2 Mental health prevention and promotion

The basis for good mental health and quality of life is formed throughout life and in many arenas: in families, kindergartens, school and education institutions, working life, the local environment, among friends and through participation in leisure and cultural activities. The commitment must therefore be aimed at these forums where the possibilities for conducting effective prevention and mental health promotion are considerable. Through this escalation plan the Government will illuminate various health promotion and preventive measures that may increase the quality of life and improve health throughout the human lifecycle. A specific goal is to reduce mental issues in children and adolescents and the percentage of young people who become disabled due to mental health issues and disorders. The Government will also work on increasing knowledge about mental health and implement measures to prevent loneliness.

2.1 Basis for the priority area

The work on health promotion is characterised by strengthening mental health through measures that increase the quality of life, coping skills, self-image, knowledge about making good choices for one’s own health, and the ability to handle adversity and stress in life. The purpose of the preventive work is to reduce known risk factors and strengthen protection factors. The work on health promotion and prevention can be directed at the whole population, groups and individuals.

Mental health disorders largely contribute to the overall disease burden in Norway. The disease burden is caused by loss of health (measured in YLD – years lived with disability) and is largely accentuated by mental health disorders and muscle and skeletal diseases.1 Most age groups are affected by these conditions, but mental health disorders represent a particularly large percentage of health loss among young people and those of working age, and parts of the immigrant population. Mental health disorders are an important cause of health loss from as early as the age of ten.2

Whilst the prevalence of mental health disorders among adults has been relatively stable over time, the percentage of children and adolescents registered with diagnosis codes in the primary health service has increased. There has also been an increase in the percentage of young girls treated by the specialist health service for mental health disorders. Moreover, there has been a significant increase in self-reported mental issues among children and adolescents, particularly girls. The Norwegian Institute of Public Health points out that the most important potential factors that may have contributed to the increase are social media and screen use, endured stress and pressure, and sleep and sleep problems.3

Research shows that mental health disorders are socially skewed.4 Mental health disorders are three to four times more prevalent in children whose parents are on a low income. These differences continue over the course of life and are also found again when the children become adults.

It is frequently pointed out that programmes offered by health and care services must be increased in order to solve the challenges of increased mental issues. It is uncertain how many people, who report mental illness, actually need health care services, and how many are expressing general and transient mental illness. Such issues may be connected to coping with day-to-day living, which again may be due to or intensified by, inter alia, sleep problems, increased use of social media or pressure at school. The causes of the trends in self-reported mental health issues and contact with the health service must be seen in relation to each other. Experienced severe mental health issues impact help-seeking behaviour, which in turn triggers the use of health services. The Norwegian Institute of Public Health has established a national professional network for research on the mental health of children and adolescents, and is further developing the cooperation with expert environments in Norway. Analyses will be performed on the causes and consequences of the increase in mental health issues in children and adolescents as a basis for assessing relevant measures to increase their mental health and quality of life. A corresponding network and cooperation with the expert environments will be built up around the mental health of adults.

2.1.1 Cross-sectoral ownership of mental health and quality of life

Good mental health and quality of life are primarily created outside the health and care services. Cross-sectoral ownership is crucial in order to strengthen the population’s mental health and prevent mental health issues. In order to succeed, all departments and sectors with instruments to foster good mental health and quality of life must participate in this work. Not least, this applies to the work aimed at children and adolescents. The commitment must be directed at forums that provide good opportunities for conducting effective prevention and mental health promotion efforts, such as in families, kindergartens, schools, workplaces and various leisure arenas. These are important arenas because this is where one can meet most children, adolescents and young adults, and it is crucial to intervene early: approximately half of all mental health issues make their debut during childhood and adolescence.5

In order to develop health promotion measures, good cooperation between the voluntary and public sectors is important. For children and adolescents with mental health challenges, good cooperation between services in different sectors is also important. The Ministry of Children and Families, the Ministry of Labour and Social Inclusion, the Ministry of Health and Care Services, the Ministry of Justice and Security, the Ministry of Local Government and Regional Development, the Ministry of Culture and Equality, and the Ministry of Education and Research have established a core group for cooperation pertaining to children and adolescents. Among other things, the core group will contribute to ensuring that the goals of sector policies, activities and resources are seen in context and initiate common efforts that may lead to better goal achievement across the sectors.

The municipalities have reported for many years that mental health is one of their major public health challenges. This emerges in both the Office of the Auditor General of Norway’s review of public health work6, and in the Norwegian Directorate of Health’s sector report 2021,7 where more than 60 per cent of the municipalities point out mental health and quality of life as two major challenges in public health. Better systems and methods for assessing how various measures impact mental health in the population with a view to, for instance, social and geographic differences is needed.

2.2 Strengthen the population’s mental health throughout the course of life

The Government will implement measures in arenas where mental health and quality of life can be promoted for the whole population, particularly among children and adolescents. One goal is to reduce the number of self-reported mental health issues in children and adolescents. Health promotion and preventive measures can be difficult to prioritise, and they are often conditional upon long-term cross-sectoral efforts and cooperation between public and voluntary actors. The Government will work on a safe and good childhood for all children and adolescents, contribute to increased mental health skills in the population and good mental health in old age. This involves the implementation of measures during the course of life, including more systematic and evidence-based parental support, targeted efforts in kindergartens, schools and various leisure arenas, and stimulation of participation in education, the labour market and activities, which may contribute to school dropout prevention and reduce the risk of developing mental health issues and disorders. The Government wants to strengthen the commitment to getting more people, particularly young people, in work and activities, and aims to reduce the percentage of young people who become disabled due to mental health issues and disorders during the course of the plan period. The Government will also strengthen the mental health of students and the elderly through targeted measures.

2.2.1 Reduce the prevalence of mental issues in children and adolescents

Most children and adolescents report good quality of life and satisfaction with life. Nonetheless, numerous surveys show a significant increase in the number of self-reported mental health issues among children, adolescents and young adults over time. This has gradually been increasing since the 1990s, particularly among girls. Just since 2011 there has been a 30 per cent increase in the number of self-reported mental health issues in the Ungdata national data collection scheme. There has been a 44 per cent increase for girls and 14 per cent for boys.

Figures 2.2 and 2.3 show the trend for girls and boys, respectively.

Source: The Norwegian Institute of Public Health, 2023.

Source: The Norwegian Institute of Public Health, 2023.

Despite all the surveys showing an increase in mental health issues, particularly among girls, the surveys have different findings. These differences are most probably caused by variations in the definition of mental health issues that are used. Different definitions in the surveys do not however explain the increase that is shown in each survey.

The prevalence of mental health issues is higher in families with fewer socioeconomic resources than in families with many socioeconomic resources. It is currently uncertain whether mental health issues are more widespread among children and adolescents with an immigrant background than otherwise in the population. Different studies give different results.8

The Government wants the prevalence of mental health issues to be reduced by approximately 25 per cent during the course of the plan period. In order to gain more knowledge about the increase in mental health issues, the Government will review the trend both in Ungdata and the student health and wellbeing study (SHoT) from the point in time when they started up in 2010 up to the present day to investigate whether changes, for instance, in the use of social media, schools, local environments, leisure time or violence and harassment can help explain the increase in mental health issues. The Norwegian Institute of Public Health will submit the results of the initial analyses of data from Ungdata and SHoT during the course of 2023. On the basis of this new knowledge, more targeted measures can be implemented.

2.2.2 The importance of family for mental health

The strengthening of health promotion and preventive work for children, young people and their families is one of the Government’s main goals. The family unit is an important factor for fostering good mental health in children. This is where the foundations are laid for trust, security, cohesion and coping. The Government will consider measures for parental support during and after pregnancy, and investigate measures for preventing and treating depression during pregnancy and postpartum depression.

The term ‘1,000 days’ is applied to the most important period from conception of a child up until the age of two and includes, for instance, mental health during pregnancy and the first year after birth. Work on children’s health and quality of life must start from as early as conception.

The Government has therefore started work on looking at how the best start in life can be facilitated for all children through adequate care of both prospective and new parents and their children. The theme ‘1,000 days’ is included in the white paper on public health launched in March 2023. It will also be referred to in the National Health and Coordination Plan and the upcoming white paper on social mobility and equality, which together will demonstrate the Government’s all-encompassing work in this area.

Correlations exist between low-threshold income and mental health problems in children and adolescents. Financial strain can lead to more mental health problems in caregivers, which in turn may affect parenting strategies and have adverse effects on children’s mental health.9 Universal schemes in the form of health services before, during and after pregnancy, kindergarten services and financial support schemes for families with children, are all components that give every child the possibility to have a good start in life. GPs and the health centre and school health service are particularly important health services for monitoring pregnancies, and in the postnatal period, childhood and adolescence. National professional guidelines for the health centre and school health service recommend that families should be offered extra follow-up if the parent/guardian shows signs of minor depression or other mental health problems or disorders with concern/problems related to, for instance, breastfeeding, diet, sleep, weight, wellbeing and interaction, and for families who for various reasons need extra support or counselling.

The Government’s strengthening of the GP service and the health centre and school health service also strengthens services for this target group. The family counselling service, crisis centres and child welfare service are other actors who can assist vulnerable families needing extra follow-up.

Parental support varies in form and content ranging from support from one’s own family and informal network to advice, counselling and evidence-based programmes under the auspices of public authorities, charities and private actors. Parental support is offered to most parents and to parents who due to various reasons have special challenges. Municipalities have overall responsibility for making sure that available parental support services can be accessed at all prevention levels. One goal is that evidence-based parental support is available in all municipalities. The grant scheme for parental support work in municipalities, which is managed by the Norwegian Directorate for Children, Youth and Family Affairs (Bufdir), aims to strengthen parents in their role as parents, and help them become good caregivers, and prevent violence, abuse and neglect. The grant scheme stipulates that the measures should be evidence-based and professionally established. Through the grant scheme and Bufdir’s digital professional support for employees and managers in municipalities, evidence-based work on parental support in the municipalities is facilitated. The scheme supports the child protection reform, strengthening prevention and early intervention as well, and reach all social groups. Further, Bufdir has an online resource offering professional support to employees and managers in municipalities who would like to strengthen work on parental support in various services. The objective of the website is to make it easier to choose the right measure(s).

Foreldrehverdag.no is a government resource run by Bufdir, which aims to give all parents easy access to good advice, help and support during parenthood. Bufdir also manages a specialised program specifically aimed at first-time pregnant women. ‘Sammen på vei’ – Nurse Family Partnership (formerly named ‘Familie for første gang’ (Family for the First Time)) is a specialised service for vulnerable families in a difficult life situation. The programme will be tested up until 2027 with the goal of, inter alia, improving the health and development of children, strengthening parental skills and preventing children from being taken into care, contributing to financial independence, and increased trust and contact with support services.

Several studies have been implemented which may contribute to new knowledge about parenthood and safeguarding the mental health of parents. The University of South-Eastern Norway is conducting research on the health of children and families with special focus on prevention and skewed development in children, young people and families at risk. The FamilieForSK study conducted at the Norwegian Institute of Public Health is a study on cohesion and conflicts in families in Norway. An evidence syntheses from Sweden reviewed 45 studies and looked at the correlations between mental health and parental leave.10 Norway is also included in the data material. The conclusion is that parental leave can prevent poor mental health both in mothers and fathers.

2.2.3 Kindergartens as arenas for mental health promotion

At the end of 2021, approximately 93 per cent of all children aged 1-5 attended kindergarten.11 Kindergartens are therefore one of the most important arenas for fostering good mental health and coping skills for each and every child. Kindergartens shall safeguard the need of children for care and play, and promote learning and formation in cooperation and understanding with the home.

Children need stable relationships with competent, supportive and caring employees who notice their needs and respond to their signals. It is therefore important to have good relational competence in kindergartens as well. A report from the Norwegian Institute of Public Health12 based on the findings of the MoBaKinder study shows that in the case of most children there is a correlation between positive and negative relationships with adults in kindergartens and schools, and the academic skills and mental health of children when they reach compulsory school age. Earlier findings have shown that relationships with staff at kindergartens correlate with the mental health of children whilst attending kindergarten. It is important that kindergarten staff are knowledgeable about various types of risk and differences in children, as this may be significant in relation to how kindergartens affect the mental health and development of children. Therefore, it is crucial that staff have the right educational and relational competencies in order for children to develop into confident children.

In addition to competence, it is crucial to have a sufficient number of staff at kindergartens. Around half of all kindergartens report having full staffing levels for 4-5 hours per day, but only 13 per cent report having full staffing levels for six hours or more.13 It is therefore necessary to strengthen both staffing levels and competence. Improved staffing levels with relevant competence can prevent mental health issues and contribute to social equalisation. The Government has pointed out that one of the biggest problems in the Norwegian education system is that we have the least competence around children in the period that is most important for their development. The Ministry of Education and Research has prepared a new national kindergarten strategy: Kindergarten for a New Era.14 The strategy aims to contribute to strengthening kindergartens as a forum for fostering mental health, and it contains plans for how competence in kindergartens will be strengthened. The strategy proposes that 60 per cent of the staff must be kindergarten teachers and at least 25 per must be skilled workers by 2030.

A better knowledge base for quality in kindergartens is important for developing measures to strengthen kindergartens as arenas for fostering mental health. Among other things, a research project commissioned by the Norwegian Directorate for Education and Training is currently being conducted at Fafo on effective ways to organise day-to-day life at kindergartens. The project aims to develop typologies for various ways to organise kindergartens and will continue up until 2025. In the MoBaKinder project at the Norwegian Institute of Public Health, the researchers are investigating which key factors attached to the quality of kindergartens can foster good mental health, quality of life and academic performance in children. The goal is to strengthen Norwegian kindergartens as promoters of health, and contribute to reducing adverse effects linked to social inequality and other vulnerabilities. The project ends in 2025.

The Government wants to strengthen kindergartens as arenas for fostering mental health, and put forward proposals for measures based on a broad knowledge base for quality in kindergartens.

2.2.4 Mental health in schools

Schools play a key role in the lives of children and adolescents, who are entitled to a safe and good school environment that promotes health, wellbeing and learning. Schools also have a responsibility to ensure that pupils develop knowledge and skills that promote good mental health, both here and now and from a lifelong perspective.

The school environment is important for the mental health of pupils. A poor school environment where the pupils, for instance, encounter bullying, stress or exclusion, may intrinsically lead to mental health challenges. A good school environment where pupils thrive, experience mastery and develop seems to promote health and is preventive.

The pupil survey shows that pupils are satisfied with the learning environment. The majority thrive well and have good relationships with teachers. They are challenged academically and experience mastery. Most children and adolescents today say they have friends to socialise with.15

At the same time, there are signs that more pupils than before experience a poor learning environment. Figures from Ungdata 2022 show that fewer and fewer thrive at school. There is also an increase in the percentage that dread going to school and play truant. The pupil survey shows a decline in wellbeing and motivation in Year 7.

Bullying is a significant risk factor for developing mental health issues and disorders, and for dropping out from school. The pupil survey from 2022 shows an increase in bullying in all year levels. Schools must have zero tolerance for violations (refer to the Education Act, Section 9 A-3) such as bullying, violence, discrimination and harassment. The work on creating an inclusive, safe and good school environment, and to prevent, detect and stop bullying, is high priority in schools.

The Government will continue its commitment to the pupils’ school environment. The Ministry of Education and Research has commissioned the Norwegian Directorate for Education and Training to review existing national services that support the work of schools and kindergartens on building inclusive, safe and good school and kindergarten environments. The Norwegian Directorate for Education and Training shall also assess the competence that the schools now need to become better at building safe and good school environments. Work has started on investigating whether the violations of the Education Act, Chapter 9A, are systematic in order to investigate whether there is a need for more competence measures aimed at precisely these areas.

Quite a large proportion of children and adolescents find schoolwork stressful. More than half of the pupils who responded to Ungdata 2022 said that schoolwork frequently or very frequently stressed them out. Performance-related stress in schools appears to have become an important risk factor for mental health issues among young girls over time. In surveys, adolescents link symptoms of mental health issues to school stress themselves.

An evidence synthesis from the Knowledge Centre for Education16 has identified four areas that are important for countering stress in schools:

• Lessons must be engaging, the pupils must feel challenged, active, happy and competent.

• The pupils must experience a social and safe learning environment where they can work in an exploratory manner.

• Workloads must be consistent, and schools must show pupils how to sort and prioritise tasks.

• School heads and teachers can help prevent a stress culture from developing by consciously being aware of how expected performance is communicated.

In 2024, a white paper will be submitted to the Storting regarding Years 5-10. The objective of the white paper is to create a school that to a larger degree safeguards and strengthens the pupils’ motivation, coping skills, learning and development. The white paper will address themes that are relevant to the mental health of children and adolescents.

The committee’s survey ‘Questions for schools in Norway’ in spring 2022 shows that many school owners and school heads request more competence in mental health.17 Pupils also request more knowledge on mental health. Knowledge of normal reactions towards stress, normal fluctuations in mood and how emotions affect thoughts and behaviour may better equip pupils to handle problems. Knowledge of how, for instance, social media and lifestyle habits affect mental health can be useful. In the long-term, better and more knowledge about mental health may contribute to preventing mental health issues in children and adolescents.

The new curricula (LK20/LK20S), which the schools started using in 2020, clearly state that pupils must develop competence in mental health in a range of subjects and in different year levels. Public health and life skills are prioritised as one of three cross-disciplinary themes in the curricula. Public health and life skills as a cross-disciplinary theme in schools shall give pupils competence that fosters good mental and physical health, and enables them to make responsible life choices.

Experience from earlier curriculum reforms shows that the introduction of new curricula takes time. Additionally, introduction of the renewal of subjects has been delayed due to the COVID-19 pandemic. It is important that schools have time and the autonomy to start using the new curricula. The new curricula will be evaluated up until 2025.

The grant scheme ‘Psykisk helse i skolen’ (Mental Health in Schools) was implemented as part of the ‘Escalation Plan for Mental Health 1999-2008’, but it is hardly designed for the new curricula. The funds in today’s grant scheme should to a greater degree contribute to supporting the work of schools on the cross-disciplinary theme public health and life skills, and mental health. The Government will support schools in taking the new curricula into use by developing a competence package on public health and life skills, where mental health is incorporated. For instance, this could be designed, among other things, to give teachers and other school staff more support and insight into an evidence-based approach towards mental health and how to convey it in line with the curricula.

The package aims to contribute to reflection on the part of teachers and others in support services around pupils regarding the work on public health and life skills in and across subjects and what it may involve in practice based on the curricula. According to the general part of the curricula, public health and life skills shall contribute to giving pupils competence that fosters good mental and physical health, and enables them to make responsible life choices. Life skills is about being able to understand and influence factors that are important for mastering one’s own life. The theme shall contribute to pupils learning to handle highs and lows, and personal and practical problems in the best possible way. Relevant areas are physical and mental health, lifestyle habits, sexuality and gender, intoxicants, media usage, consumption and personal finances. Choice of values and the importance of meaning in life, interpersonal relationships, the ability to set boundaries and respect those of others. The ability to handle thoughts, emotions and relationships also belongs to this theme. The Government will also stimulate the development of mental health teaching resources, and guarantee research and evaluation of the schools’ work on mental health.

2.2.5 Leisure and cultural arenas that promote mental health

Leisure and cultural arenas such as youth clubs, sport arenas and cultural events are important for promoting mental health and quality of life in the population at large, particularly for children and adolescents. All types of leisure activities can have a positive effect on the mental and physical health of children and adolescents, in addition to preventing exclusion. These arenas contribute to social support and coping skills, participation and belongingness. During the COVID-19 pandemic, encroaching restrictions in the form of, inter alia, highly reduced leisure services and less contact with friends and peers led to increased mental health issues and reduced quality of life. The restrictions on social contact were particularly perceived as stressful.18

The Government signed a renewed Declaration of leisure time in autumn 2022 along with the Norwegian Association of Local and Regional Authorities and NGOs. The declaration of leisure time states that all children shall have the possibility to regularly participate in at least one leisure activity with others. The declaration builds on the United Nations Convention on the Rights of the Child, particularly Article 31, which concerns the right of the child to rest and leisure time, and engage in play, leisure activities appropriate for their age and to participate in cultural life and the arts. The solutions must be found together, and the parties will cooperate nationally and locally to ensure that all children and adolescents regularly participate in at least one organised leisure activity with others.

The sense of mastery and social support help to promote mental health and quality of life, and protect against risk factors that may contribute to mental health issues later in life.19 Both organised and non-organised leisure activities can therefore be considered part of the work on health promotion and preventive public health.20 The benefits of such measures are attached to improved health and quality of life, the prevention of exclusion and mental health challenges, and socioeconomic profitability in the form of getting more people in work and activities.

A report from the Centre for Research on Civil Society and Voluntary Sector shows clear social differences when it comes to participation in leisure activities.21 Adolescents form the most resourceful homes are also the ones who participate most in organised leisure activities and the differences are substantial. Adolescents from homes with the highest socioeconomic status are likely to participate in organised leisure activities twice as much as those from homes with the lowest socioeconomic status.

The local community can be a source for good mental health and quality of life. Libraries have become an important meeting place in many local communities by arranging, inter alia, lectures, debates, concerts and courses. Many have long opening hours and services for multiple generations.

Cultural institutions and cultural actors with government support are particularly responsible for including more people to enable everyone to experience art and culture. Arts and Culture Norway is a national coordinator for the work on promoting increased diversity, inclusion and participation in the culture sector, and has implemented several measures to break down barriers for participation, inter alia, for minority groups and people with disabilities.

Youth clubs as health-promoting arenas

Youth clubs are one the largest leisure arenas for children and adolescents, and therefore play a vital role in their leisure services.22 The clubs are meeting places where youth can socialise with peers, and where they can participate in various cultural and leisure activities under the supervision of safe adults. Youth clubs are often a contact point for the police, child welfare service and substance use or outreach contacts.

Youth clubs are a low-threshold and substance-free leisure service, which often has a free of charge principle, and as such are available to all youths, regardless of their socioeconomic background. Figures from Norwegian Social Research (NOVA)23 indicate that the service to a slightly higher degree attracts low-income families, and adolescents who are more frequently involved in violence, bullying and break rules. Research also indicates that young people in low-income families participate less in organised leisure activities compared to peers.24 NOVA’s report Fritidsklubber i et folkehelseperspektiv (Youth Clubs from a Public Health Perspective) shows that youth clubs may be suitable for meeting youths it is relevant to reach out to, as part of the work on public health. Youth clubs are therefore an important public health measure for youths who do not feel at home in or interested in organised or performance-orientated leisure activities.25 Many youth clubs are included in open municipal recreational services for youth, such as community centres and cultural, music and dance workshops.

To follow-up the Cooperation Strategy for Children and Youth in Low-Income Families 2020-2023, Equal opportunities when growing up, the Ministry of Children and Families called for a report on open meeting places, of which, youth clubs are an example. The Government wishes to gain more knowledge on how youth clubs are financed and regulated, how they are anchored in the municipalities, and what competence and working conditions the employees have. The purpose is to develop the Government’s basic knowledge of today’s situation, strengths and weakness of today’s organisation, and how various measures can impact this youth service.

Good framework conditions for health-promoting voluntary organisations

The voluntary sector contributes to local engagement, community, integration, and cultural and demographic awareness. Giving children and adolescents the opportunity to participate in a variety of leisure arenas in the local community is immensely important for a good upbringing. It also contributes to preparing children and adolescents for social participation in more formal settings later in life. Voluntary organisations are also immensely important for integration, and immigrants’ participation and belongingness in society. Services under the auspices of voluntary organisations are an important supplement to the integration work of the authorities. Voluntary organisations offer a range of activities and function as a meeting place for new and old citizens. The voluntary sector carries out a range of important societal tasks and also supports public services. This is expressed, for instance, in the Public Health Act were municipalities are ordered to facilitate cooperation with the voluntary sector.

Historically, voluntary and non-profit organisations have been important supplements to public services in the field of mental health, and they continue to play a key role both for users and next of kin as well as in preventive work. The Government recognises the social role of voluntary organisations and will create good framework conditions, so the voluntary sector is perceived as inclusive and representative with equal opportunities for participation. It is important that the public authorities are aware of and respect the uniqueness and independence of the voluntary sector. Good framework conditions involve, for instance, predictable and fair funding, uncomplicated regulations and grant schemes, and transparency on how funding is distributed.

In general, it is important that municipalities and other service providers have intentional and systematic work connected to the cooperation with the voluntary sector. In order to recruit, retain and cooperate well with voluntary actors, municipalities must have an active voluntary policy, and prioritise resources for systematic and professional follow-up.

2.2.6 Social media and mental health

Ninety per cent of Norwegian 9-18-year-olds use one or more social media platforms. There is not enough knowledge about how the use of screens and social media impacts the mental health and wellbeing of young people.26 The Government therefore wants to direct more attention to social media and mental health and, inter alia, establish a committee to summarise the knowledge base and propose new measures attached to the screen use, sleep, mental health and learning difficulties of children and adolescents. The committee will build on the knowledge of earlier committees, for instance, the Medieskadelighetsutvalget (social media harms committee), which delivered its report in 2021.

The Government will consider additional measures during the course of the plan period when new knowledge is presented about the effect of social media on mental health.

Surveys from the USA indicate a coincidence in time between the introduction of social media on smartphones and an increase in mental health issues and disorders in young people. The Ungdata survey shows that 57 per cent of all adolescents in lower and upper secondary schools use social media two-three hours or more every day. Social media, including online gaming, are important social arenas for adolescents.

In 2022, the Government decided that a white paper on a safe digital upbringing would be presented to the Storting. The Ministry of Children and Families is coordinating this work. The white paper for the Storting follows up the National Strategy for a Safe Digital Upbringing (Rett på nett – Nasjonal strategi for trygg digital oppvekst), and will look at the problems and objectives in the strategy in more detail. The Norwegian Media Authority is the coordinator at directorate level, and will launch an action plan to follow-up the strategy.

The Government has implemented a review of children’s consumer protection in digital media Several ministries are involved in this work. Marketing that may adversely affect children and lead to mental health problems and body image pressures are some of the topics that will be looked at in more detail.

In recent years, more attention has been drawn to the potential harmful effects of social media on the mental health of children and adolescents. The Commission for Freedom of Expression however points out that it is difficult to give a clear answer and that some studies pull in different directions. Further, they point out that the studies on these phenomena are far more uncertain than what the debates indicate. Medieskadelighetsutvalget (social media harms committee) points out that most children have positive experiences when using social media and are not harmed, and it provides many possibilities for development and entertainment.

The findings from a study conducted by the Norwegian Institute of Public Health27 show that social media may be a platform for seeking and receiving support. Many young people share difficult topics with friends. The findings show that most adolescents who shared something difficult on social media were socially supported afterwards. Further, the adolescents, who experienced social support, reported improved mental health after sharing compared to those who were not socially supported.

The findings also indicate that social media may function as a social arena and supportive environment for adolescents, and provide opportunities for sharing difficult emotions and incidents. Receiving support and help through social media may have positive effects on mental health and wellbeing.

Social media and the correlation with mental health is a new research field and at the present time little is known about how social media should be understood as a factor in adolescents’ lives. It is paramount to obtain more knowledge about the aspects of using social media that adversely affect the mental health of youth, and those which have a positive effect on mental health and quality of life. In 2020, the Norwegian Institute of Public Health initiated the Social Media Use and Mental Health and Wellbeing among Adolescents Project (Sosiale medier – psykisk helse og trivsel blant ungdom). The purpose of the project is increased knowledge about the use of social media and how the use is linked to health-related factors.

2.2.7 Mental health and quality of life of students

The majority of students are happy, but the student health and wellbeing study (SHoT) (Studentenes helse- og trivselsundersøkelse (SHoT)) shows that the percentage who report poor and extremely poor quality of life has increased substantially, and there has also been a steady increase in mental health issues.28

The Government will contribute to improved health and quality of life among students. It involves counteracting loneliness and isolation, and the facilitation of good meeting places and inclusive communities. Measures aimed at students may also reduce the number of self-reported mental health issues from young people.

Mental health has become an increasingly important problem in student welfare. The SHoT study shows a steady increase in the number of students who report severe mental health issues: In 2010, 18 per cent of students said they had severe mental health issues compared to 35 per cent in 2022. The SHoT surveys are carried out by the Norwegian Institute of Public Health and student organisations. The survey response rate was 35.1. There was also a larger share of women in the sample. This impacts generalisability.

The prevalence and level of mental health issues is still much higher among female students than male students. There are no clear age differences in the prevalence of mental health issues even though the level is somewhat lower among the oldest students. The percentage of students with severe mental health issues is much higher than the percentage in the same age group otherwise in the population.

We know little about the reasons why students report such high prevalence of mental health issues, loneliness and suicidal thoughts. In the SHoT survey, a large percentage of students reported risky or harmful alcohol use (41 per cent). More male students reported this than females. The percentage of students with risky/harmful alcohol use was highest in the 21-22 age bracket (46 per cent). Students with a high level of alcohol consumption are more at risk of reduced quality of life and increased mental health problems than students who do not have such a high consumption. The researchers conclude that it is important that education institutions and student organisations increase awareness about mental health problems and responsible alcohol use.29

Students with financial problems had more mental health problems and health issues, and failed examinations more often than students who rarely experienced financial difficulty. A higher percentage also reported experiences of self-harm and suicide attempts. The researchers underpin boosting the financial situation of students and student health services as potential measures.30

SHoT data also showed a significant increase in loneliness over time. The youngest and oldest students were relatively the most lonely, but also single students and those who lived alone reported more loneliness. This underscores the importance of being concerned with inclusion and belongingness for students, and demonstrates the need for good preventive measures. The public health campaign ‘ABC for Good Mental Health’ includes measures particularly aimed at students.

The host municipalities have the primary responsibility for the students in their municipality with treatment being offered by the ordinary health services. Student organisations are responsible for student welfare services. This service should include health, housing, kindergartens, training services and cultural services. Several student organisations have low-threshold services for students who need advice or someone to talk to. Studentsamskipnaden SiO has been changing its services since 2015, which has led to a significant increase in capacity and completion of treatment with a psychologist, counselling and course participation. At the same time, in spring 2023, it has a long waiting time, i.e., up to five months before the start of treatment with a psychologist.31 This is a clear increase in the waiting time compared to previous years.

Additional analyses from the SHoT surveys are needed to acquire more knowledge about the reasons, so targeted measures can be implemented. The Norwegian Institute of Public Health will use SHoT data to investigate the significance of potential explanatory variables, such as body image, sleep problems, screen use/social media, perfectionism and loneliness. Results from the first analyses will be available in 2023.

The ‘Studenter – psykisk helse og rusmiddelbruk’ (Students’ Mental Health and Substance Use) grant scheme aims to promote good health and wellbeing among students and prevent problems attached to substance use. The scheme shall also cover the SHoT surveys. Study institutions, students, student organisations and the authorities must come together to put in place measures that give students adequate tools to cope with student life and the psychosocial conditions. The Government will assess whether the grant scheme functions optimally and consider new measures during the course of the plan period.

2.2.8 Strengthen the mental health of the elderly

The population is living longer and for many people old age lasts for several decades. The work on promoting good mental health and quality of life must therefore continue throughout the course of life. We have limited knowledge on the mental health of the elderly. The Government will increase the commitment to improve the mental health and quality of life of the elderly.

Most of the elderly are satisfied with life and the youngest of the elderly are more satisfied than younger age groups.32 However, from the age of 75-80 the quality of life declines, and the prevalence of depressive disorders and loneliness increases. Many also find that their coping and social skills are reduced. We have least knowledge of the quality of life and mental health of the oldest over the age of 80. As part of Meld. St. 15 (2022–2023) White Paper on Public Health – National Strategy to Reduce Inequalities in Social Health and this escalation plan, the Government will map the mental health and quality of life of the elderly.

The prevalence of loneliness has slightly increased among the elderly. At the turn of the year 2020-2021, 34.4 per cent of all those aged 67 and older living in private households lived alone.33 Since the number of elderly persons is constantly increasing, we must also expect the prevalence of loneliness to increase. evidence-based measures to prevent loneliness in the elderly are greatly needed (refer to the continued discussion on loneliness under Chapter 2.7, which also explains that the Government will consider including loneliness in the Public health Act when it is revised, and consider an action plan in 2025 to counteract loneliness).

Lifestyle habits are important throughout the course of life. A good diet and physical activity can increase resistance against illness, accidents, fragility and functional disability in old age, but also contribute to improved mental health and quality of life. There is considerable potential in preventing mild mental health disorders in the elderly. Social interaction and good meeting places in the local community has a positive effect on mental health and the quality of life. Participation in meaningful socialisation and activities strengthens the ability to cope with one’s own life situation. Becoming engaged with the quality of life of others in one’s network, the local community or through voluntary work can be a good way to make connections, experience self-worth and meaning, and to prevent physical and mental health issues.34

In spring 2023, the Government will submit a report to the Storting (white paper) about the Safe at Home Reform, which aims to contribute to a vibrant, age-friendly, inclusive local community. In order to reach the Government’s goal for the elderly to live at home longer, it is important to enable them to maintain good mental health through health promotion and preventive measures, preferably well in advance before services are needed. It has been proven that low-threshold services for physical activity in the local community (for instance, senior centres) have a good effect on the mental health of the elderly, Systematic preventive home visits in the municipalities is a measure that can take care of many aspects of prevention, also related to loneliness and mental health, and recruitment to voluntary activity and work. In addition, feeling safe in one’s own home might contribute to less anxiety and restlessness as well. GPs are important actors in detecting and following up mental health issues and disorders in the elderly. More municipalities have also established designated health centres for the elderly. Health centres are a municipal low-threshold service to supplement other services and give useful information about measures that may prevent loneliness and isolation, and therefore mental health issues and disorders.

The public health campaign ‘ABC for Good Mental Health’ is an initiative directed at activity, meaningfulness and community. Several municipalities cooperate with voluntary organisations working within mental health and quality of life of the elderly, inter alia, the Norwegian Women’s Public Health Association, Norwegian Public Health Association, Norwegian Pensioners Association in Trondheim and Norwegian Foundation Livsglede for Eldre (Joy of life for the Elderly). All work in accordance with the principles of the ABC model for the prevention of loneliness and mental health issues in the elderly. The Government wants to harvest experiences in connection with how the campaign can best be aligned with the elderly in the population. The ABC campaign is described in more detail in Chapter 2.6.

In the elderly population, depression and anxiety are most common mental health disorders. Many of the elderly experience loneliness and social isolation as risk factors for developing mental health conditions. During investigation and treatment, aging, cognitive function, cultural background, concurrent diseases and use of medicines must be taken into consideration. Elderly persons often have complex problems and less capacity to handle them. The Norwegian Directorate of Health has prepared national professional recommendations for mental health disorders in the elderly.

2.3 Getting more people to work, activities and education

Participation in education, work and activities is important to promote coping skills and prevent mental health issues. In many cases, participation in work promotes health, also for people with mental health issues and disorders. Studies clearly indicate that loss of employment leads to poorer mental health but returning to work has a positive effect on mental health.35 The commitment to increasing the number of pupils who complete upper secondary education and training is intrinsically important, and also contributes to more people being qualified for employment. The Government will therefore strengthen the commitment to get more people, particularly young people, in work, activities and education. Statistics from the Norwegian Labour and Welfare Administration show that the number of young people (aged 18-29) receiving disability pensions has significantly increased in recent years. As a percentage of the population in the same age group, this group has doubled in the last few decades. Among new recipients, those with various types of mental health disorders continually represent a larger percentage compared to other diagnosis groups. Of young people under the age of 30 receiving the work assessment allowance, more than 70 per cent have mental health disorders.36

Through measures in, for instance, the health, employment and education sectors, and intersectoral cooperation, it is aimed to reduce the percentage of young people, who become disabled due to mental health issues and disorders, during the plan period. Efforts aimed at young people should be put in place early and incrementally before life on disability benefit becomes a reality.

The Government clearly states in the Hurdal Platform that everyone, who can and wants to work, shall have the opportunity to do so. The Government will strengthen the commitment to young people who are not in education or employment. A new youth guarantee will be introduced from July 2023. The guarantee aims to counteract long passive periods of not being in education or employment, and contribute to more young people completing education and getting jobs. Young people aged 16-30, who need supported employment, will receive early intervention services, a permanent contact person and close individually adapted follow-up from the Norwegian Labour and Welfare Administration for as long as necessary. This will help to build trust, clarify expectations and needs, and find potential solutions in dialogue with the young person, employer and other relevant actors. Better coordination with the health and care services and education authorities are key components in the follow-up.

The exclusion of young people is a major and complex social problem involving massive costs for both the individual and society. Meld. St. 5 (2022–2023) Report to the Storting (white paper) Long-Term Plan for Research and Higher Education (2023–2032) includes a social mission to reduce the percentage of young people not in education or employment and those outside of society through cross-sectoral and targeted efforts aimed at impact factors for a good upbringing. The Ministry of Children and Families coordinates the work on cooperation with other affected ministries.

The Government will present a report to the Storting on social mobility and social equalisation. The report aims to draw attention to children, young people and their families, and what is required to prevent poor living conditions being passed down the generations. The work on the report is a cooperation between the Ministry of Labour and Social Inclusion, the Ministry of Children and Families, the Ministry of Health and Care Services and the Ministry of Education and Research. The report will provide an overall presentation of the knowledge base for this field, and cover important phases and arenas in the lives of children and adolescents, in addition to the transition from childhood to adolescence and adulthood, including measures aimed at young adults.

Many with various health problems not in employment, including people with mental health issues and disorders, need concurrent assistance from both the Norwegian Labour and Welfare Administration and the health and care services to get a job and to improve their health. This means that the health and care services and the Norwegian Labour and Welfare Administration must cooperate in order to meet the needs of users for services. The Norwegian Directorate of Health and Directorate of Labour and Welfare play a key role in further developing the labour and health fields. Among other things, the Directorates have got together to form a strategy for the fields.37 The strategy emphasises components, such as early intervention, greater commitment to local actors, collaboration, coordinated efforts between the health services and the Norwegian Labour and Welfare Administration (NAV), and cross-sectoral knowledge and competence building. The Directorates are cooperating on following up the strategy. As part of the follow-up, the Directorates have been jointly commissioned in 2023 to follow up the need to coordinate and strengthen competence and quality within labour and health. The Directorates and regional health authorities find that it is necessary to strengthen and coordinate competence and quality within labour and health at the local, regional and national level, and that the goal should be to establish a competence unit anchored in the respective sectors. This will be investigated and concretised in more detail (refer also to the discussion on labour and health in Chapter 3.5).

The Norwegian Labour and Welfare Administration shall assist people struggling to get a job on their own. The agency should be in close contact with the labour market and have a good overview of what companies need in relation to labour. For people with a need for supported employment, various labour market measures contribute to strengthening opportunities in the labour market. Measures such as work training, follow-up, wage subsidies, training, subsidies for inclusion and use of a mentor can be offered depending on individual needs and situation of the labour market. Several evaluations of the use of instruments in labour market policies have been conducted At the same time, there is a continued need for more knowledge about the effects of labour market measures, and how different measures work for different groups. There is also a need for knowledge on coordination and the use of instruments across the sectors.

Many of those not in employment have only completed primary and lower secondary school education. For a substantial number of these, the completion of upper secondary education and training will be critical in order to get a job. The Storting adopted a new Education Act in spring 2023. With the new Education Act, both youth and adults have a stronger right to education and training. This includes, among other things, giving all pupils the right to upper secondary education and training up until they have completed and achieved the Higher Education Entrance Qualification or vocational competence, and a vocational re-qualification right, which gives everyone who has achieved the Higher Education Entrance Qualification or vocational competence the possibility to obtain other vocational competence.

Closer cooperation between the Norwegian Labour and Welfare Administration and regional county councils shall contribute to more people not in employment having the possibility to complete professional and vocational training. The agency also cooperates with county council follow-up services to get young people who dropout of upper secondary education and training back to school or working.

The Act relating to integration through training, education and work (Integration Act), which entered into force on 1 January 2021, largely focuses on formal qualification by, inter alia, facilitating the completion of special subjects and vocational training within the framework of the introduction programme. The changes introduced with the new Integration Act were founded on a solid knowledge base, which indicates that education is a key instrument for success with early integration of newly arrived immigrants into Norwegian society and permanent attachment to the labour market.

It is important to follow-up young people early to prevent them from being passive over time in order to reduce the risk of mental health issues and disorders and permanent exclusion. Increased commitment to getting more people, particularly young people, in work, activities and education is therefore important to the Government, and will result in substantial human and socioeconomic benefits. Different activity and coping skills programmes may also be relevant in this context. This is described in more detail in Chapters 3.3.2 and 3.5.

For a more detailed discussion on the importance of job participation for health, reference is made to the White Paper on Public Health.

2.4 Good living conditions

Housing covers one of our most fundamental needs and the World Health Organisation considers housing as one of the most import impact factors for health. Living conditions impact both physical and mental health.38 Housing contributes to belongingness, it provides physical security, creates identity and is an important social arena. Conversely, living in poor conditions or homelessness can have serious negative consequences. Poor living conditions make it more difficult to accept and benefit from health, care and welfare services, to complete education and participate in the labour market.Research shows that living conditions particularly impact vulnerable groups such as children, low-income families, immigrants and people in poor health.39

Government’s social housing policy

The national strategy We all need a safe place to call home (2021–2024) contains three priority areas for the social housing policy. No one shall be homeless, children and adolescents shall have good living conditions, and the disabled should be able to choose where and how they live as equally as anyone else. The Norwegian State Housing Bank plays an important role in supporting the work of municipalities on preventing people becoming disadvantaged in the housing market and helping the disadvantaged to acquire and retain a suitable dwelling. The Norwegian State Housing Bank manages the housing allowance scheme, start-up loan scheme and rental property loan scheme. Loans for rental properties shall contribute to the acquisition of more rental properties in safe residential areas. The housing must be of a good standard and be functional, and the location must suit the residents’ needs. The owners must enter into a long-term agreement with the municipality giving it the right to refer applicants to at least 40 per cent of the homes in the project for at least 20 years. In addition, the Norwegian State Housing Bank in cooperation with the Norwegian Association of Local and Regional Authorities and selected municipalities, KOBO, is developing a digital system for municipal rental properties. The system simplifies the application process, allocates and administers municipal rental properties, follows up residents and provides better management information.

The Government wants everyone to live in good safe conditions. In 2024, the Government will present a report to the Storting (white paper) on a holistic housing policy. It will address the role of municipalities in reducing social and geographic inequalities, and place emphasis on the value of good local environments in cities/towns and villages. The report will also look at how the Norwegian State Housing Bank can have a renewed role in the housing policy.

New Act relating to the responsibility of municipalities in the housing for welfare field

The municipalities have an overarching responsibility for assisting people, who cannot safeguard their own interests in the housing market, and therefore need assistance in acquiring or retaining a suitable dwelling. This responsibility is reinforced and emphasised in a new Act relating to the responsibility of municipalities in the housing for welfare field, which enters into force on 1 July 2023. The purpose of the Act is to obtain clearer and more comprehensive rules in the field. It may contribute to more disadvantaged persons receiving essential help and the municipalities having more equal levels of housing for welfare stock.

Among other things, the Act contains an obligation for the municipalities to have an overview of the need for ordinary and adapted housing for the disadvantaged in the housing market, which must be included in the basis for municipal planning strategies. Adapted housing means housing with assistive and protective measures for those who need them due to age, disability, substance use and/or mental health disorders or other reasons. This includes, inter alia, housing that due to its design, furnishing and location is particularly suitable for people with substance use and/or mental health disorders. Holistic socio-spatial planning in municipalities, which includes housing for welfare considerations, will enable municipalities to create safe and health-promoting cities/towns and residential areas that prevent problems caused by living conditions and contribute to the reduction of social inequalities. The Act emphasises that municipalities shall ensure cooperation across the sectors and coordination of their services in the housing for welfare field. Municipalities shall also cooperate with other public actors that can contribute to the work for the disadvantaged in the housing market.

In order to help those who are unable to acquire or keep a suitable dwelling, the Act contains a provision emphasising that municipalities shall provide individually adapted assistance to the disadvantaged in the housing market. The Act provides the municipalities with the freedom to act and decide how to set up the assistance in each single case. At the same time, it is important that the disadvantaged in the housing market can be involved in the offer, as such, the principle of user involvement is therefore continued in the new Act. Emphasis on the responsibility of municipalities to give individually adapted assistance may, inter alia, prevent exacerbation of individual living conditions.

2.5 Increased knowledge about mental health in the whole population

For many years, we have delivered successful campaigns focusing on lifestyle habits and physical health. Nowadays, the vast majority of people know that smoking is harmful, exercise is good for them and that eating fruit and vegetables is healthy. When it comes to the field of mental health, there has been no equivalent ongoing work on giving such defined and transparent information. The Government will therefore increase knowledge about mental health and the factors and activities that may have a protective effect and counteract the development of mental health issues giving increased quality of life.

The ‘ABC for Good Mental Health’ public health campaign contains components that might both promote health and have a preventive effect. ABC stands for Act, Belong, Commit. Its goal is to increase public knowledge about mental health, promote good mental health and prevent mental disorders. Trøndelag County Council will run a pilot study in 2023-2024 which will form the basis for recommendations on a nationwide public health campaign. Founded on the results, the Government will assess how a national public health campaign based on ABC can be implemented at population level and for various social groups

Research shows that the components in the ABC campaign significantly impact quality of life even for those who struggle with mental health issues.40 Concurrently, these activities may seem protective and prevent the development of mental health issues.

One important aspect of ABC for Good Mental Health is that it is suitable to use in kindergartens, schools, workplaces, universities and university colleges. A national information campaign will contribute to increasing the whole population’s knowledge about what strengthens mental health. A public health campaign based on ABC will benefit from solid foundations in the form of extensive mental health research, experiences in Australia and Denmark, and measures in Norway and the Trøndelag Public Health Alliance.

Experiences from other campaigns, for instance, in the field of alcohol and tobacco, show good results in relation to changes in habits and behaviour patterns thus leading to improved health. For instance, the Norwegian Directorate of Health has implemented the communication effort ‘LEV’, which communicates lifestyle habits, i.e., tobacco, diet, physical activity and alcohol in relation to mental health, and mental health and physical health being closely linked. Measurements from before and after the campaign started show an increase in awareness and trust in the Norwegian Directorate of Health’s advice in all five lifestyle habits.

In 2023, it will be 30 years since the United Nations created the World Mental Health Day to promote worldwide awareness about mental health. The goal of the World Mental Health Day is to contribute to knowledge, transparency and engagement around mental health by mobilising the instigation of measures that can strengthen public mental health, reduce stigmatisation and increase awareness of what contributes to strengthening or reducing mental health.

Health literacy is the ability of a person to understand, assess and apply healthcare information to make evidence-based decisions concerning their own health. This applies equally to decisions related to lifestyle choices, measures for preventing illness, coping with illness, and use of health and care services.41 The health literacy of low-income groups or those with a shorter education is usually lower than that of higher-income groups or those with a longer education.42 Additionally, the health literacy of some of the immigrant population is lower than the population at large. Low health literacy is associated with poorer health and follow-up of one’s own illness, higher prevalence of illness and more frequent admission to hospital. Strengthening the health literacy of the population may contribute to improved public health.

The Norwegian Directorate of Health’s survey on the population’s health literacy highlights that many people struggle to find information on how to manage mental health issues.43 Information on how to manage mental health issues should be more readily available in different languages and at such a level that the population—regardless of country of origin—can use the information to take care of their mental health. The ABC pilot study in Trøndelag is planning how the message and measures can be adapted to various groups according to language and culture as well.

The strategy to increase the health literacy of the population expires in 2023. In the work on the National Health and Coordination Plan, the Government will assess the need to prepare a new strategy to increase health literacy of a diverse population, and assess the responsibility of the services to adapt to the varying levels of health literacy.

2.6 Prevent and reduce loneliness in the population

Loneliness and social isolation is one of the major challenges in public health. A high degree of loneliness is associated with significant loss of quality of life. There is a great need for evidence-based measures to prevent and reduce loneliness in various groups in the population. The municipalities should have an overview of the scope of loneliness in their populations and initiate measures to reduce and prevent it. The Government will therefore consider including loneliness in the Public health Act when it is revised, and prepare a guide for public health measures against loneliness and consider an action plan in 2025 to counteract it. The ‘ABC for Good Mental Health’ public health campaign is also an important measure for combating loneliness.

Loneliness concerns having no or insufficient social relationships, but also the need or wish to have better or more social relationships. Loneliness is often associated with stigmatisation and higher risk of a number of physical and mental disorders, and premature mortality. Loneliness can also be a cause and consequence of a mental health disorder. Multiple studies have shown that loneliness and social isolation may be risk factors for heart and vascular diseases, and dementia, in line with known risk factors such as smoking, physical inactivity and poor diet. Poor health and financial hardship are also risk factors for loneliness. It is therefore important to both prevent and reduce involuntary loneliness.

Around 15 per cent of the population state that they often feel lonely, and loneliness has increased the last 10-15 years among adolescents and young adults alike.44 Immigrants experience loneliness and exclusion from society to a greater degree than the rest of the population.45 Loneliness and social isolation have a negative impact on the individual, people around them, the local community and society. Despite the prevalence of loneliness remaining relatively stable for many years in Norway, it has increased in some groups, i.e., among people under the age of 35 and the elderly. Since the number of elderly persons is constantly increasing, we must also expect the prevalence of loneliness to increase. During the COVID-19 pandemic with infection control measures that caused more social isolation, loneliness increased among students and the elderly.46

The quality of life of lonely people is poorer than the quality of life of those who have a partner, and lonely people in all age groups report more loneliness, concern and low mood than those who have a partner.47

As commissioned by the Ministry of Health and Care Services, the Norwegian Institute of Public Health prepared an evidence synthesis in 2022 assessing the effects of various loneliness prevention measures. The conclusion is that there are few documented measures and many of the studies are low-quality. Notwithstanding this indicates that social measures can be effective for reducing social isolation and psychological measures can reduce loneliness. The Government will prepare a guide with public health measures against loneliness and consider creating an action plan.

State and municipal authorities, and decision-makers, cannot eradicate loneliness, but facilitate prevention and reduce it. The mental health promotion arenas referred to above can all contribute to exactly this. Increased commitment to getting more people in work and activities, especially young people, will presumably prevent and reduce loneliness as well. Participation in voluntary work can also reduce loneliness and social isolation. This applies to all age groups. In addition, multiple studies have shown that animal-assisted therapy in elderly care is effective in reducing the feeling of loneliness.4849 The ‘Safe at Home Reform’ initiative aims to contribute to preventing and reducing loneliness in the elderly.

Loneliness is one of the factors that leads to the highest quality of life loss. Good quality of life is unequally distributed between different groups in the population, and one of the goals is for as many people as possible to have good quality of life. The Government has therefore decided to put forward a national quality of life strategy in 2024. The main goal of the strategy is to ensure that society develops in a manner that equalises social differences in quality of life and reflects what the population believes is important for a good life. The Government has decided to include quality of life and will consider incorporating loneliness into the Public Health Act when it is revised.

2.7 Using social psychology knowledge in municipalities

Social psychology knowledge relates to how psychological, social, socioeconomic, societal and physical factors work together in preventing and promoting people’s health and quality of life through the course of life, and is therefore important in the planning and development of local health-promoting measures and measures at system level. Many municipalities have employed both clinical and social psychologists. Social psychology knowledge can be used when planning and designing low-threshold interventions within mental health at various levels. Social psychology knowledge also includes knowledge about health and welfare policy guidelines important for health promotion and prevention work.

It must be ensured that municipalities use their expertise on mental health and public health to promote mental health at the population level as well. The Government will assess how the municipalities can best exploit social psychology knowledge to promote health and quality of life in the whole population through local community-based measures and measures at the system level, and will consider this when the Public Health Act is revised.

The Norwegian Institute of Public Health annually publishes public health and childhood profiles for Norway’s counties and municipalities. The profiles provide updated information and an overview of how the population in each municipality and county are distributed across indicators for living conditions; kindergartens and schools; leisure time and the local community; the environment; injuries and accidents, and health and health behaviours. The overview of public health challenges will be incorporated as a foundation for the work on planning strategies. Social psychological knowledge should be used to plan how the information from the profiles can be incorporated into planning strategies, and used to promote mental health and quality of life in local communities.