Dear Editor

According to the World Health Organization (WHO), mental health is an essential component of overall wellbeing. It helps people reach their greatest potential, manage everyday stressors, operate efficiently and effectively, and positively impact their communities. Good mental health is essential for academic achievements, quality of life, and social interaction, especially in adolescents ( 1 ).

Adolescence is a transitional phase of growth and development that occurs between childhood and adulthood. According to WHO, an adolescent is anyone between the ages of 10 and 19. During this phase, individuals undergo significant physical, psychological, and social changes as they approach adulthood ( 2 ). Since the majority of mental health disorders in adults start before the age of 14, diagnosing and treating mental health disorders in teenagers is essential. Globally, 14% of teenagers between the ages of 10 and 19 suffer from a mental health illness ( 3 ), and it is a major contributor to youth disability ( 4 ). Given the age of onset and influence on health trajectories, adolescents are therefore a high-priority group that needs care to prevent or manage mental health disorders.

In 2021, estimates place the number of people with mental health conditions at 14%, most of whom went undiagnosed and untreated. Teenagers who suffer from mental health issues are particularly vulnerable to physical ailments, human rights abuses, educational difficulties, social marginalisation, stigma, and discrimination ( 3 ). A descriptive study found that depressive disorders (5%), separation anxiety disorder (5.3%), and oppositional defiant disorder (ODD) (5.9%) were the most common psychiatric illnesses among Iranian children and adolescents. Anxiety disorders (11.2%), behavioural disorders (9.4%), and mood disorders (5%) were the most prevalent categories of psychiatric diseases. These results demonstrated how common mental health issues are among Iranian kids and teenagers ( 4 ).

When someone experiences potentially traumatic events, timely and appropriate intervention can help reduce the risk of developing mental health problems or lessen their severity. However, many people at risk do not receive adequate support or treatment, even when services are available. Research showed that family and friends can play an important role in recognizing the symptoms of mental health problems. In fact, many teenagers reported that if they were to experience a mental health problem, they would first turn to a friend or peer for help ( 5 ). During adolescence, it is expected that individuals develop hypothetical-analogical, logical, and systematic thinking abilities which enable them to learn and adapt. Furthermore, they are also expected to gain a sense of identity by reflecting on their present and future roles in the world. As a result, this period is a crucial time for education, and it can be challenging for adolescents to take on the role of a “helper” ( 6 ).

School-based educational programs for adolescents are recognized as a tactic to improve mental health status. To strengthen support for peers struggling with mental health problems, a study using Delphi consensus was carried out in Australia to identify essential messages that adolescents should learn in a mental health education program. Accordingly, the mental health first aid training program (tMHFA) was designed. The program has two courses: tMHFA 10-12 for older students aged 16-18, and tMHFA 7-9 for younger students aged 12-15 ( 7 ).

Adolescents participating in these courses will learn how to: (a) recognize warning signals that their peers may be experiencing mental health problems; (b) discuss mental health and seek help with peers; and c) find relevant sources for mental illness and professional help; and (d) react in a crisis. The main purpose of using this program is to help peers in the short term until a responsible and trusted adult can step in ( 7 ). tMHFA classes teach students to recognize general indicators of a mental health problem in a friend rather than focusing on specific mental illnesses. The MHFA instructors are experienced professionals who have expertise in supporting young individuals, with a particular focus on addressing mental health challenges in adolescents ( 7 ).

Evidence suggested that mental health first aid guidelines are likely cross-culturally generalizable, but cultural adaptation is still necessary. For example, adapted guideline in Sri Lanka (8) showed although it was similar to English-language guidelines, some individual and family involvement and health communication styles were culturally specific ( 8 ) and should be added to this guideline.

As the same way, culturally adapted first aid guidelines for suicide in Brazil emphasized the importance of family and friend involvement in helping a person who is at risk of suicide ( 9 ).

The school is an ideal setting for promoting health literacy as it brings together individuals from various social backgrounds. Interventions implemented in schools are cost-effective and have resulted in positive health outcomes for populations ( 10 ). In spite of the prevalence of mental health challenges among adolescents and the importance of providing appropriate first aid, mental health first aid training is not currently included in the training of healthcare providers and counselors in Iran. Recent research has shown promising outcomes from such training. Thus, it should be incorporated into the school curriculum. However, we are currently facing a shortage of counselors in schools in Iran. As tMHFA has been effective in improving the intention of teenagers to seek help ( 5 ), training mental health first aid for teenagers could be a possible solution to encourage them to seek help and alleviate the pressure of mental health problems. To do so, it is primarily necessary to carry out cross-cultural generalization of tMHFA using the Delphi method by psychology and health education experts in Iran. After cultural generalization, it is then recommended that health care professionals and counselors in Iran’s secondary schools should incorporate this information into their educational curriculum.

Authors’ Contribution

Mahnaz Solhi: Contribution to the conception, drafting the manuscript and reviewing it critically. Zahra Saboohi: Contribution to the conception, drafting the work and reviewing it critically. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work, such that the questions related to the accuracy or integrity of any part of the work.

Conflict of Interest

None declared.

References

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