Child as per Convention on the Rights of the Child (1989) is a person younger than 18 years, unless the majority (i.e., the legal threshold of adulthood) is attained at a younger age in a particular country. Adolescence is historically defined by WHO as the period between ages 10 and 19 years.
Almost 90% of children and adolescents live in low-income and middle-income countries (LMIC), where they form up to 50% of the population. It is estimated that by 2020-2030, up to 40% of patient visits to pediatricians will involve long-term chronic disease management of physical and psychological/behavioral conditions. As per WHO “Child and mental health is the capacity to achieve and maintain optimal psychological functioning and well-being. It is directly related to the level reached and competence achieved in the psychological and social functioning”. When we look in the problem statement Indian data suggest the prevalence of mental illness in the age between 1-16 is 13%, we do not have specific data from Nepal.
Common mental health problems in child and adolescent are
- Scholastic: Related to academic performances like mental retardation, dyslexia
- Emotional like anger, anxiety, aggressiveness
- Behavioral like truancy, disobedience, anger outbursts
- Drug/substance use problems
- Core psychiatric problem like depression, phobia, schizophrenia, bipolar disorder, attention deficit hyperactivity disorder
- Personal Problem like conflicts, problems in body image
- Family: behavioral and emotional problems related to the familial issues
Apart from this Chronic disease in young people such as diabetes, are associated with an increased risk of mental disorders. Injuries and violence are important contributors to the burden of disease in young people. Mental disorders can predispose to exposure to violence as a perpetrator or victim.
Some mental illnesses are preventable, many are treatable, and children with psychiatric disorders could be living normal or near-normal lives if given appropriate treatment. Sometimes failure to recognize the problems in children lead to further aggravation of problems. For example, a depressed child who is acting badly may be punished for being naughty or may be told to “snap out of it.”
An anxious adolescent may consume increasing amounts of alcohol in order to cope but is told to “just say no!” There might be social exclusion, punitive action, and criticism leading to lowered self-esteem. They become deprived of the assistance they need. Further, if the help is sought stigmatization may result, with a range of negative impacts, including a reduction in the resources needed for treatment.
Specific mental disorders occur at certain stages of child and adolescent development, screening programs and interventions for such disorders can be targeted to the stage at which they are most likely to appear. Since there is a high degree of continuity between child and adolescent disorders and those in adulthood, early intervention could prevent or reduce the likelihood of long-term impairment.
Effective interventions reduce the burden of mental health disorders on the individual and the family, and they reduce the costs to health systems and communities. There is a role of every individual, family, and schools in identifying and managing the condition. The role of schools is foremost because the child spends the majority of the active time in schools.
The schools have a responsibility in
- Regular screening, Health check-up
- Impart skills for mental health promotion
- Early identification of emotional and behavioral problems
- Intervention in scholastic problems
- Drug awareness campaigns
- Skills and ability to say “no” to drugs
- Positive lifestyle behaviors
There are certain challenges in our part of the world: Nepal does not have a child’s mental health policy. The legal system doesn’t have any special provisions related to child mental health and related disabilities. Another most neglected area is the promotion of research in child and adolescent mental health. There is a strong need to expand the community services for child mental disorders via mobile health camps, the involvement of female community health volunteers or primary care clinics.
To conclude in the medium and low-income countries a large chunk of the population is children and adolescents and the prevalence of psychiatric illness in this age group is increasing worldwide. Childhood and adolescent mental health problems have a unique requirement in terms of diagnosis and intervention. There are identifiable risk factors and preventive interventions. There is a need for acknowledgment of this specialty as a discrete area of health care and the primary health care approach is required at the community level in this area – early identification, prevention, and treatment with legislative support, inter-sectorial cooperation.