The Role of Mental Health in Shaping Young Adults’ Positive Attitude and Emotions for Holistic Development: The India Scenario

Amartya Krishnaditya - MIT ADT University

The Role of Mental Health in Shaping Young Adults’ Positive Attitude and Emotions for Holistic Development: The India Scenario

Amartya Krishnaditya, B. Tech Bioengineering

(MIT ADT University, School of Bioengineering Sciences and Research)

Executive Summary

This paper looks into the foremost critical aspect of human well-being, that is the mental health – Understanding its significance in terms of shaping a constructive thought process that anchors the way for a balanced emotional quotient in the young adults, which would imbibe in them the concept of self-care and well-being. There is substantial description of mental health status with respect to the Indian context – tracing the development of initiatives and framework based implementation , since inception of first mental health programme , major challenges identified by the stakeholders in implementing these policies, notably the lack of inter-sectoral coordination and fragmentation of governance, budgetary constraints and scanty human resources , also includes key inputs to develop a concrete policy instrument that testifies to have comprehensive approach on adolescent mental health to address the gaps in the extent of involvement of young people and address the burden of mental health problems in young people to have an emotionally intelligent youth force. The statistical interpretation of the case studies and surveys (National Mental Health Survey 2015-16, National Mental Health Policy 2014 and stats by WHO) throws light on real world implications - that how adolescent well-being is affected by social and educational determinants operating at individual, family and community level. This paper furnishes indirect analogous comparison, amongst various published references, depicting multifarious opinions on the topic, thus drawing inputs for policies and programs to be better aligned with evidence-based practice emerging from these referential studies and program implementation experience. This paper attempts to make a rational analysis of the mental health condition of the young adults – in terms of its effect on the socio-economic aspect of the society ,that calls for enhanced understanding of mental health and strengthening of leadership in this sector at all levels to achieve universal access to mental health care and incorporation of mental health education in school curriculum that can destigmatize this issue with an aim to normalise mental illness with a proactive public participation to unfold a new, well equipped socially stable community.

Mental Health – The Current situation

“Mental Health” even today, in India is an issue that is stigmatized and brushed under the Carpet. As students, our mental health plays an integral role in the way we perceive the societal environment, that facilitates open discussion and dialogue with the general public rather than just the experts of the field. It acts as a main skeletal framework that intrinsically links to our physical health and wellness , that tends tom amend our course of response in any situation ;Such an atmosphere would help the children hone life skills, develop poise, build resilience, stress tolerance and creativity with long term objective to create a sustainable and equitable atmosphere that can detect mental health problems at an early stage ,thus resolving this issue in their formative years , by coming with a comprehensive policy that would address the mental health needs of students cum young adults. These problems have significant adverse impacts on individual, family and society and are frequently associated with poor academic, occupational, and psychosocial functioning, and contribute to premature mortality through their association with suicide and accident-related mortality, both the leading causes of death in this age group [1]. Further, more than half of the burden of mental disorders in adulthood has its onset in adolescence. However, evidence shows a lack of comprehensive policy response to the mental health needs of adolescents in both low- and high-income countries [2]. The recent Lancet Commission on adolescent health and well-being [3], suggested that the focus of health policy needs to expand from infectious diseases to non-communicable diseases, including mental health and substance use.

According to a survey conducted by UNICEF and Gallup in early 2021 (with 20,000 children and adults in 21 countries), children in India seem reticent to seek support for mental health issues; Only 41 per cent of young people between 15 -24 years of age in India said that it is good to get support for mental health problems, compared to an average of 83 per cent for 21 countries. In fact, India was the only one of 21 countries where only a minority of young people felt that people experiencing mental health issues should reach out to others. In every other country, a majority of young people (ranging from 56 to 95 per cent) felt that reaching out was the best way to deal with mental health issues. The survey report, previewed in The State of World’s Children 2021 found that around 14 per cent of 15 to 24-year-olds in India, or 1 in 7, reported often feeling depressed or having little interest in doing things. The proportion ranged from almost one in three in Cameroon, one in seven in India and Bangladesh, thus median being one in five young people.

The disoriented political intervention (fragmentation of governance between centre and state) with patchy implementation of policy and programmes (National Mental Health Policy-2014, Rashtriya Kishore Swasthya Karikram-2014 {National Adolescent Health program}, Mental Healthcare Act -2017) is one of the major reasons, driving lack of clarity on mental health as a public issue. There is not enough information available on the issues faced by the adolescents which can be used as a referential source to define the problem extensively so that actual problem be addressed rather than working on its peripheral aspects; There i lack of awareness on and absence of specialized care for the students’ mental health issues- there is not enough information available on issues faced by the adolescents which could be used as a referential source for analysis driven conclusive study in order to address the exact problem rather than working on its peripheral facets. The role of youth engagement in the form of peer educators, in the delivery of interventions, or governance – these issues are yet to resolved clearly. In the core, lies the disintegrated governance in the healthcare sector – including weak technical capacity and ineffective execution of the designed framework in this regard. Going forward, this problem calls for inter-sectoral collaboration -NGOs working with the government setups and academic institutions with proper monitoring and supervision and capacity building programmes, involving the community health workers and counsellors thus leading to mobilization of youth.

Literature Review and Methodology

The research for this paper cites numerous literature that covers diverse set information on topics of mental health condition of adolescent students , policies and programmes implemented in this domain – its benefits ,challenges that hindered effective execution of these policies , a brief note on School mental health program and global level impact of this issue and course of response by respective institutions, thus ,making an analogous comparison in terms of varied opinions held by various stakeholders or institutions with respect to the Indian scenario. There is emphasis on the political interventions in terms of various surveys and policy framework designed to solve this problem – its methodology, challenges and conclusive study based on results. This paper aims to present a rational picture of the mental health scenario in our country – discussing each of government’s initiatives, its socio-economic impact and asses the policy environment for addressing mental health disorders of adolescents. Relevant secondary data in terms of factual information, statistical interpretation of case studies and analysis reports mentioned in research articles included in the paper have been indicated wherever necessary.

Invisible illness – Policy Intervention and Public Perception

The World Economic Forum cites India as having more than ten million children with autism, ten million people with epilepsy and more than 150 million people with a mental illness that will at some point require the intervention of therapy or other medical treatment.

In December 2017, when President Ram Nath Kovind warned of a potential “mental health epidemic” in India, it cast a light on one of India’s major public health concerns – that is one of the most neglected. The National Mental Health Survey, 2016 found that close to 14 percent of India’s population required active mental health interventions. About two percent suffered from severe mental disorders,” Kovind said at the time. Despite the findings, vast numbers of those suffering from mental health conditions remain undiagnosed. Of those with a diagnosis, few receive treatment (healthissuesindia.com).

Mental Health Care Act-2017: The Mental Health Care Act 2017, replaced the older act that was implemented in 1987. The new act cements a number of rights for those suffering from mental illness. To formulate laws and legislation with correspondence to mental health care practices in India and ensure that they are implemented across various sectors, stakeholders, and institutions, this act came into being. The main aim is to entitle the rights of people with mental illness to health and social care and a life with dignity, and to ensure that the law is aligned with the UN Convention on the Rights of Persons with Disabilities (UNCRPD).

Process: This policy was accomplished with extensive engagement of diverse mental health stakeholders, including mental health professionals, persons with lived experience, families and policy makers, led by the Ministry of Health and Family Welfare. This act cemented a number of rights for those suffering from mental illness.

These rights include: access to affordable health care (of which state hospitals are obliged to provide free of charge to those who cannot afford it), the capacity to provide informed consent and power to take decisions and the right of confidentiality and to live within a community. Certain protections have been put in place such as the criminalisation of discriminatory behaviour towards the mentally ill, as well as protection against intrusive procedures such as shock therapy (healthissuesindia.com).

The act made it mandatory for health insurance companies to provide insurance to mental illnesses in the same manner they would for physical illnesses. Until recently, most insurance companies failed to comply with this provision of the act.

Without insurance coverage, treatment of mental health conditions can become an unmanageable expense.

Case 1: Bloomberg Quint gives the example of seventeen-year-old Akash. Akash suffers from bipolar disorder, often experiencing violent mood swings that have resulted in him occasionally having depressive episodes in which he considers taking his own life. These episodes would often result in prolonged — and expensive — hospital stays.

Akash’s family has so far spent over Rs 500,000 over the three years since his diagnosis. They say they were denied health insurance because counselling is an outpatient expense. Recognition and coverage under insurance policies are vital in ensuring adequate healthcare is provided.

National Mental Health Policy (NYP)-2014

A set of guidelines was drafted for mental healthcare in India with focus on disease burden, treatment, management and provision of services. It was introduced with a vision to promote mental health, prevent mental illness, enable recovery from mental illness, promote de-stigmatization and desegregation, and ensure socio-economic inclusion of persons affected by mental illness by providing accessible, affordable and quality health and social care to all persons through their life-span within a rights-based frame work (vikaspedia).

Process: A policy group of experts constituted by the Ministry of Health and Family Welfare, and comprising mental health professionals and persons representing the lived experience and families synthesize evidence and conducted five regional consultations with diverse stakeholders.

Rashtriya Kishor Swasthya Karyakram (RKSK)-2014

In order to create a holistic approach for adolescent healthcare with a special focus on nutrition, sexual and reproductive health care, non-communicable diseases, substance misuse, injuries and violence, National Adolescents health program (RKSK) was introduced.

The main objective of this program was to envisage adolescents in India to be able to realize their full potential by making informed and responsible decisions related to their health and well-being.

Process: It involved extensive consultative process with many organizations and experts led by the Ministry of Health and Family Welfare with support from UNFPA.

Note: These above-mentioned programmes didn’t have specified role of youth engagement in policy development.

Adolescents Mental Health- Statistics

India is home to the largest number of adolescents in the world, comprising about a fifth of its population (243 million) [4]. A meta-analysis reported that 6.5% of the community samples and 23.3% of school samples experienced significant mental health morbidity [5]. Suicide is the leading cause of death in older adolescents [4]. There has historically been little explicit attention to adolescent mental health in India but, in the past decade, both mental health and adolescent health have received increasing attention in policy and programs (India’s response to adolescent mental health: a policy review and stakeholder analysis- ncbi.nlm.nih).

Mental health in India is still a fairly new topic and the mental health myths and taboos attached to this subject are prevalent to this date. According to the National Health program by the Ministry of health and family welfare, 6% of Kerala’s population has mental disorders. 1 in a 5 has some emotional and behavioural problems. Close to 60 to 70 million people in the country suffer from common and severe mental disorders. India is the world’s suicide capital with over 2.6 lakh cases of suicide in a year. WHO statistics say the average suicide rate in India is 10.9 for every lakh people(pharmeasy.in).

The reasons that contribute to this problem are:

Ignorance- Social Stigma:

The Live Love Laugh Foundation (TLLLF) is a charity that works for awareness of mental health to destigmatize this issue. The Foundation commissioned How India Perceives Mental Health: TLLLF National Survey Report 2018.The results of the report present a damning image. Of those surveyed only 27 percent said they would support someone perceived as having a mental illness. Almost as many (26 percent) claimed to actively fear the mentally ill.

Almost half (forty to 47 percent) claimed their awareness of the mentally ill was limited to stigmatised phrases such as “retard” and “mad”. 44 percent believed those with mental illnesses are always violent, while a further 41 percent believed interacting with the mentally ill can deteriorate the mental health of a healthy individual. These reasons account for the fact that people with mental illness rarely seek help. This necessitates for change of public attitude and education can be instrumental to achieve this feat.

Lack of Help:

We have just 43 state-run mental health institutions across the country. 3800 psychiatrists available as against the requirement of 11,500; 898 clinical psychologists as against 17250, 850 psychiatric social workers as against 23000, 1500 psychiatric nurses as against 3000. That means there is only one psychiatrist for four lakh Indians and only 1,022 college seats for mental health professionals are set aside in India.

Adding woes to the existing problem - How Pandemic aggravated this Issue:

(-pharmeasy.in)

India’s statistics related to addressing mental health issues were poor, to begin with always. It was made worse by the COVID-19 pandemic as the first wave spread across the world in 2020. Reason behind this

Long periods of isolation
Frontline workers not being able to come physically close to their family members
Loss of job and financial difficulty
Not being able to see or meet loved ones
Alcohol and substance abuse due to stress
Fear of the unknown
Cloud of uncertainty
Constantly worrying about getting infected and infecting people around you and losing loved ones due to infection
Not being able to express oneself
Having to work overtime, complete disruption of work-life balance

The mentioned points heightened the critical situation of unaddressed mental health already existing in India. Although the pandemic presented a great opportunity in the form of work from culture to spend time with one’s family and loved ones (who earlier had to deal with periods of separation due to pressing work commitments), not all people received the same benefit or felt the same about having to work from home. The negative impact of the pandemic felt by the greater portion of the country became prominent in the form of anxiety, depression, burnout and a tendency to commit suicide.

The Insightful Case Study – National Mental Health Survey 2015-16

Mental health becomes a top priority as a nation develops and the role of citizens in nation-building increases. In order to turn this roadblock into a stepping stone for growth, development & productivity of society, the National Mental Health Survey was conducted (by National Institute of Mental Health and Neurosciences) with an aim to:

Improve the community’s understanding of mental health and the mind-body connection between mental and physical health.
Strengthen mental health programmes and services to deliver appropriate and comprehensive services for millions across the country who are in need for the same and also, develop data driven analysis to envision a healthy atmosphere for mental well-being.

Develop required pre-requisites for systematic assessment of resources and services to meet the current demands.
Bridge the gap in the mental health care by integrating the inputs from National Human Rights Commission and directives from Supreme Court for effective implementation of the then, announced Mental health Policy.

This survey undertaken by NIMHANS (National Institute of Mental Health and Neuro Sciences), conducted across 12 selected states with data collection from 39,532 individuals (statistics as per NMHS report 2015-16) presented the results in 2 parts – part 1 that provided data on prevalence, pattern and outcome and second one reported the current status of mental health systems.

The report revealed that in general, nearly 15% of Indian adults are need of active intervention for one or more mental health issues.

1. Understanding the impact of Mental Health Issues- “A wake up call”:

Mental disorders contribute to significant load of morbidity and disability, even though few conditions account for increasing mortality. As per the review analysis and research studies concern ,100 million people are in need of systematic care based on data3 that are few decades old and have serious methodological limitations.
It affects everyone irrespective of age, gender, residence and living standards only impact varies.
As per evidence from research there is close association of these disorders as consequences of wide range of acute and chronic conditions like Non-Communicable Diseases5,6 injury and violence. Eg: Cancer and depression are known to co-exist and link of anxiety with cardiovascular disorders7.
From cultural perspective, wide range of Societal and social problems faced by people whose illness have not been recognised or managed well, that is also a consequence of considerable amount of stigma in the Indian society, leading to neglect and marginalisation.
An alarming fact that has been recognised for several years, is huge gap3, referred to as treatment gap, in the care of mentally ill in our society and that is result of lack of awareness, limited availability and accessibility of resources which also impacts the growth and productivity of our work force and this a huge concern from economic point of view.

2. Integration of Mental Health in Healthcare System

It is essential to make the healthcare systems strengthened and made responsive to changing health priorities and concerns. A good mental health system has the responsibility of reducing the substantial burden of untreated mental disorders, decreasing human rights violations, ensuring social protection and improving the quality of life especially of the most vulnerable and marginalised subgroups in a society. Moving beyond care, it should also integrate and include mental health promotion and rehabilitation components10.

Our healthcare system needs to amend the conventional approach by setting up of a system perspective for mental health that gives a broader framework for healthcare in terms of integration of already available services and improve uptake of care for the ones with mental health issues.

Proper planning, implementation, evaluation and strengthening of mental health services requires – clear understanding of burden of mental disorders as well as existing resources and services across country. The statistical interpretation of the good quality data is an important pre requisite for the same. The availability of good quality, scientific and reliable information is the bedrock of all public health programmes and more so in mental health.

Methodology

NMHS Report Analysis:

1. Survey Population Characteristics:

The response rate at household was 91.9%, while individuals interviewed were 88%.
Out of every 3 respondents in survey was a young adult (age 18-29 years).
Female Respondents – 52.3%; The proportion was slightly higher in Kerala, Assam and Manipur.
Nearly one-third respondents reported ‘household duties’ as their predominant occupation.
One third of households reported having a BPL card varying from 5% in Tamil Nadu to 75% in Chhattisgarh.

2. Prevalence of Mental Disorder

It was estimated that excluding tobacco use disorder, mental morbidity of individuals above 18 years was 10.6%.
The life time prevalence in surveyed population was 13.7%. This proportion of population required active intervention.
Nearly 150 million Indians are in need of active intervention.

The weighted prevalence across diagnostic categories in urban metros was higher than in rural and urban non-metro areas due to the following factors: (fast paced lifestyle, stress, complexities of living, breakdown of support systems, challenges of economic instability). It has been inferred that rapid urbanisation is linked with mental illness.

There is variation in urban in rural population in terms of availability, accessibility and affordability of mental health services and awareness as well. These factors contribute to the varied perspective of the young adults in rural and urban areas that reflects their mindset that demines their orientation of thoughts and course of action (form of an immediate response) in any scenario.

The weighted prevalence of depression for both current and lifetime was 2.7% and 5.2%, indicating that nearly 1 in 40 and 1 in 20 suffer from past and current depression, respectively. Depression was reported to be higher in females (in age group 40-49 years residing in urban areas).

a) High suicidal risk – An increasing concern

Nearly 1% of the population reported high suicidal risk. Majority of them had co-occurring mental illness. This warrants the need for multi-sectoral actions. Suicide and suicidal ideations are important public health problems – Its causes, risk factors and consequences are poorly understood in India and this calls for extensive data driven research at national and state level as well as coordinated and comprehensive interventions.

b) Children and adolescents – Vulnerability to mental disorders:

Prevalence of mental disorder in age group 13 -17 years was 7.3% (nearly equal in both genders). Approximately 9.8 million Indians are in need of active intervention.
The cases were almost double in urban metros (13.5%) compared to rural areas (6.9%).
Most common prevalent problems: Depressive Episode & Recurrent Depressive Disorder (2.6%), Agoraphobia (2.3%), Intellectual Disability (1.7%), autism spectrum disorder (1.6%), Phobic anxiety disorder (1.3%) and Psychotic disorder (1.3%).
As per a study in Himachal Pradesh 15-24 years of age the adolescents suffered wide range of mental health conditions like – depression (6.9%), anxiety (15.5%), tobacco (7.6%) and suicidal ideation (5.5%) requiring urgent intervention13.
The inference drawn from the statistical evidence, addresses the critical point of emotional quotient which holds key aspect in the mental health programmes; So incorporating the same in the school curriculum in such a way that it blends well with the academic aspect can be a probable solution to develop the mental poise in students that would largely reflect in their behaviour and positively altered mindset.

3. Treatment gap disabilities and impact of Mental Illness:

3 out of 4 persons with such problems experience significant disability in work, family and social life.
Economic burden of mental disorder is huge – Mental illness results in poor quality of life, decreased productivity and lower earning potentials.
People continue to be stigmatized that affects their societal behaviour.

4. Hinderances to effective implementation of Mental Health System and available Resources:

The assessment conducted across 12 states on the domains of policy / programme implementation revealed the limited reach, slow progress, partial focus and peripheral importance given to mental health. Apart from a lack of public health approach, the programme suffered from administrative, technical and resource constraints.

A cohesive approach of state and the centre in order to prepare a broad framework for mental health action plan is lacking. A state level action plan that works with coordination as per directives and further extensive research and discussion with Centre would make the implementation of these programmes quite fluidic.

The existing healthcare system should address the following pointers of concern in order for effective implementation of mental health programmes:

Developing a health information system that prioritizes mental health.
Preparing a broad-based network of Institutional mental health care and rehabilitative services.
Addressing the limited availability of specialist mental health human resources (Psychiatrists, Clinical psychologists and psychiatric social workers).
Streamline mental health financing by proper utilisation of allocated budget for the same.
Promotion of mental health literacy to address the issue of prevailing stigma and huge treatment gap.
Establish a structural framework for inter and intra sectoral collaboration for mental health programmes at state level.
Improve the programme monitoring and evaluation system.
Research programmes focusing on different priorities is required to address knowledge gaps.

Benefits Reaped from NHMS:

This survey in 12 centres provides an important reference point about mental disorders in the community. Taking the earlier WMHS (reported in this issue of the journal) [11] covering ten states, we have a rich baseline to plan services at the level of prevention, promotion, and treatment of mental disorders.

The methodology and the use of information technology used for the survey is a major methodological advance in psychiatric epidemiology in the country. This survey provides a wake-up call to redesign mental health care in the country.

Global Level Studies and Review Work:

(- Journal of Behaviour Health and social sciences)

As per the Norwegian Students Health and Welfare survey 2014,(SHOT 2014;conducted amongst 2430 full time students) whose sole objective was to assess the connection/link up of mental distress among the students with their academic self-efficacy and study progress: found that 31% of the students responded to this survey , with 17% reporting severe symptoms of psychological distress ;majority of students reported this issue owing to low academic efficacy and a significant count reported delayed study progress , compared to students reporting few or moderate symptoms of mental distress.27% of them reporting severe mental stress had sought professional help ,whereas 31% had considered seeking help.

The mental stress which students often encounter or talk about is not just because of the academic pressure, it’s a transitional consequence of changing mindset, guided by our emotional and mental health, which is a creation of changing social atmosphere in terms of perceiving everything with an unhealthy competitive approach among the people which often takes form of jealousy and hatred, leading to such distress. Each one strives hard to achieve the desired aim they have set for themselves – inferring the fact that each one has a plan for success, but no one plans for the aftermath of failure, that is the “Achilles' heel”/

that may just seem like a nail in the coffin after not getting the desired result one worked for. This may then seem like vicious circle that will keep chasing us.

As per the extensive research carried out in the States in field of higher education and its association with mental health of students:

A bidirectional pathway points out the broad-based foundation that is setup to determine the factors essential for success in college life – first one is sociological theories of evolution such as Astin and Tinto (1993), second being the social cognitive learning theory by Bandura (1997). Astin points out to the fact of students taking part in learning environment, whereas Tinto (being indirect extension of Astins’ theory) emphasises students’ own driving force as motivation, intentions & adherence to education. Bandura’s social cognitive learning theory emphasises the ability to develop to control over thoughts, feelings & actions.

A review article based on students’ studies in Australia: infers that loneliness (linked to depression) was a lone factor for low study progress and expectations to perform along with financial insecurities concerned their studies. Also, globally the knowledgebase regarding students’ mental health is scarce.

The emotional quotient is necessary to work upon in order to acquire the necessary skillset that would help to have control on our emotions that will provide us with multidimensional broad-based outlook with a cool mindset to deal with any unforeseen situation with a problem-solving approach, thus making us an emotionally intelligent person. The aspect of EQ can only be worked upon when we have a research driven atmosphere that combines educational and psychological theory in higher education that can significantly help us to understand linkage of our behavioural aspect with Workfront.

A paper, presented at 4th World Conference on Psychology, Counselling and Guidance explained the concept of mental health and significance of promoting the same among students, which also had a report for the sample study conducted amongst 289 students regarding their mental health status; it was found that 37.37% students were suspected to have mental disorder. It explained mental health from a wide perspective in terms of its broad-based definition in three general forms: first, that is self-definition by Freud, second one being about self-actualisation and self-realization and third is that “many people have stable social network” that is integrated (adopted by many sociologists). (-ScienceDirect: Procedia – Social and behavioural Sciences)

Integration of Mental Health in Education Curriculum:

For most people, mental health issues emerge when they are young -half of these disorders emerge by the age of 14 years and three quarters by the age of 25. The mental health has a core role in shaping students’ life not just by means to flourish their educational journey, but also to imbibe in them the spirit of perseverance with a sense of responsibility such, that they are able to cross the threshold of their own mental barrier that will boost their self-confidence. The adoption of Whole School Approach system (with involvement of parents & Edu-leaders) is one of the key features for promoting mental health & well-being with its main aim to embed a safe & inclusive learning environment, providing with social and emotional skill programs and timely support for the ones with additional needs.

Our curriculum should incorporate the theoretical know-how with physical and mental wellness, making it an integral part of the curriculum that will help:

To have a control on our emotions
Develop empathy for others and understand the dignity of every relationship
To have mental poise that reflects in a well-managed work-life balance
Tackling the unforeseen circumstances constructively
To emerge as a leader

“Education cannot be effective unless it helps child open up himself to life.”

As quoted by Maria Montessori, it points out to the fact that the definition of smart /intelligent student needs to go beyond the conventional concept of academic excellence, with holistic development (intellectual, mental, physical, emotional and social abilities in a child to face everyday challenges) occupying a critical position in a students’ life, that will evolve a comprehensive approach in learning:

To develop abstract, logical and analytical thinking abilities
To have a balanced emotional quotient, that includes:

- development of intra-personal and inter-personal abilities

- development of empathy and “social competency” (cooperation and coordination) and

- action-oriented response in any situation

This altered system would boost the morale of the students which would inspire them to achieve greater heights in the career while becoming upstanding citizens of the society, thus contributing to the development of our nation.

Mental Health Programs in India – Examples: (-turnthebus.org/blog-mental health)

1.The ‘Mental Health Justice’ program by Mental Health Innovation Network- [4] was started to bring mental health services to school spaces. This program aimed to pilot a replicable mental health justice program in schools in Mumbai that included sensitising stakeholders in schools about mental health issues and building their capacity to support the cause.

2.Yuva Mitr in Goa- is a community-based program for youth health promotion which included peer to peer learning, teachers training and awareness programs on youth health subjects like mental health, reproductive health, etc. On evaluating its impact, the program piloted in rural and urban area showed more openness towards seeking help for mental health issues like substance abuse, sexual abuse and suicidal thoughts.

3.SAATHI in Sikkim- ‘SAATHI’ stands for Sikkim Against Addiction Towards Health India’. It recognises that mental health issues (especially in a context like Sikkim, India) is intricately linked with substance abuse and thus uses a ‘peer education’ model to advocate against drug use among school students, parents and school staff.

There is an urgent need for a comprehensive School Mental Health Program based on the PPEI model. It can happen only if there is proper intersectoral coordination and stakeholders' involvement. A cohesive effort should lead to framing of a long-term SMHP, keeping the socioeconomic realities of the country in mind.

Comparative Study – Report by US department of Education - On supporting Child and Student Social, Emotional, Behavioural and Mental health needs:

As per a report by U.S Department of education highlights 7 key challenges to provide school or program based mental health support across early childhood and higher education institutions and present corresponding recommendations:

Reference -US department of Education: Supporting child and student Social, Emotional, Behavioural and mental health needs)

Use Cases:

a) Formation of a community planning committee involving key staff, student and family members for planning and development of central’s comprehensive distance learning and hybrid learning models. Prime focus on Tier 1 school wide practices to teach and model healthy coping strategies and stress management.

b) Infant and early childhood Mental health consultation (IECMHC)-Promoting young children’s emotional and behavioural health in early childhood settings.

c)Massachusetts School of mental health Consortium came with a new methodology which would have active participation of member districts through shared learning collaboration and consultation that would benefit the student’s overall well-being.

d)The community drive design concept in Native American Community Academy emphasises on importance of holistic wellness.

e) A survey of October 2020 conducted by University of South Carolina, department of Psychology student advisory board (to understand mental health status of graduate students) revealed that 69.29% (29/37) of graduate students experienced 3 or symptoms of negative mental health (covid-19has added to its woes).

This led to creation of Mental health and well-being committee with a core team of the faculties (Experimental, Clinical Community & Ph.D. students) and graduate student representatives to meet twice a month and address the mental health issues of graduate students.

f) The adoption of pyramid model (a tiered {promotion, prevention, intervention} public health framework into which care-givers, professionals, and systems can assess, align and implement evidenced based strategies and practices that support children socially and emotionally) by Minnesota and Wisconsin has trained hundreds of students, administrators and families.

g) The University of Columbia has adopted an interdisciplinary approach where every student has access to school behavioural and health services support, the key factor being the collaboration with Community based organisations to supplement the existing support and services.

The burden of mental disorders across the states of India - The Global Burden of Disease Study 1990–2017:

(-The LANCET Psychiatry)

This report described the prevalence and disease burden of each mental disorder across the states of India, from 1990 to 2017.The states were grouped based on Socio-demographic Index (SDI) (a composite measure of per-capita income), mean education, and fertility rate in women younger than 25 years. The prevalence of mental disorder has been estimated, with bifurcation in terms of:

Years lived with disability (YLDs) and disability-adjusted life years (DALYs).

The report found that one among every seven people in India had a mental disorder, ranging from mild to severe. The proportional contribution of mental disorders to the total disease burden in India almost doubled from 1990 to 2017. This disease domain has been dominated by anxiety and depression followed by schizophrenia and bipolar disorder. These disorders have been higher in developed southern states (may be a consequence of rapid urbanisation) than the northern states.

In recent years, there has been an exponential rise in cases of mental illness, which can be major roadblock to our nations ‘Growth. Projections show that India will suffer massive economic losses owing to poor mental health conditions. As of 2015, on a global level, over 322.48 million people suffered from some form of depressive disorder and as of 2017, more than 14% of total population in India suffer from various mental disorders. This percentage can be doubled in the coming decade.

Globally, the current scenario of covid-19 aggravated this issue that reported high rate of symptoms of anxiety (6.33 to 50.9%), depression (14.6 to 48.3%), post-traumatic stress disorder and stress (8.1-81%).

a) The first National Mental Health program was launched in 1982, further relaunched in 1982 as the district mental health programme. The National Mental Health Policy was introduced in 2014, and a rights-based Mental Healthcare Act in 2017, which replaced the Mental Healthcare Act of 1987.49.

b) The child health programme under the National Health Mission and the National Adolescent Health Programme includes components to address the mental health of children and adolescents. The Ayushman Bharat (Healthy India) initiative launched in 2018 aims to provide comprehensive primary health care and health insurance coverage for non-communicable diseases including mental disorders, which could contribute to reducing the adverse effect of mental disorders at the population level.

c) The inefficient execution of these programs and policies have led to a high treatment gap for mental disorders, poor evidence-based treatment, and gender-differentials in treatment. There is an acute shortage of mental health personnel, with two mental health workers and 0·3 psychiatrists per 100,000 population (with 20-25% students facing lifetime mental disorder; 23.2% reported anxiety issues ,15.4% and 31.8% students were impacted by depression and stress respectively. Less than 5% students lived stress free life – source: as per the governments’ youth.gov website) that is lower than the global average. Additionally, the discriminatory attitude of health workers towards people with mental illness and demand-side barriers such as low perceived need for care, paucity of knowledge of mental disorders, and stigma attached to mental disorders are challenges that need to be addressed. An integrated approach to detect, treat, and manage patient needs related to mental and physical health is need of the hour in India because people with mental disorders die prematurely and have excess disability, though substantially more work is needed for it to be implemented on a large-scale.

Lancet studies suggest that India’s contribution to global suicide deaths increased from 25·3% in 1990 to 36·6% in 2016 among women, and from 18·7% to 24·3% among men. As per the National Mental Health Survey 2015-16, conducted by the National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, under the purview of the Union Ministry of Health and Family Welfare, it was revealed that 9.8 million teenagers in the age group 13-17 years suffer depression and other mental health disorders and are “in need of active intervention”. Whereas, according to a study by the Lancet, suicide deaths ranked first among all causes of death in women aged 15-29 years in 26 of the 31 states, and in women aged 15-39 years in 24 states in the country.

WHO also estimates that, in India, the economic loss, due to mental health conditions, between 2012-2030, is 1.03 trillion.

Nowadays people, (especially our youth) are so conscious and aware about their physical health in terms of their diet, workout routine and the superfoods to be taken but when it’s about mental health, they are enveloped by virtue of introversion in such a way that some of them may not be even aware that they may be suffering from some form of mental health and these stats are enough to show the grim reality.

Expert Panel Analysis & Opinion:

Dr Harish Shetty, a psychiatrist at Dr LH Hiranandani Hospital told TOI, “Students who commit suicide do not necessarily have a mental illness. Their coping mechanism to deal with small frustrations, failure/loss is poor.”

“Any event be it relationships, exams or issues relating to one’s immediate environment affects students profoundly. That, and the apparent social disconnect with people who care compound their problem, making for a potent suicide cocktail.”

“Many students are brought up in cocooned surroundings, which also accounts for their low threshold of pain.”

Main Challenges:

1. The conservative environment in which majority of our children are raised creates a barrier between them and their family members, this makes them ponder over and over about their life problems and ultimately all that suffering takes the shape of a mental health issue.

2. The social stigma attached to seeking help in terms of mental health consultation that leads to ignorance towards our mental health.

3. There are not enough working professionals to seek help.

Solving the Problem at Root Level – National Education Policy and Mental Health:

The National Education Policy can be instrumental about the need to include socio-emotional learning (SEL) in school curricula, while also emphasising the importance of counselling and mental health services in schools. Claims about SEL being the new frontier of school based mental health laud its efficacy in facilitating academic and career accomplishments.

(Eg: In 2018, the Delhi government launched its ‘happiness curriculum’ across several public schools. This is a class taught alongside other core subjects such as Maths and science, and comprises three main aspects: mindfulness meditation; stories to promote responsibility; and activities meant to prompt self-reflection by students about their thoughts, emotions, and behaviour.)

Emotional abuse’, is though often talked about and recognized as one of the issues of child protection. Currently, no data is presented in this regard, and the response is largely focused on violence.

Proposed Solution (Hypothetical Ideation)

The technology can be utilized for the best to have a unique solution for this problem:

At school and college level, a web based Mental wellness community can be created, i.e., “MANAS – “Man se motivated” which would highlight the EQ-IQ balance and effective communication and human dynamics. A program whose sole objective will be to work towards the well-being of students in terms of reorienting their thoughts. A platform that would integrate students of all age groups (school and college) with a motto to help them have a balanced approach towards any given task they perform in their day today life, thus working on the aspect of their social and emotional in order to have mental poise.

This program will put to test their comprehending skills (in order to understand the working of this program: -through interactive sessions, games & activities), the power of conviction (convincing the psychologically by trying to perceive the requirement of their mindset) &also generate effective communication to deal with diverse set of people.

The main purpose will be to develop a web-based community wherein each student would have to attempt a questionnaire (a mix of puzzles, some situation-based questions, immediate response to a given hypothetical situation, some personal questions based on choice & preferences, some questions indirectly related to them academic subjects) on the basis of which they would be able to move to the next level ; where based on their responses they would get a list of groups priority wise which they can join (for Eg: someone with a pre meditated approach in anything he or she does may be allotted the group that caters to the need of imbibing in students the sense of patience & not being reactive immediately in a given situation).

➢Now , like this sub communities would be created within an app , and based on the group they belong to – it would be combination of activities , interactive discussion ,some games which would in a way look to amend their thought process in a way that reorients their approach towards any situation , which would change their typical response type which was present earlier .

➢Incorporating this as a subject in the scholastic area along with the other subjects (via an app as mentioned) and further this database would be present with the teacher where they could monitor each one’s participation in the same; annually on the basis of which a report would be generated that would assess their performance in terms of percentage as the students get in their mainstream academic subjects.

This would lead to their overall growth & may also be away to assess their personality which would provide a pathway for them to decide what they should pursue ahead (which stream they should join) in order to be a successful professional.

The app may have encapsulated the following aspects:

“Khud ki khoj” – Discover a new you
“Connecting with people”-Interpersonally Yours
“Man, se motivation” –Motivation Essentials
“Emotion ka saregama” - The right balance of EQ &IQ
Decipher the psyche – “Promotion of the program catering to the psychological requirements of individuals

(Disclaimer: This is just a hypothetical ideation, because any such app if made can only be, made in consultation with a team of psychologists, psychiatrists and required medical professionals).

Including it as a subject with mainstream academic subjects can be address this issue in following ways:

promoting better cognitive development;
reducing academic pressure and dependence on coaching;
multiple entry points and academic credit bank
distributing exam pressure by adopting suitable models
reducing hostility by sensitizing students on human values, equity and respect for diversity
Improving access to education for women and transgender people

Conclusion

In India, psychiatric epidemiology remains a challenge. Mental health illness is about a person’s mental and emotional well-being. Good mental health or being mentally sound would mean that one possesses a balanced mind, confidence and self-esteem. A mental illness is a problem that significantly affects how a person thinks, perceives and reacts. With well oriented governmental policy intervention and balanced collaborative effort of the academic institutions and NGOs this existing problem can be addressed in an effective manner. Also, treatment interventions should ideally be integrated in routine healthcare and made easily accessible, beginning from inculcation of this problem as subject with mainstream academics in form of open discussions and counselling. The policies and programs need to be better aligned with evidence-based practices emerging from both scientific studies and program implementation experience. India, being home to the largest number of adolescents and young people in the world and a coordinated effort to correct the deficiencies in the existing policies and to coordinate their implementation to optimize coverage and impact will have national and global impacts on addressing the burden of mental health. It is hoped that the description and comparative analysis along with recommendations outlined in this paper can be used as a suitable referential source for formulation of effective policies in the domain of metal health in the Indian Context .

Appendices:

https://pharmeasy.in/blog/mental-health-illnesses-in-india/

https://www.ideasforindia.in/topics/human-development/understanding-india-s-mental-health-crisis.htm

https://www.healthissuesindia.com/mental-health/

https://journals.lww.com/indianjpsychiatry/Fulltext/2021/63010/School_mental_health_program_in_India__Need_to.15.aspx

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61973-5/fulltext

https://journals.sagepub.com/doi/full/10.1177/02537176211048335

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443608/

https://www.unicef.org/india/press-releases/unicef-report-spotlights-mental-health-impact-covid-19-children-and-young-people

https://vikaspedia.in/social-welfare/differently-abled-welfare/policies-and-standards/national-mental-health-policy

https://www2.ed.gov/documents/students/supporting-child-student-social-emotional-behavioral-mental-health.pdf

https://www.education.vic.gov.au/school/teachers/health/mentalhealth/Pages/promoting-mental-health.aspx