Mental health disorders are a major issue facing adolescents globally. Worldwide, one in seven adolescents (ages 10-19 years) experience mental health disorders.1 Moreover, one-third (35%) of individuals experience their first mental health disorder before age 14 and almost half (48%) before age 18.2 Despite growing recognition of the importance of supporting mental health during the unique developmental stage of young people, less than half of adolescents receive the mental health services they need.3 The COVID-19 pandemic has further exacerbated mental health issues facing young people, drawing additional attention to unmet needs in mental health services.4
Sport for development (SFD) organizations are well-positioned to address mental health challenges facing youth. A systematic review of adolescent mental health programs found that universally delivered interventions can improve adolescent mental health outcomes and reduce risk behavior, with two program components showing consistent signs of effectiveness across a range of outcomes: 1) interpersonal skills (eg, empathy, communication) , and 2) emotional regulation (eg, being able to manage emotions).5 These areas tie closely with the goals of many SFD programs,6 while also linking with the innate life skill and relationship development opportunities provided by sport (eg, teamwork, self-discipline, goal-directed behavior).7
Grassroot Soccer’s approach
In response to the growing crisis in youth mental health, Grassroot Soccer (GRS)—an adolescent health organization working in over 60 countries worldwide—launched a mental health strategy in January 2022. The strategy includes four strategic priorities:
- Integrate mainstream positive mental health content into all of GRS’s “SKILLZ” programs
- Innovate by developing creative solutions for mental health promotion and prevention
- Advocate to reduce stigma and create environments that support adolescent mental health
- Evaluate to identify a clear and compelling research and learning agenda for adolescent mental health
GRS’s strategy was developed to align with international standards and practices. This includes the United Nations Inter-Agency Standing Committee (IASC)’s intervention pyramid for mental health and psychosocial support, which recommends four ‘tiers’ or layers of complementary supports to meet the needs of various groups8 and reflects insights and consensus of practitioners across regions, disciplines, and sectors.
Figure 1 shows how GRS is working to address each of the four layers of the pyramid, from providing basic services and security by integrating positive mental health concepts into 100% of its programs at the bottom to offering referrals for youth in need of specialized services at the top. Additionally, GRS developed an adolescent mental health global monitoring, evaluation, and learning (MEL) framework, including a theory of change and a detailed list of performance indicators against which it will measure its progress over time. This framework draws on international guidelines from such bodies as the United Nations IASC,9 United Nations Children’s Fund,10 and USAID,11 while also aligning with Sustainable Development Goal 3 concerning good health and wellbeing.
Figure 1: Application of the United Nations IASC’s Intervention Pyramid for Mental Health and Psychosocial Support to GRS’s programming and services
GRS’s core principles support its design and delivery of mental health programming. Its use of play-based activities can enhance social-emotional learning and minimize fears around discussing sensitive mental health topics. Its programming is stakeholder-driven and relationship-focused, enabling the co-development of solutions in partnership with communities while providing safe spaces and positive bonds between adolescents and trained GRS coaches. GRS takes a strengths-based approach of building on adolescents’ existing skills and assets. Finally, GRS intentionally engages parents, teachers, and other important figures in adolescents’ lives to help de-stigmatize mental health.
Balance and Stress offers an example of one of GRS’s play-based activities to support mental health wellbeing. Participants work to keep up a ball representing a “healthy mind” at the same time as “stressor” balls are introduced. This activity teaches participants that stress is a normal part of life but that too much stress for too long has consequences for our mental health. Stress makes it difficult to keep the “healthy mind” ball in the air. The key message is that everyone faces stress and needs ways to cope with stress. Talking with each other when we need support is one coping strategy.
The way forward
SFD organizations have a unique opportunity to address mental health challenges facing youth around the world, given their access to young people, foundation within communities, use of activities-based learning, and ability to promote key life skills and relationship-building. We encourage other SFD organizations to reflect on ways to incorporate mental health into their strategic objectives and/or programming. We look forward to collaborating with organizations and continuing discussions about innovative approaches to strengthen mental health support for adolescents globally.
Chris Barkley is the Technical Advisor for Mental Health at Grassroot Soccer, consulting on the development of GRS’s adolescent mental health strategy and new mental health curriculum products. He previously held multiple other roles at GRS in business development, strategy, and curriculum and training and holds an MBA from the Schulich School of Business at York University.
Andy Dallos is the Director of Strategy and Innovation at Grassroot Soccer, overseeing strategy for GRS program products and technical assistance services. He previously led the US Government funding portfolio on the GRS Global Business Development team. He holds an MSc in Public Health from the London School of Hygiene and Tropical Medicine.
Devyn Lee is the Research Manager for Grassroot Soccer, where she oversees multiple research partnerships and supports several internal learning platforms. She holds an MPH from the Columbia University Mailman School of Public Health.
Kate Merrill, a former Grassroot Soccer employee, is a researcher at the University of Illinois Chicago’s Center for Dissemination and Implementation Science. She holds a PhD from the Johns Hopkins Bloomberg School of Public Health.
1. WHO. Adolescent mental health[updatedNovember172021Availablefrom:[updatedNovember172021Availablefrom:https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health.
2. Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale metaanalysis of 192 epidemiological studies. Molecular Psychiatry. 2022;27:281-95.
3. Ghafari M, Nadi T, Bahadivand-Chegini S, Doosti-Irani A. Global prevalence of unmet need for mental health care among adolescents: A systematic review and meta-analysis. Archives of Psychiatric Nursing. 2022;36:1-6.
4. Panchal U, Salazar de Pablo G, Franco M, Moreno C, Parellada M, Arango C, et al. The impact of COVID–19 lockdown on child and adolescent mental health: systematic review. European Child & Adolescent Psychiatry. 2021.
5. Skeen S, Laurenzi C, Gordon S, du Toit S, Tomlinson M, Dua T, et al. Adolescent Mental Health Program Components and Behavior Risk Reduction: A Meta-analysis. Pediatrics. 2019;144(2).
6. Whitley M, Massey M, Camire M, Boutet M, Borbee A. Sport-based youth development interventions in the United States: a systematic review. BMC Public Health. 2019;19(89).
7. Anderson-Butcher D, Bates S, Amorose A, Wade-Mdivianian R, Lower-Hoppe L. Social–Emotional Learning Interventions in Youth Sport: What Matters in Design? Child and Adolescent Social Work Journal. 2021;38:367-79.
8. IASC. Guideline: Mental Health and Psychosocial Support in Emergency Settings. Geneva; 2007.
9. IASC. The Common Monitoring and Evaluation Framework for Mental Health and Psychosocial Support in Emergency Settings: with means of verification (Version 2.0). Geneva; 2021.
10. UNICEF. Operational guidelines on community based mental health and psychosocial support in humanitarian settings: Three-tiered support for children and families. New York; 2018.
11.USAID. Integrating Mental Health and Psychosocial Support into Youth Programming: A Toolkit. Washington, D.C.; 2021.