Building Resilient Adolescent Mental Health Systems in Asia and the Pacific

Adolescence is a critical development period between childhood and adulthood, marked by rapid brain maturation—particularly in the prefrontal cortex, which governs decision-making, emotional regulation, and impulse control. This stage presents both opportunities and risks as nearly half of all mental health conditions begin by age 14.

The risks are shaped not only by pathophysiology, but also by environments and systems over which adolescents have little to no control. Family stressors, academic pressures, societal and cultural norms, poverty, violence, and stigma surrounding mental health exacerbate existing challenges. Experiencing a mental health condition during this critical stage of identity formation can profoundly shape their identity, social relationships, and future opportunities.

Neglecting mental health can affect education, employment, and social participation—increasing the likelihood of persistent challenges into adulthood. Early identification and treatment can enable adolescents to access timely care, fostering recovery and resilience.

Despite ongoing efforts, responses to adolescent mental health remain insufficient. On average, countries in Asia and the Pacific spend an average 6.2% of GDP on health—compared to 9.3% in OECD countries. Within this, mental health typically receives less than 2% of total health budgets globally, and often even less in low- and middle-income countries.

A persistent workforce shortage compounds the problem. Most countries in the region have less than 0.5 adolescent mental health professional per 100,000 population. Even when services exist, these are often concentrated in urban areas, leaving the rural and marginalized communities underserved.

Additionally, pervasive stigma continues to limit progress by excluding mental health as a public health priority. Fragmented data systems make monitoring and evaluation difficult, hindering evidence-based planning and reducing the ability to assess service coverage and quality. These issues are evident across the region, although their scale and nature vary by country context.

To illustrate how these challenges play out in specific contexts, the following two case studies offer practical insights:

Cambodia: Limited access and cultural barriers 

Cambodia has made progress in recognizing mental health needs, but adolescent-specific services remain limited. As of 2023, there were only 97 psychiatrists and 33 specialized mental health nurses for a population of 17.18 million—0.56 psychiatrists per 100,000 people, far below the global average of 3.95. Most facilities are in urban areas, leaving about 85% of adolescents in rural areas with limited care.

While the Mental Health Strategic Plan 2023–2032 outlines national priorities, it lacks a clear provisions for youth. Funding remains low and limited research and evidence-based analysis further constrain planning. Deep-rooted stigma and low mental health literacy also impede care: mental illness are often attributed to spiritual possession (khamoch chaul or being possessed or jum n’ger chkout or madness), pushing adolescents toward traditional healers or informal care instead of professional support.

India: Decentralized system 

India’s decentralized approach provides flexibility to adapt mental health policies locally, but it often leads to inconsistent implementation. With only 0.75 psychiatrists per 100,000 people and unequal distribution of specialists and services, gaps in access remain significant. Mental health receives only about 1% of the national health budget, most of which are focused on adults and specialist care.

Stigma remains a major barrier. Terms like pagal (madness) reinforce perceptions of mental illness as weakness or failure, discouraging adolescents from seeking professional help. Limited mental health literacy among the youth and communities also means early signs often go unrecognized.

However, promising Initiatives are emerging. The Tele-MANAS program offers remote mental health support, while Rashtriya Kishor Swasthya Karyakram integrates mental health into broader adolescent health services. Still, without treating mental health as a distinct priority, integration risks diluting focus.

The challenges surrounding adolescent mental health are widespread across Asia and the Pacific. Without prompt and targeted action, these gaps will continue to impede progress toward the Sustainable Development Goals. To address these gaps, four priority actions have been identified:

• Prioritize adolescent mental health in regional and national agendas. Integrate youth mental health into the policy framework as one of priority deliverables similar to Australia’s National Action Plan for the Health of Children and Young People 2020–2030.
• Improve mental health literacy and reduce stigma. Implement sustained, culturally relevant public awareness campaigns in partnership with youth networks, people with lived experience, and community leaders. Integrating mental health education into school curricula, similar to the R u OK? Campaign, can normalize conversations and promote early help-seeking.
• Increase mental health service and research funding. Allocate funding consistent with the WHO framework for low- and middle-income countries. Funding should expand access to community-based care, including schools and digital services, strengthen mental health workforce, and promoting research and development, particularly in underserved areas.
• Foster multisectoral, cross-sectoral and international collaborations and partnerships. Develop partnership frameworks that engage governments, international organizations, development partners, multilateral development banks, academia and community-based organizations to ensure coherence and alignment.

Note: Mental health was part of the discussions during ADB's 1st Health Forum: Inclusive, Sustainable, Prosperous and Resilient (INSPIRE) Health Systems in Asia and the Pacific.

T. Hirota et al. 2020. Starting at the Beginning. Laying the Foundation for Lifelong Mental Health. Child and Adolescent Mental Health Needs, Services, and Gap in East and Southeast Asia and the Pacific Islands. Academic Press.

The Lancet Global Health. 2020. Mental Health Matters. 8 (11).

UNICEF. Adolescent Mental Health in East Asia and the Pacific.

V. Yiengprugsawan and R. Parikh. 2025. From Hospitals to Communities: How to Expand Mental Health Access. Asian Development Blog.

World Health Organization. 2023. Psychiatrists Working in Mental Health Sectors (per 100,000).