CHANCES-6: Improving the life chances of young people living in poverty

Poverty really gets under the skin and
into the neural pathways of the brain. One example is that poverty tends to foreshorten one’s view of the future so one tends to discount future rewards for more immediate rewards because the situation is so pressing and so that provides us with a really exciting opportunity to think about potential interventions to think about problem-solving strategies For CHANCES-6 we are aiming to understand the impact of cash transfer programmes and mental health interventions and the mental health and the future life
chances of young people living in poverty in low- and middle-income
countries By cash transfers I mean cash
supplements provided to very low-income families. And these can be unconditional
or they can be conditional based on participation in education or
participation in immunization programmes for example. For most of the programmes, like in
Brazil, it is conditional – so you receive the money but your kid must go to school
you, mother, have to go to primary care your immunization must have been on time, and there are a lot of data showing it works It is few money with good results. I mean there have been initiatives to evaluate how effective cash transfer programmes are, for instance, in encouraging young people to stay in education. But it is a very
under researched area when it comes to the impacts of cash transfer
on mental health We’re going to answer this question employing a variety of methods
so first we are doing quantitative analysis of existing longitudinal data
sets in six different countries. And this is really about understanding the
mechanisms and pathways to improve life chances. We are also doing qualitative
analysis. And this will be done through interviews and focus groups and really
trying to understand the experience of young people living in poverty, how they
understand mental health, and also thinking about how they would recommend improving the programme and its delivery. And finally, we are also doing economic
analyses trying to understand better the return-on-investment for these types of
programmes, but also thinking about this synergy that could be developed through
combining cash transfer and mental health interventions and the additional
economic impact that that could make. So we are including a variety of
stakeholders throughout the research, and these include people
working in mental health systems and people working in anti-poverty work or
working in cash transfer programmes and also young people who have experience of working with the programme. What is really important as part of this project is that we are trying to address what has been called the
vicious cycle of poverty and mental health disorders meaning that both phenomena, both conditions, poverty on the one side and mental health problems or positive health and not being in poverty usually can go
hand-in-hand It sounds like a simple question: Why are
people poor? And you think: It is because they do not have money. But there can be a
really complex set of circumstances which influences and maintains poverty
over time. There are currently missed opportunities in the way the cash transfer programmes in low- and middle- income countries are designed so they are not actually including at the moment mental health aspects which is really
important for young people Poor mental health is absolutely a risk factor for descent into poverty, social exclusion, not having a job, all the rest of it,
absolutely. It could be perceived that mental health is a luxury issue and in fact it is something that that knits together many many issues in both high-income and low- and middle-income countries It is also related to other
social circumstances, violence, to other health conditions like cardiovascular disease, HIV. And so it can both be a driver of other social and health problems, and also maintain some of those social and health problems. Sometimes there is a perception that the only things we should be interested in are things that lead to early death, premature death. So you hear about AIDS and malaria and infectious diseases and so forth. But all over the world now we are moving much more towards disease burden being about non-communicable disease. And mental health is a really key driver. And from an economic point of view it impacts on
people’s participation in education and employments. It has impacts on families.
And that all costs money because you are reducing lifetime opportunities. When we think about mental health
interventions we think about maybe things done in hospitals or things done
by psychiatrists or psychologists that kind of thing. But there are other ways, in
which you can improve people’s mental health and one of them is actually to
make sure that they are not in abject poverty. So the principle here is that even though
mental ill-health is common across the entire life many of these problems have
their origins very early in life. And we manage to treat these problems or if we manage to reduce their consequences in early life we may be
better placed also to prevent mental health problems later in life. In South Africa we have a huge problem of youth unemployment. The general population unemployment rate is around 27%, which is already very high. But among young people aged 15 to 24 it is currently 67%. That is almost 10.3 million young people unemployed. That is a huge loss of human potential. It
is also in terms of life trajectories, if young people drop out of school their chances of long-term development and growth into
education, training and employment are that much less. Data from a recent survey indicated between 15 to 20 percent of adolescents here in Colombia suffer a
significant mental health condition. If you consider that you know that around
13% of the population, of the kids, have mental health problems, we are talking
about million and millions of youth with problems. So that’s one thing.
Around 70 percent of symptoms of mental health problems started when you are
young. So it is chronic. It is damaging your life for many, many years.
Especially in the UK, you have this very good cohort study showing that if you have mental health problems when you are like 10 years old it still impacts on your
your life when you are 55. It is about giving people a better
start in life, really. And how best to do that. And then there is a big return-on-investment potentially both for the individual and indeed the society that
they live in. So I think the idea or vision we are seeing is that we have integrated systems between existing mental health programmes and cash transfer programmes, or where there are no existing mental health programmes or very limited
we have an integration of mental health aspects into cash transfer programmes. One of the great values of the project is that because we are looking across a
number of countries, we should be able to develop a framework and have outputs
that can be applied in other places. Of course there will be contextual
adaptations that have to be made. And I think the key is as we take the field
forward is not just to focus on mental health per se but to look at the
cognitive and affective and behavioral styles associated with poverty and really
to try and develop resilience by targeting some of those especially in
young people. The final type of analysis that we will be doing will be to understand the economic impacts of both improving mental health but also
improving poverty circumstances so looking at the quantitative data and
trying to not just look at the impact on life chances and but also looking at what would be the economic impacts associated with those life
chances in the future. If you prove from CHANCES-6
especially in these deprived regions that by this decrease in poverty you
increase mental health I think it is amazing so hopefully in two to five years we will be able to prove that. And more than that, we may be able to understand the pathway: It [the cash transfer programme] should be conditioned or unconditional.
It should give money for mothers or directly to youth. So if you understand that and you have a lot of data to do that, so I think it is very powerful.

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