Sourced From Dr. Rajesh Sagar - AIIMS (Delhi)

Child and adolescent mental health is the key to broader public health improvement and any imbalance needs to be diagnosed early and correctly, says Dr Rajesh Sagar.

The youth population is the biggest asset for the progress and development of any country. India has one of the largest proportions of young people in the world. Children and adolescents (less than 18 years) are more than 40 per cent of our entire population. The mental health of young people is largely a neglected area, though it is a matter of national interest and priority.

The period of childhood and adolescence is extremely crucial for biological, psychological and social development. In early childhood, the exposure to various experiences and influences gradually shape up the kids’ personalities which become important throughout the developing years. The educational or extra-curricular achievements prepare them for a larger and meaningful role in society. Adequate mental health in this period ensures a smooth progress, while any ill health is likely to have negative repercussions in later adult life.

Few epidemiological studies done in India for this young population suggest that 10-15 per cent have diagnosable psychiatric disorders. Suicide rates in Indian adolescents appear to be several-fold higher than anywhere else in the world. Another matter of concern is that most adult psychiatric disorders have beginnings in the adolescent period. Therefore, there is a significant role of preventive work for this age group by not only improving the mental health of young people but also in reducing the occurrence of adult psychiatric disorders.

The reasons for the increasing magnitude of problems could be due to the changing socio-cultural milieu and transition including urbanisation, industrialisation, nuclear families, single-child or lack of siblings, social isolation, high academic demands or pressures, high competitive environment, poor social support system and reduced parental involvement.

Unfortunately, childhood disorders often are hidden by the family or diagnosed late because of the stigma associated with it and lack of awareness. This despite the broad awareness about childhood and adolescent mental health, which is slowly increasing from the last few decades in India. However, there is still a lack of awareness in a large majority of the general population, especially among parents, teachers and health professionals.

Psychiatrists, psychologists or special educators are not the first filters in diagnosing childhood disorders. For example, parents of children with learning disorders usually contact “others” (i.e. teachers, neighbours, relatives and guardians of fellow classmates) followed by allopathic practitioners and traditional healers. The first choice of parents of children with intellectual disability is usually an allopathic and traditional practitioner or healer.

Fifty per cent parents of children with ADHD have been found to have consulted psychiatrists first while others have visited neurologists, general medical or alternate medicine practitioners. In several childhood psychiatric disorders, parents do not seek professional help or even if they do, it is quite delayed after the occurrence of symptoms. This pattern of lack of or delayed help may be due to ignorance, stigma or taboo.

The first few months or even years are very crucial to analysing behavioural patterns but parents do not seriously contemplate the reasons and consequences of behavioural and attitudinal changes in a child or adolescent, considering them to be temporary phase. The later identification of mental disorder is the reason why the condition cannot be managed appropriately. In fact, the condition worsens.

We need to generate quality evidence and collective data for cost-effective, preventive, promotional and treatment strategies. Because mental health provisions, services and efforts are inadequate to deal with the current burden of mental health problems in children and adolescents. School-based activities in primary and secondary schools are insufficient. There is paucity of manpower like mental health professionals and costly diagnostic tools and intervention programmes are proving to be a barrier.

Keeping this view, there is an immense need to take steps in strengthening the mental health services for children and adolescents in terms of training manpower at various levels. This means ensuring the availability of mental health services at all levels, be it regional, district, and peripheral, and spreading awareness among parents and teachers.

Formal courses and short-term training programmes can be organised to impart necessary skills to primary healthcare physicians and health workers, anganwadi workers and primary care for early identification as well as promotion of child mental health. The school teachers and counsellors should be made aware about approaching the issue with sensitivity and accuracy.

They should be provided with regular screening and early health check-up modules for identification of emotional and psychological problems. We must psycho-educate and train parents so that they can create a healthy and supportive environment at home. Communities should develop easy accessibility of resources and coordinate our efforts with non-governmental organisations. The National Rural Health Mission and Reproductive and Child Health programmes have also recommended inter-sectoral linkages for general health and welfare of children and adolescents.

Lastly, it is important to emphasise that we need to go beyond the clinical approach to a public health approach to reduce negative consequences and promote health. Even at its best, the clinic-based treatment-oriented approach in the young remains limited in its scope. In contrast, the public health approach depends on (a) a primary emphasis on population, (b) focus on promotion and prevention, (c) addresses determinants of health, and (d) engagement in a process

A public health intervention means a broad environmental and policy change. The public health principles allow us to focus on reducing mental health problems among children for whom a problem has been identified and helping them optimise their potential.

Child and adolescent mental health is the key for broader public health improvement and important for overall growth and development of individual, family, society and the nation. A country places a major stake in the younger population and issues affecting their mental health are indeed a public health challenge.

The author is professor, Department of Psychiatry, All India Institute of Medical Sciences