Applying the 4-S Framework to Address Adolescent Mental Health
The Department of Child and Adolescent Health and Development’s ‘4-S Framework’ for
strengthening health sector responses to adolescent health and development provides a structure
for initiatives to improve adolescent mental heath through:
1. Gathering and using strategic information
2. Developing supportive, evidence-informed policies
3. Scaling up the provision and utilization of health services and commodities
4. Strengthening action and linkages with other government sectors
By using mental health as an entry point for addressing young people's health, there is the
opportunity for strengthening the response for related health problems of public health
importance. This is because depression, anxiety and low self esteem can lead to excessive risktaking behaviours which are often at the heart of problems such as STIs including HIV/AIDS,
unwanted pregnancy, eating disorders, substance use and abuse, and accidents and injuries. Many
of these problems are preventable and all are helped by psychosocial interventions.
1. Strategic Information
Our aim is to gather the best epidemiologic and programme monitoring data related to
mental health problems in adolescents, analyse these and used them for policy formulation and
strategy development. For this to happen, Ministries of Health need firstly to define a set of
indicators in each of the following areas:
 Health outcomes: incidence and prevalence of key mental health problems in adolescents
 Behavioural data: risk behaviours that could contribute to mental health problems, and
protective behaviours that could protect adolescents from them and their consequences
 Determinants: bio-psycho-social factors contributing to mental health problems
 Programmatic data: appropriateness of interventions, and their quality and coverage.
Secondly, Ministries of Health need to gather data, aggregated by age and sex, through established
health information systems, surveys and studies. Finally, they have to analyse the data and apply
these for advocacy, policy formulation and strategy development.
We will support Ministries of Health to select the most appropriate indicators, and data
collection and analysis methods and tools. We will also support them in data analysis and its use
for decision making.
2. Supportive Evidence Based Policies
Our aim is that national- mental health policies and strategies, or the mental health
component of overall national health policies and strategies are guided by strategic information
and sound evidence. Further our aim is that there are clear policy statements calling for actions by
different sectors to promote mental health, prevent mental health problems and respond to them
if they occur.
We will support Ministries of Health by reviewing their policy and strategy documents, and
where appropriate helping them to strengthen these.
3. Services and Commodities
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Our aim that is adolescents with mental health problems are identified in their
communities and referred to primary level health facilities where they get the care and support
they need. Those adolescents requiring specialized care have to be referred to secondary and
tertiary level health facilities.
For this to happen, Ministries of Health need to put in place a continuum of services from
the community, through the primary level to the referral level. At the community level, teachers,
social workers and other non-health workers should be enabled to recognize problems and refer
those adolescents who might need help to health services. At the primary level, health workers
should detect mental health problems early and provide timely treatment and support including
counselling, cognitive-behavioural therapy and where appropriate, psychotropic medication. At the
referral level, a multi-disciplinary team should deal with the bio-psycho-social and rehabilitation
needs of adolescents with serious mental health problems. One key emergency service that should
be in place is care and support for adolescents who harm themselves or are at the risk of doing so.
We will support Ministries of Health by providing them training, self learning and desk
reference tools for community members and health workers. We will also provide guidance on the
WHO recommended essential medicines and supplies that are needed at the primary and referral
levels, and on the referral networks that should be put in place.
4. Strengthening Other Sectors
Our aim is that other sectors support the efforts of the health sector to enable adolescents
to obtain the mental health services they need, and in addition make the important complementary
contributions that they need to, in order to promote mental health in adolescents, to prevent
problems from arising, and to respond to mental health problems promptly, effectively and
sensitively. For this to happen, Ministries of Health need to:
 engage and support other sectors- in particular the education, social welfare, media,
employment and youth and sports sectors - to make the important contributions that they
need to
 ensure that their actions are evidence based, carried out well, reach all adolescents and
especially those who are most vulnerable, and are carried out collaboratively with other
sectors
We will support Ministries of Health in defining the contributions that other sectors need to make,
and in ensuring that their actions are evidence based. Here are some illustrative examples:
Setting
Sector
Home
Social welfare services
School
School staff
Actions
 Educating parents to help them understand the emotional needs of
adolescents and how to respond to these needs; the nature of
mental health problems that might occur and how to respond to
them as well as when and how to seek help.
 Supporting vulnerable adolescents and their families
 Building individual assets such as self esteem and life skills.
 Discussing sexual health, injuries and violence and substance use, and
promote healthy attitudes and behaviours.
 Making the school a safe environment (i.e. free from physical and
emotional violence) and a supportive one (i.e. where students and
staff feel valued and supported).
 Training teachers to detect adolescents who might need help, provide
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
Community
Community leaders and 
members


Media and new
communication
technologies
Media personnel


them with counselling support, and refer those who need medical
help to health facilities.
Working with social health services to identify and provide support to
those adolescents living in difficult circumstances.
Engaging and sensitizing community leaders and members to help
create a caring and supportive environment for adolescents at risk of
mental health problems, those with these problems and their families.
Engaging and sensitizing community members to intervene when
there is violence in homes and elsewhere in their communities.
Training selected community members to detect and refer those
adolescents who might need help to health services.
Disseminating information on factors contributing to mental health
problems in adolescents, on effective ways to prevent mental health
problems and respond to them when they occur, and on substance
use and mental health problems.
Preventing glamorization of suicides.
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