Children and adolescents constitute about 40% of population of our country. About 12.5% children suffer from psychiatric disorders. Besides them there are other children also who do not fulfil the criteria for disorder but have symptoms of poor mental health and require help. Children suffer from developmental disorders like Attention Deficit Hyperactivity Disorder, Mental retardation, learning disorders. Most of the adult disorders like anxiety disorders, schizophrenia, and bipolar disorder also have onset in adolescence in almost 50% of cases. Problems of substance abuse and suicide are increasing in youth.
Developing countries have certain risk factors which lead to more problems in children like socioeconomic deprivation leading to reduced access to education and child labor. Neurobiological risk like perinatal insult to brain, brain infections, nutritional deficiencies, and chronic poor physical health, disruption in family functioning, affect cognitive and language development. Also, children living in conflict zone like Kashmir are more at risk for developing psychiatric disorders.
To provide support and help to this large population, there is almost complete absence of child and adolescent mental health services in most parts of the country. People seek help from available resources like general practitioner, paediatricians, or faith healers, religious places or traditional practitioners who are not trained to deal with these problems. To address this, emphasis should be on the mental health promotion and prevention of disorders. It requires capacity building at different levels in the community like parents, teachers, children and adolescents, primary care workers etc.
Also, we must aim for the mental health promotion rather than treating the ill population only. The aim should be to reduce the prevalence of mental illnesses in the population. Therefore one should focus on the mother and the child. Promotion of maternal physical and mental health and teaching parenting skills to mothers during infancy and early childhood will improve child’s outcome.
“There is almost complete absence of child and adolescent mental health services in most part of the country”
For children the best place to start is schools where they spend significant time other than home. Education enables the children with core abilities. Educational opportunities should be provided to all through low cost neighborhood schools.
Teachers at schools should be trained in delivery of universal mental health promotion programs starting from kindergarten level. There is research evidence that such programs have beneficial effects on children which persist for long term. For example: good behavior games, life skill training, mindfulness training etc. All these have been done at school by the teachers only in weekly classes.
“For children, the best place to start is schools”
Life skills like decision making, problem solving, effective communication, interpersonal relationship, etc. should be taught to children through structured activities and role plays at schools. This will promote development of sound mental health.
Finally one cannot wait till adequate number of child mental health professionals are available. Rather, integration of mental health in to general health should be done through exposure of mental health problems of children to professionals at different levels.
Government should understand that physical and mental health of children is directly related to future human resource of our country. Direct cost of providing health care and indirect cost of inability to develop fully and lost opportunity is enormous. Therefore, there should be more emphasis on mental health promotion and prevention through low cost community resources besides provision of health care to the ill population.