Implementing Early Mental & Physical Health Detection & Support: Promoting a Whole-School Approach to Health & Well-being (ISOBAR)

青春期是人生的关键阶段，为终身健康和幸福奠定了基础。现在已经确定，在成人生活中导致残疾或死亡的大多数严重精神障碍都是在12-25岁之间发病的，其中一半以上是在16岁之前发病的。虽然焦虑、抑郁和精神病等疾病在青少年时期发病，但对它们的认识往往较晚，而且提供干预措施时往往“较晚”；只有当失调已经形成，残疾开始出现的时候。大多数青少年生活在低收入和中等收入国家，这些国家资源匮乏，对健康不良的耻辱感很高，最脆弱的群体处于最不利的地位。心理健康问题与身体问题之间经常存在联系，特别是与营养有关的问题，包括营养不足和肥胖。因此，青少年最常见的非传染性疾病，以及他们最大的负担，与精神疾病和营养相关问题的组合有关。高收入国家的工作已经证实，这类疾病是可以预防的，如果及早发现，可以用低强度干预措施进行治疗，以防止成年性和延续性。ISOBAR项目旨在在印度和尼日利亚两个低收入中等收入国家的学校环境中实施基于证据的干预措施。项目团队在这些国家的学校环境中与年轻人合作方面拥有丰富的经验。我们以前在这些国家的工作表明，虽然许多青少年患有这类疾病，并将学校视为他们寻求帮助的地方，但在这些环境中，几乎没有国家资助的学校提供任何促进积极健康和防止出现严重疾病的保健方案。我们将招募和培训基于证据的干预措施方面的校本辅导员，这些干预措施是根据当地社会文化背景量身定制的，并以交错的方式向每个地点的三所学校（印度两所，尼日利亚一所）提供这些干预措施。我们将与学校、年轻人、他们的照顾者、当地社区组织、保健提供者和政策制定者建立公平的伙伴关系，开展这项工作。通过实施研究框架，我们将评估我们的方案是否为当地社区所接受，是否有助于促进积极健康，防止出现严重疾病，并确保需要专业护理的人及时有效地获得护理。我们将确定干预的成本和收益，并探索在项目生命周期之外影响其可持续性的因素。这项工作将留下持久的遗产，有可能改变发展中世界数百万青少年的健康和福祉。

Adolescence is a critical life stage where the foundations of lifelong health and wellbeing are laid. It is now well-established that most serious mental disorders that disable or kill in adult life have an onset between the ages of 12-25, with over half having an onset before the age of 16. While disorders such as anxiety, depression and psychosis have an adolescent onset their recognition is often delayed, and interventions, when offered, are often 'late'; only when the disorders have become established and disability set in. The majority of adolescents live in low- and middle-income countries (LMIC) where resources are scarce, the stigma of ill-health high, and the most vulnerable are at the greatest disadvantage. There is a frequent association between mental health problems and physical problems, especially those related to nutrition, both undernutrition and obesity. The most common non-communicable disorders (NCDs) of adolescence, and their greatest burden, is hence related to a combination of mental ill-health and nutrition-related problems. It is well-established from work in high-income countries that such disorders can be prevented and, if identified early, be treated with low-intensity interventions to prevent chronicity and continuity into adult life. The ISOBAR project aims to implement evidence-based interventions in school-settings in two LMICs, India and Nigeria. The project team has extensive experience in working with young people in school-settings in these countries. Our previous work in these countries has shown that while many adolescents suffer from such disorders and see schools as places where they would seek help, almost no state-funded school in such settings offers any health programmes that promote positive health and prevent serious disorders from emerging. We will recruit and train school-based counsellors in evidence-based interventions which have been tailored to local socio-cultural context and offer these in a staggered manner to three schools at each site (two in India, one in Nigeria). We will conduct this work in an equitable partnership with schools, young people, their carers, local community organisations, health providers and policymakers who have strong and well-established links. Using an implementation research framework, we will evaluate our programme for whether it is acceptable to the local community, useful in promoting positive health, preventing serious disorders from emerging, and ensuring that those who need specialist care receive it in a timely and effective manner. We will determine the costs and benefits of our intervention and explore factors that affect its sustainability beyond the lifetime of our project. The work will leave a lasting legacy that has the potential to transform the health and well-being of millions of adolescents in the developing world.