Dr. Suresh Bada Math, NIMHANS, Head of community Psychiatry and Telemedicine Department  and Dr. Chetana Kishore, Senior resident, Department of Psychiatry, NIMHANS elaborate on this year’s WHO theme for the World Mental Health Day- “Young people and mental health in a changing  world”

 

World Mental Health Day 2018 is observed on October 10th across the world by identifying a theme every year with the objective primarily being to raise mental health awareness, initiate change talk, mobilise supports needed for this change and to bridge the gap to achieve better mental health. This year, the theme of World Mental Health Day is “Young people and mental health in a changing world”

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Mental conditions in youth start as early as 14 years of age

India with 1.21 billion people constitutes the second most populous country in the world, while children (below 18 years) represents 39% of total population of the country. India has more than 50% of its population below the age of 25 and more than 65% below the age of 35.

WHO statistics

According to the WHO Data available, 1 out of 6 people in the world is aged between 10 to 19 years. Young age is a unique period of growth unlike other and has a very formative role in the years to come in a person’s life.

Although young people are presumed to be healthy, as per World Health Organisation, an estimated 2.6 million young people aged 10 to 24 year die each year and a larger number of these people suffer from illnesses which hinder their ability to grow and develop to their full potential.

Adverse situations, experiences and risk factors can be critical and hence can have lasting influences on the mental health of these young people.

World Health Organisation reports that almost 16% of GBD (global burden of disease) in the 10 to 19 years age groups is due to Mental Health conditions and half of these conditions start by 14 years of age and they are undetected and untreated.

Depression is the leading cause of illness and disability among mental health conditions and suicide is the third leading cause of death.

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Factors contributing to mental health issues in youth

Youth living in high tension zones:

• Young people, on one hand, living in areas of conflict, disaster zone, war, and strife are being subject to physical and sexual violence

Youth living in urban areas:

• Those living in areas of prosperity are being exposed to the pitfalls of a technologically evolving society be it cyberbullying or varieties of behavioural addiction such as internet addiction, gaming addiction, pornography addiction and so forth
• Be it conforming to gender roles, subjecting and complying to peer pressure, need for independence, increased risk of substance use and exploration of sexual identity all confers a greater risk of vulnerability on these individuals

At risk youth:

• Within this subset of population are another group of young people who have higher risk of developing mental health conditions because of the underlying physical, intellectual, social or other disabilities
• Examples of these include young people with chronic illness, developmental disorders, child or early marriages, pregnancy and parenthood, orphans and other minority groups

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Urban India's problems is a mixed bag

In a developing and rapidly urbanising country like India, the problems that young people face are a mixture of the above described. Poverty still remains an important risk factor. Young people In India are equally susceptible like their western counterparts to develop depression, mood disorders, substance use, eating disorders or self-harm behaviours.

Notable Indian studies

A review article by Singh Sunitha and Gopalkrishna Gururaj in 2014 looked at health behaviours and problems amongst young people in India.

• Prevalence of Common mental disorders (CMD) varied from 12-16.5 percent including depression, panic and social anxiety disorder
• Suicide is also noted to have an age-specific suicide rate increase among 15 to 29 years from 3.73 to 3.96 per 1,00,000 population per year from 2002 to 2011

In another systematic review by Pal and his colleagues (2009) in young people aged between 13 to 15 years showed:

• A median prevalence of tobacco use (ever users) to be 18.2 percent; 14 percent among males and 6.3 percent among females
• Alcohol use was around 21.4% among men aged 12 to 18 years
• It was also noted that around 43 percent adolescents indulge in substances abuse with 58.7 percent of the students having used one or more substances at least once in life, while 31.3 percent regularly use one or more substances

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Public Health Strategy

The steady increase in the identification of psychological and social difficulties faced by young people shows us the need to ensure their psychosocial well-being through an active collaboration between schools, colleges, and mental health practitioners.

Every effort should be made to identify, evaluate and intervene when problems related to developmental delays, academic difficulties, substance addiction, peer pressure self-esteem, and emotional functioning arise. The most important strategies to be adopted are as follows

• Creating awareness regarding the prevalence of youth mental health problems
• Promotion of positive mental health
• Enforcing and building resilience in young people
• Imparting Life skills to children
• To prevent substance and non-substance (behavioural) addiction
• To decrease the stigma and discrimination of persons with mental illness
• Access to care without barriers
• Early detection and treatment
• Training of specific personnel who will be equipped to deliver services to this subset of a population

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Services could be delivered in various ways through one on one or in a group based setting

1. School-based interventions including Life skills education along with comprehensive sex education are effective strategies. School-based programs also can include sensitising teachers and staff in identifying at risk children, early detection of mental illness, substance use and prevention of suicide. These programmes are incorporated in School mental health programme as part of the larger District Mental Health programme (DMHP) in India.
2. Creating youth leadership platforms along with mentorship programmes also create a positive role model and encourage peer related discussions which have a positive impact on mental health.
3. Distress helplines are also run and maintained by various governmental and non-governmental organisations which are also seen to be helpful in assisting young people during stressful situations.
4. Programmes intending specifically to educate about risks of substance use and high-risk sexual behaviours can also be beneficial.
5. Also of significance would be specific programmes designed for assessing and addressing needs of at-risk individuals including, those affected by conflict, subject to physical/sexual violence, young people with special needs, minority and discriminated groups.

There should also be an active change at the policy level in terms of enforcing the legalities that come with addressing the issues of adolescents. Some laws already in place include punishable offense as to the sale of substances to minors etc.

Behavioural addictions in the form of gaming, social media addiction, multiplayer game and virtual role-playing are the recent emerging new age disorders. Parents/guardians play the major stakeholders in the detection and treatment of these conditions.

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Facing the challenges of lack of trained mental health professionals

All adolescents face serious emotional and psychological challenges as they move into adulthood but in general, there is a lack of mental health care professionals in India, as a result, it is almost impractical to have professionally trained mental health professionals to address the mental health concerns of children in schools.

In such cases, it calls for decentralisation of services and integration with the available resources in the community. National Institute of Mental Health and Neuro Science, (NIMHANS) Bangalore in this endeavour has developed an interactive, skills-based program designed to promote positive mental health and psychological well-being of adolescents using teachers, school counsellors, educators, social workers, nurses, and other mental health professional as the facilitators in the schools.

This school promotive mental health programme designed to reduce risks and enhance psychosocial competencies and resiliency of adolescents in schools. It is universal as it applies to all students. NIMHANS is leveraging the IT revolution and have established ‘NIMHANS DIGITAL ACADEMY’ through which scarcity of mental health human resources is addressed through digital training.

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To conclude, the theme of this year is very relevant in today’s world for the above-mentioned reasons. Young people of today are the future of tomorrow. The decisions of today have a lasting impact on the days to come. A multi-level integration is required in the deliverance of care geared towards this population. High-quality research should also be geared towards evaluation and generation of evidence-based management in this subgroup.

Disclaimer- The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of M3 India.