Youth Confront Deep-Rooted Mental Health Stigma in Lithuania
University of Copenhagen published the article “Mental health of young Lithuanians”, where Agnietė Kairytė, a PhD student at the Center for Psychotraumatology at Vilnius University Faculty of Philosophy, and Austėja Dumarkaitė, a clinical psychologist and a post-doctoral researcher at the Center for Psychotraumatology, explain the factors leading to mental distress among Lithuanian youth and tell about the proposed digital interventions to help address the crisis.
With the kind permission of publishers, we share the article with our audience.
Today's youth in Lithuania represents the first generation born and raised in an independent country following the political changes of the 1990s in Europe. During the Soviet occupation, Lithuania's mental health care system was marked by a reliance on medication, institutionalisation, and the resulting social exclusion—leaving a lasting impact on the current system. Despite notable progress and ongoing reforms, deeply rooted stigmas and outdated perceptions still affect thousands of youth across Lithuania today, underscoring the need for continued change.
Nineteen-year-old Živilė (not her real name) from a small town in Lithuania often slips by quietly, keeping to herself. Her dark eyes seeming to carry a weight her friends don’t understand. She’s been through difficult times.
“People would mock me for being quiet and looking down. I’ve noticed that those who knew me growing up, and saw my mental health decline, now seem uneasy around me. It’s as if they view me as ‘a former psychiatric patient' even though I have never been one. I struggled with intense anxiety but never sought help because of the stigma surrounding therapy here. Many of us still see it as something only ‘crazy’ people need,” shares Živilė in a social media post, describing how lingering glances from others remind her of the cultural stigma still present around her. Živilė is not an isolated case.
In 2023, the Institute of Hygiene (the public organization that works under the Ministry of Health of the Republic of Lithuania) reported that a significant portion of mental health problems in Lithuania develop early in life, with 48.4% of youth experiencing such conditions by the age of 18 and 62.5% before turning 25. These numbers are not surprising; they are pretty similar to those of the rest of the world. However, even if access to mental health care services is getting better every year, Lithuania still lacks human-centered early interventions for such problems for young people, as well as the continuation of mental health care services in different developmental stages.
Factors leading to mental distress among Lithuanian youth
“Overall, the developmental stage, which we call 'emerging adulthood' – is quite complex. Young people face many life challenges, for example, looking for potential partner, maintaining relationships, looking for career paths, searching for their identity, or possibly encountering money issues. These are normal stressors. However, these stressors may increase the risk of mental health difficulties,” explains Agniete Kairyte, a PhD student at the Centre for Psychotraumatology at Vilnius University.
Recent analyses of the ADVANCE team in Lithuania revealed some of these stressors. Trauma weighs heavily on youth, with studies indicating that 67.5% to 77.2% of students have experienced at least one traumatic event in their lifetime, and 91.3% have endured adverse childhood experiences. Exposure to trauma increases the likelihood of post-traumatic stress disorder (PTSD), often linked with social anxiety disorder, substance abuse and suicidal ideation.
"Studies show that we have quite high rates of suicidality in the youth cohort and also quite high rates of alcohol consumption. We assume that this behavior was developed as a coping mechanism due to our historical context. Today, as mental health specialists and researchers, we must focus on the existing situation and provide youth with constructive coping strategies to take care of themselves and those around them in the community," adds Kairyte.
Previous studies on youth mental health in Lithuania focused on several issues. For example, it was shown that bullying significantly worsens the mental health of young people, with both in-person and online victims being particularly vulnerable. Also, in Lithuania, body image issues and eating disorders present major challenges, as positive body satisfaction is strongly linked to a better quality of life. However, societal pressures, such as media-driven thinness ideals, disproportionately affect young women, while young men face stress related to masculinity standards. Approximately 19.2% of Lithuanian students are at risk of developing eating disorders influenced by factors like gender, body weight, and pandemic-related stress. Moreover, the COVID-19 pandemic further deepened the mental health crisis, with 8.9% of students reporting suicidal thoughts during this period. Nearly half of Lithuanian youth experience nervous tension, and sexual and gender minorities in Lithuania face heightened rates of mental health issues and risky behaviors, underscoring the need for targeted support.
Traces of cultural trauma and stigma
“Today, we also have many global challenges such as climate change, political instability, and wars that add to the uncertainties of the youth, and we need to address that,” says Kairyte, citing the distress that comes from the ongoing war in Ukraine, among others.
Olena Zelenska, First Lady of Ukraine, has once described this impact of conflict on mental health as something similar to radiation: "no borders or distances can protect against the anxiety, uncertainty, and phobias that wars bring about to people".
The situation is compounded by the stigma surrounding mental health. Previously a biomedical approach described mental health, believing that mental issues are purely biology with minimal consideration of the environment and situations that the individuals are in. This resulted in a lingering perception similar to what Živilė has encountered. Nearly half of the population is uncomfortable with the idea of working or living alongside individuals suffering from mental health conditions. This stigma, partly rooted in Lithuania’s Soviet history, further marginalizes those already struggling.
Various initiatives are actively working to address the issue and reduce stigma. The non-governmental organization “Mental Health Perspectives” focuses on human rights and person-focused mental health policy in Lithuania. Also, the Institute of Hygiene recently initiated a mental health ambassadors’ program, which mainly focuses on the destigmatization of mental health difficulties. Furthermore, today, the Lithuanian mental healthcare system is in a paradigm shift from institutional to community-based care. However, the initiative and reforms are new and have not yet provided results.
Young people’s access to mental health services
The Lithuanian ADVANCE report highlighted that financial difficulties and rural living conditions pose significant barriers to accessing mental health services. In rural areas, for instance, a major challenge is the scarcity of mental health specialists, as most practitioners are concentrated in urban centers, leaving only a handful to serve smaller communities. This lack of access often prevents young people from receiving confidential and continuous psychological support.
"Furthermore, statistics show a gap between low-income and high-income groups in Lithuania. Probably, this could significantly affect the youth well-being in Lithuania as well," says Kairyte.
Additionally, many adolescents rely on school psychologists, but this support typically ends upon graduation, disrupting continuity of care. Another barrier noted is that school-aged youth require parental consent for psychological services, deterring many from seeking help during adolescence.
The team also identified particularly vulnerable youths, such as sexual minorities, foreign students, or people with disabilities, who are also at risk.
“Most of the studies on the context of Lithuania were conducted on student samples. So, we could not capture all young people in Lithuania and see the specific groups. But we concluded that youth in Lithuania as a whole could be at risk,” says Kairyte.
Read this European-level policy guidance and priority actions to advocate for mental health with greater respect for human rights while tackling structural injustices.
Proposed digital interventions to help address the crisis
In support of national efforts, the ADVANCE project introduces innovative solutions, including the STARS intervention developed by the World Health Organisation (WHO). Austeja Dumarkaite is a clinical psychologist and a post-doctoral researcher at the Center for Psychotraumatology at Vilnius University. Together with Kairyte, she is working on implementing the STARS intervention into youth´s daily lives.
“STARS is a chatbot-based program for distressed youth developed by the WHO. It consists of ten sessions-short chats, which are 10 to 20 minutes long. It is based on cognitive behavioral therapy. A user signs up for the program and starts chatting with the chatbot, which we call Sija in Lithuania. The chatbot provides basic psychoeducation about stress management, emotions, when stress is useful, and when stress is not useful. It tries to help the user identify his or her own stressors, stress symptoms, and how he or she could manage that,” explains Dumarkaite.
“Throughout the program, specific strategies or techniques are taught by the chatbot. These are various so that users can choose between different ones. The aim is to learn all of them, so the user could apply these interventions through various life situations. It starts with basic ones, like breathing exercises and grounding techniques, so that when you are very stressed, you could stop for a moment, be more in touch with yourself or with your environment, and detach a bit from stressful situations. Once you are calmer, you can come back to the situation and then solve things,” explains Dumarkaite on how Sija aims to work.
“Another technique involves solving problems and breaking them down into smaller ones. For example, if you see a mountain, it's really difficult to climb it, but if you decompose it into smaller steps, then you can take action and solve your problems. Users chat with the chatbot, and they also have several calls with so-called e-helpers, specially trained people who help users to use the chatbot. They answer questions if something is not clear, explain how to do things, or assist if difficulties arise. This additional help makes it a guided program, so users are not alone in this,” adds Dumarkaite.
What gaps will ADVANCE attempt to fill
One of the aims of the ADVANCE project is to find out more about the state of Lithuanian youth and the effects of the program, as Dumarkaite explains: “Firstly, we want to find out more about how young people are doing in general, what their mental health is like. We don't have that much information here in Lithuania. We have some information from Europe and the world that is very similar. But as Agniete mentioned, a lot of research studies are focused on students. We want to broaden our sample and not only focus on students, although students are important because many young people go to universities here in Lithuania. Another point is that since we are adapting the chatbot-based program and testing its effects, we want to find out how such a program works here, whether it is acceptable to young people, what they think about it and whether it is effective.”
ADVANCE’s Lithuanian team has had positive results with using internet-based interventions that uses videos and audio recordings in their previous studies done with young people with traumatic experiences. “The young people found it a good experience because they could use it anonymously, wherever they were and gain valuable skills to maintain good mental health,” says Dumarkaite.
Ongoing initiatives like the ADVANCE project, which promote mental health awareness and work to reduce stigma, are crucial for enhancing the well-being and future prospects of young people in Lithuania, including individuals like Živilė.
The Sija pilot study was launched 30 October 2024 through the efforts of Vilnius University and WHO.