Sec. 2. Findings; sense of congress

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Congress finds the following: According to the 2016 Global Burden of Disease Study, an estimated 1,000,000,000 individuals worldwide have a mental health or substance use disorder. Mental disorders are major contributors to the global burden of disease, and depression is among the primary causes of illness and disability in adolescents. An individual’s mental health is a complex interaction between genetic, neuropsychological, and environmental factors, and environmental and social factors, from the early years through childhood and adolescence, can have long-term impacts on mental health.

According to a Lancet Commission report, allocations for mental health have never risen above 1 percent of health-related global development assistance. Estimates indicate that child and adolescent mental health receives just 0.1 percent of health-related global development assistance. The National Alliance on Mental Illness estimates that depression and anxiety disorders cost the global economy $1,000,000,000,000 in lost productivity each year. According to Lancet, mental health disorders are projected to cost the global economy $16,000,000,000,000 between 2010 and 2030, in part due to the early age of onset.

According to the World Health Organization (WHO), half of mental health disorders emerge by age 14, and 14 percent of children and adolescents worldwide experience mental health conditions, the majority of whom do not seek care, receive care, or have access to care. Exposure to violence and early childhood adversity, including trauma, has been linked to negative, lasting effects on physical and mental health. Early childhood adversity can impact brain development, nervous and immune system functioning, the onset of mental health conditions, and future behaviors.

The United Nations asserts that widespread school closures due to COVID–19, which have affected roughly 1,500,000,000 school-aged children, have placed many children at higher risk of exposure to traumas, such as household violence, abuse, neglect, and food insecurity. According to the United Nations, more than 1 out of every 5 individuals in conflict-affected areas has a mental health disorder. Roughly 1,500,000,000, or 2 out of every 3 of the world’s children under 18 years of age live in countries affected by conflict, and more than 1 out of every 6 children live in conflict zones.

A greater number of children live in areas affected by armed conflict and war now than at any other point this century. The mental health burden in conflict-affected contexts is twice the global average. Gender, age, disability status, race and ethnicity, and other identity characteristics contribute to different risks and needs for mental health and psychosocial support. Research has shown that harmful gender norms contribute to higher prevalence of depression and anxiety disorders in women and girls, while socialization of boys and men contributes to higher prevalence of substance use disorders.

Risks and experiences of gender-based violence, particularly sexual violence, are a key driver of mental health and psychosocial support needs for children. Girls account for 98 percent of verified incidents of conflict-related sexual violence. According to the World Health Organization, 35 percent of women globally face sexual and/or intimate partner violence in their lifetime and these survivors can, according to the Centers for Disease Control and Prevention, experience mental health problems such as depression and posttraumatic stress disorder

(PTSD)symptoms , signifying the urgent need for age and gender-responsive mental health and psychosocial support services. According to the World Health Organization, risk factors that increase susceptibility to mental health disorders include poverty and hunger, chronic health conditions, trauma or maltreatment, social exclusion and discrimination, and exposure to and displacement by war or conflict. These risk factors, along with demographic risk factors, manifest at all stages in life. Preliminary research already illustrates that the COVID–19 pandemic has increased communities’, families’, and individuals’ risk factors for multiple types of adversity and compounded preexisting conditions and vulnerabilities. Crisis situations put parents and caregivers under mental and psychosocial duress, which can prevent them from providing the protection, stability and nurturing care their children need during and after an emergency. The Lancet Commission estimates that between 15 and 23 percent of children globally live with a parent with a mental disorder, and parental ill health can impact the emotional and physical development of children and predispose these children to mental health problems. Numerous and compounding stressors and uncertainty caused by COVID–19 have exacerbated distress and further impede caregivers’ ability to provide responsive care to their children. Investments in the mental health, resilience, and well-being of the children in a country to ensure that they continue to thrive into adulthood and contribute to their societies can help break cycles of poverty, violence, and trauma and further the country’s future potential. Investments in protecting and improving mental health in a country across the life course must take into account the need to target vulnerable populations and address social, environmental, and other risk factors in conjunction with other sectors and local partners. It is the sense of Congress that— ensuring that individuals have the opportunity to thrive and reach their fullest potential is a critical component of sustainable international development, and the global public good benefits from investment in child and adolescent mental health; mental health is integral and essential to overall health outcomes and other development objectives; mental health is an issue of critical and growing importance for United States foreign assistance that requires a coordinated strategy to ensure that programming funded by the United States Government is evidence-based, culturally competent, and trauma-informed; the United States Government foreign assistance strategy should include a mental health and psychosocial support component; the redesign of the United States Agency for International Development (referred to in this Act as USAID ) reflects the nexus between humanitarian and development interventions and should be applied to all mental health and psychosocial support efforts of United States foreign assistance programs; and ongoing efforts to improve social service workforce development and local capacity building are essential to expanding mental health and psychosocial support activities across all United States foreign assistance programs.