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In Parsiana’s 60th year while the emphasis is on the fate of aging Parsis, one cannot and should not overlook the ills that plague the young. Dr Zirak Marker, whose expertise is children and youth, writes about the issues afflicting the young.

Mental health problems affect about one in 10 children and young people. One in five school going children have signs of a mental health condition. These include depression, self-harm, anxiety (social or separations) and conduct or behavioral disorders. 

Worldwide statistics reveal that 20% of adolescents may experience a mental health problem in any given year; 50% of mental health problems are established by age 14; 10% of children and young people (aged 5-16 years) have a clinically diagnosable mental problem, yet 70% of children and adolescents who experience mental health problems have not had appropriate interventions at a sufficiently early age. 

The World Health Organisation states that India is the most depressed country in the world. One in six children and teenagers aged between 10 and 19 years of age suffer from depression. As we speak there is one suicide attempt every three seconds and one death by suicide by youth every 40 seconds.

An average of 31 children died by suicide every day in India in 2020 and 2021, according to government data, with experts underlining that the Covid-19 pandemic may have accentuated the psychological trauma faced by children to a great extent.

According to the National Crime Records in metros, 11,396 children (5,392 boys and 6,004 girls) died by suicide in 2020 (31 deaths per day or one child committing suicide per hour) an 18% rise from 9,613 such deaths in 2019 and 21% rise from 9,413 in 2018.

Family problems (4,006), love affairs (1,337) and  illness (1,327) were the main causes of suicide among children below 18 years of age. 

The emotional wellbeing of children is just as important as their physical health. Good mental health allows children and young people to develop the resilience to cope with whatever life throws at them and grow into well-rounded, healthy adults.

There are certain risk factors for mental health problems and suicide in children, whether at home or at school. These include having a parent who has had mental health problems or an illness, substance abuse or has been in trouble with the law (genetic factors) or financial losses. Toxic parenting or negligent parenting are also factors. Experiencing the death of a parent or someone close to them; having parents who separate, divorce or have severe marital conflict or family problems; having been severely bullied or physically, emotionally or sexually abused; living in poverty or being homeless or suffering severe financial losses are other causes.

Additionally, experiencing discrimination, perhaps because of their race, sexuality or religion; having long-standing educational difficulties or a specific learning disability; substance abuse (alcohol, drugs like marijuana); having a long-term, chronic or terminal illness; social media and peer pressure; belonging to the lesbian, gay, bisexual, transgender, queer or other orientation may be causes for suicide. 

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Warning signs for children who are thinking about suicide might be discerned through their mood, thoughts, behavior or health. They may talk, ask or be preoccupied about suicide or death in general with their parents, friends or teachers. There may be lack and loss of interest in almost everything; seeming anxious and on edge; emotional, with crying spells, mood changes or angry outbursts. Children may drop hints that they might not be around anymore; talk about feeling hopeless, helpless, worthless or feeling guilty. They may pull away from friends or family, isolate themselves in their rooms or become very quiet. 

Some may write songs, poems, or letters about death, separation, and loss; start giving away treasured possessions to siblings or friends; lose the desire to take part in favorite things, sports, play or activities; have trouble concentrating or thinking clearly, especially in school; experience changes in eating or sleeping habits; engage in risk-taking behavior, self-harm or substance abuse; lose interest in school; have consistent mood swings, irritability, meltdowns, crying spells or anxiety. 

It is a misconception that childhood is a carefree, trouble-free period in our lives. How many children can express that they do not worry about peer acceptance, not being invited by friends for birthday parties, being cyber-bullied, get insufficient marks in an examination, or fall short of parental expectations?

How many can express their severe anxieties and fears when their parents are fighting or deciding to separate or divorce, or when they are struggling with basic reading comprehension or written work in the classroom or not passing in any academic examinations?

Adults often forget that children are powerless and have no control over their own lives, nor do they have inborn coping mechanisms, strategies or problem solving capabilities. They also have difficulty in understanding or regulating their emotions and feelings. This can be frightening and frustrating to live with day after day. At this point most children feel a sense of insecurity, helplessness, hopelessness and worthlessness. They feel they cannot find a solution to the perceived problem or don’t have the strength or support to do so. 

Children are far more vulnerable and susceptible to psychological and emotional problems than any other age group today.

Often timely intervention is delayed on the assumption that this is a passing phase or the result of a weak mind or fear of being judged or perceived as having a mental problem. 

Parents sometimes say they are embarrassed and beset with severe guilt and self-blame for their child’s condition. Some also share that they’re afraid of asking their children directly about self-harm or suicide as it would put such untoward thoughts into their heads. 

Myths and misconceptions about psychiatric and psychological treatment and medication also deter families from seeking help. Many parents feel that psychiatric medications are harmful and have long-term side effects such as weight gain, drowsiness or cognitive dullness. They also feel that these medications cause dependency and need to be taken for life once they’ve been started. 

Parents sometimes don’t have the patience and want a quick fix. They do not realize that counseling, therapy and most treatments require longer periods of time, sometimes extending to over a few weeks or months. It’s a journey. 

Most people don’t know that psychological or psychiatric conditions are caused because of neurochemical imbalances or physiological disruptions in the brain. Many individuals, educators and caregivers are unable to recognize warning signs of mental health conditions because the symptoms are usually unseen or are related to behavior or thoughts in the mind. It’s like a silent epidemic.

In my opinion, as parents we need to act first in a timely manner and reserve emotional judgment for a later stage. Getting timely professional guidance, an accurate diagnosis and initiating early treatment can be extremely beneficial for the recovery path, prognosis and progress of a child’s mental health condition. 

Having faith in one’s mental health professional is also crucial. India has very few child psychiatrists or psychologists. Statistics show that there is only one psychiatrist for every four lakh Indians. Also, a multidisciplinary team approach provides security and hope to many families as the question of only one professional’s judgment does not arise. Ideally, a good work-up includes being consulted by a child/adolescent psychiatrist, child psychologist (clinical or counseling psychologist) or a school counselor. 

Being patient is crucial to deal with the mental health of youth. It takes a while for them to build up a rapport and develop trust or faith in the therapist, especially when they are already feeling insecure. Building a professional and confidential bond so that they feel safe, secure, accepted and not judged, is crucial to the child’s progress and recovery. 

If pharmacotherapy is necesary and medications are prescribed, it is mandatory to also have counseling, psychotherapy, cognitive behavior  therapy or rational emotive behavior therapy (or any other research based approaches or therapies) provided for the young person and their families in a mindful manner. 

Recovery rates and rehabilitation are extremely good for youth. As informed, educated individuals it is our prerogative to create more awareness regarding mental health so as to ensure that the next generation is happy and secure, that these individuals live more productive and meaningful lives. 

Schools have to integrate a mental health and life skills curriculum within school hours and across all age groups and grades, within the time table. This is the only way to increase awareness and reduce stigma. There is nothing more important than to hold a child who is breaking down or falling apart because he’s been severely bullied or just been told that his parents are getting a divorce or that he’s failed an exam. There is nothing more gratifying than to help him search for and pick up the broken pieces so that they may be fixed back into the complex puzzle of life. There is nothing more overwhelming than to see such a child stronger, more complete and at peace with himself. There is nothing more beautiful than empowering a child’s emotional and psychological wellbeing. That’s the magic we hope to achieve here at Mpower — The Centre (a mental health care facility in Bombay that offers counseling, therapy and other services). 

Dr Zirak Marker is senior psychiatrist and advisor at Mpower — The Centre, Bombay and medical director at The Aditya Birla Integrated School.