into the
promote mental violence and
youth clubs school curriculum harassment

health literacy

ENSURE SAFE OPTIMAL SCHOOL ENVIRONMENT

AND ENABLING
LEARNING Implement a whole-of- Implement a whole-of- Implement school
Promote teacher-parent

ENVIRONMENTS
communication on the
education approach to education approach to substance-use policies and safety and wellbeing of
mental health promotion address violence and bullying education programs children and adolescents

EDUCATION STAFF CAPACITY

Implement programs to support
Provide training and resources
mental health and well-being of
to education-based workers education-based workers

MHPSS 2022 8
 PACKAGE OF PRIORITY MHPSS ACTIONS FOR
CHILDREN AND ADOLESCENTS

03 Mental Health Promotion: Ensuring an

Enabling and Safe Environment

COMMUNITY
COMMUNITY-BASED MENTAL HEALTH PROMOTION
Train community-

ENGAGEMENT
Implement Build capacity of
based workers, adolescents and provide
campaigns to
religious, community opportunities for them to

AND
address mental
leaders, and participate in planning,
health-related educators to raise design and evaluation of

PARTICIPATION
stigma and awareness about MHPSS policy and
discrimination mental health programs

POLICIES, STRATEGIES AND PLANS

SUPPORTIVE Adopt a national mental

health strategy that Adopt a multi-sectoral
Integrate mental health into
early childhood

MENTAL national suicide-

details the multi-tiered development, juvenile
and multi-sectoral vision prevention plan justice and justice health

HEALTH-
and plan for mental health policies and plans

RELATED LEGISLATION AND ACTIONS REQUIRED FOR EFFECTIVE MENTAL HEALTH SERVICES

POLICIES AND Address legislation that denies access to

mental health care for migrant, displaced or
Address the barriers in accessing
mental health care.

LEGISLATION
other marginalised children and adolescents

Adopt legislation that ensures

Remove legislation that criminalizes
childrens' and adolescents’ right to
suicide or attempted suicide access mental health services.

Adopt legislation that mandates access to

Adopt policy that defines high- mental health care for children and adolescents
quality mental health care who are deprived of liberty, in conflict with the
law, or in out-of- home placements
POLICIES, STRATEGIES AND PLANS FOR CHILD AND ADOLESCENT MENTAL HEALTH

LEGISLATION TO PROTECT WITHIN THE MENTAL HEALTH SYSTEM

Adopt protections to ensure that
Prohibit physical restraint of children and
deprivation of liberty is a last resort, for
adolescents with acute mental conditions
the shortest appropriate period, and
in all settings providing services or care
subject to periodic review

POLICIES, PROGRAMS AND LEGISLATION TO PROTECT FROM HARM AND DISCRIMINATION

Prohibit :

Forced marriage of adolescents All forms of violence against Prevent and eliminate The association and recruitment
under the age of 18 years children and adolescents child labour with armed forces/groups

Adopt legislation to prohibit discrimination on: Adopt legislation that: Implement social
gender political affiliation restricts access to lethal weapons
protection
race geographic location specifies the minimum age of
ethnicity gender identity criminal responsibility programs with a
religion sexual orientation specifies the minimum age of focus on families
disability decriminalise consensual purchase of substances (alcohol and carers
nationality sexual acts and other drugs).

MHPSS 2022 9
 RECOMMENDED SECTORAL
ROLES AND RESPONSIBILITIES
LEADING ROLE SUPPORTING ROLE

HEALTH SOCIAL
(LEAD SECTOR) WELFARE

1. Screening those at risk 1. Screening those at risk

2. Referral systems and 2. Referral systems and
mechanisms mechanisms
3. Multi-disciplinary case 3. Multi-disciplinary case
management and support management and support
4. Establishing specialised and
clinical services
5. Establishing residential Accessible and
services
responsive services
for mental health
EDUCATION conditions
EDUCATION

1. Early identification of those with

1. Referral linkages and
mental health conditions or risks
mechanisms
2. Ongoing education participation for
those with mental health conditions

JUSTICE
SOCIAL
WELFARE

1. Screening for certain subpopulation

1. Community-based and who are under the purview of the
outreach services justice sector
2. Establishment of residential 2. Referral linkages and mechanisms
rehabilitation services 3. Specialised services and supports

MHPSS 2022 10
 RECOMMENDED SECTORAL
ROLES AND RESPONSIBILITIES
LEADING ROLE SUPPORTING ROLE
EDUCATION EDUCATION
(LEAD SECTOR)

1. Raise awareness about positive

1. School and education-based parenting
programs and approaches:
-Mental health promotion HEALTH
-Social and emotional learning
-Positive peer relationships
-Violence and bullying 1. Training of educators on
-Substance use mental health and providing
-Teacher-parent communication school-based interventions
2. Support to mental health
2. Establishing youth and peer Prevention of mental approaches in education
support groups health conditions 3. Digital literacy
3. Digital literacy and civility 4. Intensive interventions to
education address risk factors
4. Performing targeted 5. Identify and address mental
interventions health needs of parents /
5. Establish optimal school carers
environment
SOCIAL
WELFARE

SOCIAL
WELFARE 1. Support to mental health approaches in
education
2. Establishing youth and peer support
groups
1. Parenting programs 3. Digital literacy
-To build skills in nurturing and 4. Intensive interventions to address risk
responsive care, and non-violent factors
discipline
JUSTICE

1. Supporting intensive interventions to

address risk factors

MHPSS 2022 11
 RECOMMENDED SECTORAL
ROLES AND RESPONSIBILITIES
LEADING ROLE SUPPORTING ROLE
JUSTICE
(LEAD SECTOR) JUSTICE

1. Legislation mandating access 1. Integrate mental health of children

to mental health care, including and adolescents into juvenile justice
removing mandatory parental and justice health policy and plans
consent requirements 2. Protection for children and
2. Legislation mandating access adolescents in the mental health
to mental health care for system
children and adolescents
deprived of liberty and in out-of- SOCIAL
home placements WELFARE
3. Legislation and policies to Mental health
prohibit violence, harm, promotion
discrimination 1. Support legislation and
policies to protect children and
SOCIAL adolescents from violence and
WELFARE
harm
2. Identifying barriers in access to mental
1. Integrating mental health into early health services for marginalized groups
child development, child protection 3. Social protection programs for families
4. Training and community-based programs
to address stigma and discrimination
HEALTH
5.Capacity building adolescents to support
participation

1. Policy and standards for high quality mental

health care
2. Training and community-based programs to
address stigma and discrimination HEALTH
EDUCATION
EDUCATION
1. Capacity building in adolescents to
support participation

1. Integrating mental health into education

policies

MHPSS 2022 12
 priority actions: short
term, midterm and long
term

01 Accessible and Responsive Services for

Mental Health Conditions

Short term: 2 years

1 Screening those with high-risk 2
Strengthening self-
behaviours and exposures referral through
including pregnant and helplines/hotlines/online
postpartum adolescent girls
3 Specialised clinical mental health 4 Person-centred care and specialised
treatment and care, specialised services and support to families of
support, case management and children with complex behaviours, in
therapy by multi-disciplinary team social services and justice settings

Midterm: 2 to 5 years
1 Community-based and mobile 2 Establish referral criteria and
services for hard to reach mechanisms within the health
population sector and between sectors

3 4
Integrate mental health into Inclusive services for child,
physical health services adolescents, and family

5 Sensitize school-based counsellors, 6

social services, and community Residential rehabilitation
workers to identify, support, and services
refer those with mental health needs

7 Ongoing participation in 8 Guidance and support for

education for those with schools on effective
mental health problems interventions following crisis

Long term: 5 years

1 Education and support for parents of
children and adolescents with mental
health needs

MHPSS 2022 13
 priority actions: short
term, midterm and long
term

02 Prevention of Mental Health Conditions

in the Immediate Social Context

Short term: 2 years

1 2 Implementing selective intensive
Establish peer-to-peer groups school-based and out-of-school
and youth clubs for both in- programs packaged with
school and out-of-school counselling and referral to services

Midterm: 2 to 5 years
1 Design and implement parenting 2 Raise awareness on nurturing
programs focused on building care, positive parenting, and
skills to support nurturing care non-violent discipline.

3 Identify and address the 4

Addressing digital and non-
mental health needs of
digital peer victimisation
parents/guardians/carers
5 6 Guidance and support for
Support teacher well-being schools on effective
interventions

Long term: 5 years

1 Promote teacher-parent 2 Implement whole-school
communication on the safety approach to mental health and
and well-being of children well-being

3 4 Implement a 'whole school/

Design and implement school
education' approach to tackle
substance use policies
violence and bullying

5 Provide training and resources 6 Implement universal psychosocial

for teachers to provide the best interventions that focus on building
environment for children social and emotional skills

MHPSS 2022 14
 priority actions: short
term, midterm and long
term

03 Mental Health Promotion: Ensuring an

Enabling and Safe Environment

Short term: 2 years

1 Design and deliver stigma Train community health
and discrimination workers, community
reduction campaigns 2
volunteers, adolescents,
religious leaders and educators
3 Provide capacity-building for to raise awareness about
adolescents in the planning mental health to address
and design of MHPSS harmful social norms

Midterm: 2 to 5 years
1 Adopt a national mental health 2 Integrate mental health into
strategy/policy that details the early childhood development,
multi tiered and multi-sectoral and social protection policies,
vision and plan strategies and plans

3 Integrate mental health into

the policy and plan of the
education sector

Long term: 5 years

1 2
Implement policies and programs Adopt legislation and actions
that protect children and adolescents required for effective mental
from harm and discrimination health services

3 Implement laws that protect

children and adolescents within
the mental health system

MHPSS 2022 15
RECOMMENDATIONS FOR STRENGTHENING
The Multi-Sectoral Mental Health System
Legislation and Policy Key Recommendations
Ensure “mental health in all policies” with more explicit
1
recognition and actions
Expand existing national mental health policy, and develop specific child and
adolescent mental health policy
Amend Article 8(2) of the Federal Constitution to include protection from
discrimination on the basis of disability, including protection for children with
developmental disorder
Review legislative and regulatory barriers to access mental health and psychosocial
support services
Improve dissemination of MHPSS-related policies and plans across sectors and to
administrative and implementation agencies
Strengthen:
Mental health legislation to include specific protections and considerations for
children and adolescents, including clearer rights with respect to consent to mental
health care and removal of mandatory requirements for parental consent
Legal protections against all forms of harm and discrimination, including
decriminalisation of suicide and prohibition of all forms of corporal punishment
Social protection policy, with a focus on children and families
Develop:
Policies and strategies to reach out-of-school children and adolescents, and other
marginalised groups
Multi-sectoral implementation plans and guidance with clear roles, responsibilities
and accountability at all levels
Multi-sectoral mental health plans at subnational level to support coordination and
implementation

Leadership and Governance Key Recommendations

Build capacity of District Offices in MHPSS to support local
2
planning, coordination and resource allocation
Develop subnational implementation plans for MHPSS that clearly articulate sectoral
roles and responsibilities, and are aligned with national goals and strategies for mental
health
Establish:
A high-level multi-sectoral national steering committee, led by the Ministry of Health,
with representation from all key sectors, authority and resources to drive action
Local multi-sectoral committees to support coordination and implementation of the
priority MHPSS package

MHPSS 2022 16
RECOMMENDATIONS FOR STRENGTHENING
The Multi-Sectoral Mental Health System
Service Delivery Key Recommendations
Develop models and standards of child and
adolescent-centred health services for mental health
3
Integrate MHPSS into other health services at community level
Transition to integrated community-based services that span the three tiers of MHPSS
Establish more community centres that provide safe spaces for children and adolescents
and provide MHPSS information and services
Build on existing school-based models to strengthen responsive care, as well as key
preventive actions
Identify barriers and service-delivery preferences for marginalised and underserved
communities, particularly strategies needed to reach out-of-school children and
adolescents, and those living with disability
Strengthen:
Two-way referral mechanism between primary and tertiary care
Online and digital service delivery models that link mental health promotion, positive peer
relationships, parenting programs, and responsive care
Protocols within justice settings to support delivery of MHPSS and protect children and
adolescents from psychological harm, and strengthen linkages with health and social
welfare agencies

Standards and Oversight Key Recommendations

Define clear multi-sectoral indicators to monitor MHPSS
4
performance
Establish a national, independent monitoring body (or technical advisory committee)
with cross-sectoral representation, reporting to the Ministry of Health, to monitor MHPSS
programs
Standard operating procedures across agencies to support coordinated care of children
and adolescents engaged in child protection or justice settings
Standardise a system to support NGO engagement in MHPSS
Develop:
Clear guidance and protocols for early identification, screening and referral, with clearly
defined roles and accountability of key actors
A national, standard referral protocol across health, education, social welfare, justice and
other settings that also supports communication back to primary providers
A national, standard mental health education curriculum for all levels of education
Strengthen:
Justice-related protocols to minimise harm to children and adolescents who come into
contact with the justice sector
Guidance, protocols and procedures with respect to delivery of child and adolescent-
friendly mental health services, including parental consent and trauma-informed
approaches
Continuous evaluation of accreditation of mental health workforce

MHPSS 2022 17
RECOMMENDATIONS FOR STRENGTHENING
The Multi-Sectoral Mental Health System
Mental Health Workforce Key Recommendations
Undertake further detailed mapping of the multi-sectoral mental
5
health workforce and existing mental health competencies to identify gaps
Integrate and strengthen pre-service mental health training for health, education, social
welfare and justice sector providers
Strengthen job aids, tools and protocols to support key MHPSS roles
More explicitly integrate MHPSS actions into the defined roles and performance indicators
of key cadres (teachers, counsellors, social workers, justice officers)
Improve:
Collaboration across sectors at national-level to facilitate development, planning and
support of the mental health workforce
Remuneration and job security / career pathways for social workers, psychologists and other
mental health professionals
Provide:
Updated in-service training for non-specialist health providers, teachers, counsellors,
psychologists, social workers, police aligned with clearly defined MHPSS roles and ensure
that this training is ongoing to support continuous development
Mental health training for community members to raise mental health awareness
Establish:
Steps to support professionalisation of the social service workforce (this could also include
school counsellors)
Mechanisms for support supervision of the mental health workforce through multi-
disciplinary teams, support networks, and services and supports to address mental health of
providers

Budget and Financial Key Recommendations

Aim for MHPSS budget allocation of 2.1% of the national health budget
6
Define a detailed minimum-services package for child and adolescent
mental health addressing responsive care, prevention and promotion that can be costed
Establish a national cross-sectoral planning body, and cross-sectoral budgeting
committees for MHPSS to coordinate budget requests and processes
Increase support for subnational and local government units
Consider establishing a public fund
Include:
Mental health services within national insurance schemes
A national mental health goal in social and economic plans, and/or as a primary program
within the Ministry of Health

MHPSS 2022 18
RECOMMENDATIONS FOR STRENGTHENING
The Multi-Sectoral Mental Health System
Participation Key Recommendations
Build capacity and increase opportunities for young people and
7
youth organisations to participate in MHPSS policy and planning
Strengthen engagement between government agencies, community, and youth
groups to ensure MHPSS approaches meet local needs and support implementation
Include youth and parent representatives in subnational committees, and/or
establish child and adolescent task forces to support planning
Establish:
Formal roles for youth and parent representatives on national mental health
committees or similar bodies, such as the National Coalition for Mental Wellbeing
Mechanisms for feedback and complaints, including for feedback on non-health
settings and in child and adolescent-friendly formats

Data, Information and Research Key

Recommendations
8
Include mental health indicators in routine health information systems,
and provide age and sex-disaggregated data
Integrate child and adolescent mental health indicators into routine information
systems of education, social welfare and justice sectors
Improve mechanisms for timely analysis, reporting and sharing of data within and
across sectors
Invest in further research and support local research capacity to understand demand-
side needs, barriers and service-delivery preferences, build the evidence for specific
actions, and evidence of effective implementation models
Establish:
A national suicide and self-harm surveillance system
A child protection information management system that is accessible within and
across sectors
A user-friendly platform “one stop shop” across sectors, to enable harmonised
collection, use and sharing of data

MHPSS 2022 19
We would like to thank the Director General of Health Malaysia
for his permission to publish this infographic