17 November 2025

THE TRIPLE DIVIDEND: WHY ADOLESCENT MENTAL HEALTH IS SOUTH AFRICA’S SMARTEST INVESTMENT

By Paula Yarrow, Chief Development Officer, Waves for Change

Evidence-based physical activity and play-based interventions have the potential to reduce the prevalence of mental health disorders in the future by targeting the root causes of mental health problems now.

In South Africa, many young people face violence, poverty, and inequality. The resulting toxic stress, compounded by limited support, harms brain development, health, learning, and future opportunities, with its impact passing to future generations.

Adolescent mental health is no longer a niche issue; it is a societal and economic imperative.

Globally, 90% of adolescents live in low- to middle-income countries (LMICs), where rates of exposure to continuous adversity are high^[1]. In South Africa, the situation is severe. In 2022/3, 1,129 children were murdered and 20,464 sexual offences against children reported^[2], further exacerbated by poverty, HIV, and gender-based violence. Literature on social determinants of mental health demonstrates that outcomes are shaped by a combination of the societal, structural, and economic conditions under which people are born, grow, work, and live^[3], making support for adolescents growing up in poverty, conflict or crisis even more vital.

South Africa has one of the highest youth unemployment rates, with 35.5% of 15–24-year-olds not in employment, education, or training^[4] ^[5]. It is also the most unequal country globally (Gini coefficient of 0.63)^[6], with over 60% of youth considered multidimensionally poor^[7].

Mental health challenges are widespread. In a 2024 research study, over half of 15-18-year-olds in the Western Cape screened positive for depression or anxiety^[8], while 33% and 21% of adolescents aged 10-14 years screened positive for depression and anxiety, respectively^[9]. Scaling treatment programmes is complex and expensive and cures the symptoms but doesn’t solve the cause.

The impact of this has far-reaching consequences, including higher risks of substance use, school dropout, gang involvement, and the resultant negative effect on possible employment^[10].

But there is hope. Neuroscience shows that adolescence is a ‘second window of neuroplasticity’ – a period of unique developmental sensitivity in which the brain can adapt, heal and grow when given the right support^[11]. This makes adolescence a key window to mitigate the effects of childhood adversity and poverty.

According to UNICEF and the WHO, investing in 10–24-year-olds yields a triple dividend: improving their current well-being, supporting their future as adults, and promoting healthier next-generation families^[12].

Since 2011, Waves for Change (W4C) has partnered with universities and worked with violence-affected youth across Africa to develop its Take 5 Model – a simple, scalable framework that utilises physical activity and creative play to build healthier, happier generations.

The WHO identifies physical activity and play interventions as effective, engaging, and scalable preventative interventions for children and teens, a group that is otherwise hard to engage^[13]. Sport, art, and culture programmes can scale cost-effectively through community programmes in schools, youth centres, and humanitarian settings.

W4C uses the Take 5 Model to help governments and humanitarian agencies scale physical activity programmes safely. The Model provides a fun and simple routine that forms the backbone of every session, and a replicable training and supervision protocol. This protocol is based on the WHO and UNICEF’s Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) guidelines and equips coaches with nine essential caregiving skills to keep programmes safe and effective.

Take 5, informed by a 2016 youth-led photo voice study with violence-exposed youth in Cape Town, has proven impact. A 2022 evaluation of W4C’s Surf Therapy programme showed it reduced risk-taking and boosted self-regulation and social connection^[14]. In Somalia, combined with sport and cultural activities via Elman Peace^[15], Take 5 improved well-being, resilience, and emotional regulation among violence-exposed adolescents in Mogadishu.

Based on initial promising results, the Take 5 Model was incorporated into the ALIVE RCT Study. Led by King’s College London, the Study is evaluating the feasibility of interventions targeting poverty reduction and self-regulation (separately and combined) to prevent depression and anxiety among adolescents living in urban poverty in Colombia, Nepal, and South Africa^[16]. The study has piloted a 20-session Take 5 and sport-based intervention focused on self-regulation, with the combined arm adding a financial empowerment component.

Preliminary findings are encouraging. Attendance was high, programme fidelity was strong, and trained coaches delivered sessions effectively. Early results indicate the training and supervision framework enhances coach confidence and competence, suggesting a promising, impactful model worth further investment.

In the ALIVE trial, caregivers received a 6-session stress management and positive parenting programme based on War Child’s BE THERE intervention. Research suggests that caregivers in poverty face high stress, battling to manage competing demands such as financial instability and worries about safety, which can limit parental monitoring and emotional support for their children^[17]. This can lead to over-protection and harsh discipline, limiting children’s development. Caregiver interventions that foster caring relationships, monitoring of children, and encouraging quality time are emerging as key to supporting youth mental health in contexts of poverty, alongside effective adolescent engagement.

Feedback from ALIVE trial attendees includes:
“I cannot say I don’t have stress, but each and every time when I’m thinking about negative things, I can manage to change my negative thoughts to positive thoughts and move on” (Adolescent).

“Although we’re people and we’re stressed by kids, what I’ve found very helpful is that you’re taught to open your mouth, to be able to talk to my child” (Parent).

Full findings on the cumulative incidence of depression and anxiety amongst adolescents, as well as secondary outcomes such as sleep quality and emotional regulation, will be available in 2026.

W4C’s evidence journey suggests that physical activity and creative play-based programmes could be effective for mental health promotion and social behaviour change during adolescence, which could prevent a mental health illness burden further down the line. Take 5 is now helping governments and humanitarians scale up sport programmes with confidence. We urge policymakers, development leaders and philanthropists to invest in sport, art, and cultural programmes to create happier, healthier spaces for young people everywhere.