“One in ten children and young people has some form of clinically diagnosable mental health disorder”

“The majority of adult mental health problems begin in childhood”

“50 percent of adult mental health problems (excluding dementia) start before the age of 15”

“And 75% of mental health problems in adult life (excluding dementia) start by the age of 18”

The above alarming findings are from robust research done in the United Kingdom over the past two decades. When I read this, the first thought that comes to my mind is that “the above data is from the Western World and does not apply to India; we are different from the West”.

We need to ask ourselves that in the current times, are we really that different from the West?

If the above is true that mental health issues in young people are a West phenomenon; then let’s look at the following-

“India Has the Highest Suicide Rate Among Youth.”

This is a guest post by Dr. Jinesh Shah, Consultant Child, Adolescent & Family Psychiatrist.  MBBS, MRC Psych (UK), Dip Clinical Psychiatry (UK), CCT in Child and Adolescent Psychiatry (UK), CCT in General Adult Psychiatry (UK), Cert. Hypnotherapy (UK).

As per The Minds Foundation, unfortunately, India has the highest suicide rate in the world among the youth standing at 35.5 per 100,000 people for 2012, the last year for which numbers are available.

“It is estimated that the incidence of nonfatal deliberate self-harm (DSH) is 250 per 100,000 persons per year.”

This is as per Paramjit et al (Indian Journal of Psychiatry).

The urbanisation, the globalisation, the emergence of working families, the exposure to social media, the pace of life, the interests/hobbies/pursuits on the one side.

The education system, the cut-throat competition, the social/personal/ethical/cultural values which we are fast adapting- are we really that different from the West?

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In fact, the reality is that we are wanting to walk in the same shoes as West in most aspects of our life (education, corporate, professional, personal lifestyle); but the infrastructure, moral/ethical/social values, timekeeping, civic sense around us does not keep pace with that.

Hence, due to this mismatch, gap, and conflict, we are probably even more exposed to frustrations, apathy, hopelessness, withdrawal than the West.

Plus stigma, reservations and lack of specialist services add to these, resulting in more difficulties in accepting, recognising and accessing specialist mental health and wellbeing services geared specifically for children, adolescents, young adults, and families.

“A child’s mental health is just as important as their physical health and deserves the same quality of support.” Kate Middleton

Things are gradually changing. Courageous and bold young people like Zaira Wasim (“Dangal” and “Secret Superstar”) are raising awareness about mental health issues in this age group.

Recently, Zaira spoke about how she suffered from Depression and Anxiety from age 13. Three cheers to Zaira for openly talking about this; this helps to combat the stigma.

The idea is not that everyone should talk openly about this; the idea being that people get the courage to access the right help and talk confidentially.

World Health Organisation has recently said that rates of depression in India in children vary between 0.3 to 1.2%.

If the above figures are for depression alone, what about other mental health disorders like Anxiety Disorder, Panic, Phobias, Psychosis, Mania, Obsessive Compulsive Disorders, Somatisation Disorders, ADHD, etc.

We also need to bear in mind that for every young person who has a diagnosable mental health disorder, there are many more that do not have a diagnosable condition.

They may only have behavioral symptoms. These are low self-esteem, selective mutism, some degree of anxiety, nervousness, fear, anger and aggression, withdrawal, social skills deficits, self-destructive behaviors, avoidance behaviors, passive and active resistance behaviors; to just name a few.

We need to understand each behavior in an individual and functional manner. All these behaviors have the potential of causing long term mental health and wellbeing issues; they can affect our personalities, our relationships, and our whole life.

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We also need to keep in mind psychosomatic illnesses where both physical/somatic features and mental health features go hand in hand and exacerbate each other.

Some common examples would be Asthma, Irritable Bowel Disease, Crohn’s Disease, Epilepsy, Psoriasis, etc.

Then there are Somatisation Disorders and Conversion Disorders where people tend to come with a physical or neurological symptom which does not have an organic cause but has an emotional or mental health cause.

Common examples would be that a person experiences pain or weakness in a part of the body, or experiences specific symptoms like a fit, or nausea, etc. Also, Medically Unexplained Symptoms is another term used in a similar context.

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To summarise: There is an underlying emotional or mental health reason, which is either clearly visible co-existing with physical symptoms or is submerged and is hard to come to the surface.

There is not just a strong health case to justify mental health and wellbeing of children, adolescents, young adults, and families; but there is a moral and ethical case (we owe this to our future generation); there is a social case (we owe this for a healthier and open society);

Above all, there is a very strong economic case for this. Our mental health and wellbeing have a huge impact on our potential, our scholastic performance, our goals, our future career, and our achievements.

Here is Dr. Jinesh Shah’s talk on Mental Health in Gujarati:

Let’ ask ourselves, again-

Are we sitting on a minefield?

Are we seeing just the tip of an iceberg?

“Sometimes the worst place you can be at is in your own head.”

Dr. Jinesh Shah is based out of Ahmedabad and can be contacted on email Email | Mobile +91-70434 04574                            

References-

• Transforming Children and Young People’s Mental Health Provision: A Green Paper published by the Department of Health, the United Kingdom in Dec 2017.

• Future in Mind published by Department of Health, UK and NHS England in Mar 2015.

• Depression in India: Let’s Talk published by WHO in April 2017.

• The MINDS Foundation for figures on suicide rates in youth in India – Pragya Lodha, Associate Programme Developer, and Raghu K Appasani, Founder and CEO.

• Revisiting profile of deliberate self-harm at a tertiary care hospital after an interval of 10 years- Indian Journal of Psychiatry- Year : 2016  |  Volume : 58  |  Issue : 3  |  Page : 301-306 by Paramjit Singh et al.

  (Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India).