The children and adolescents spend most of their unique and formative time at school. Whilst most adolescents have good mental health there are factors like physical, emotional and social changes, exposure to poverty, abuse, or violence, that can make adolescents vulnerable to mental health problems. Mental health issues contribute to problems with achievements and relationships at schools and possibly lead to students not attending classes and further to lower academic performance and disruptive social behavior.
The social stigma associated with mental health and limited availability/access to resources has further prevented the children and their parents from seeking treatment. Given the high prevalence of mental health problems and relatively low use of services, it has been essential to consider alternative methods of raising awareness and promoting mental well-being among children.
It has been long recognized that schools are the heart of health in a society as it plays a crucial role in shaping young kids and adolescents. Given that children spend a substantial part of each day within the school setting, schools become a natural and important venue for mental health service delivery.
As we know many of the disabling mental health disorders have an onset at an adolescent period, the school can be important in not only raising awareness but also an important junction for early identification and intervention.
Child and adolescent mental health problems are a major contributor to the global burden of disease and health-related disability of disease. Half of all cases of mental disorders develop by age 14 years, although most remain undetected and untreated until later in life. 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”.
Global Statistic of Mental Health Issues at School
A meta-analysis done including 41 studies conducted in 27 countries, has shown a worldwide‐pooled prevalence of mental disorders in children to be 13.4%. The prevalence as per disorders were: any anxiety disorder, 6.5%; any depressive disorder, 2.6%; major depressive disorder, 1.3%; attention‐deficit/hyperactivity disorder, 3.4%; any disruptive disorder, 5.7%; oppositional defiant disorder, 3.6%; and conduct disorder, 2.1%. This data suggests that the psychiatric problems in the school going children throughout the world are at a rise.
It has been seen that in recent decades substance use in children and adolescents is on a rise with estimates ranging from 1- 24%. From the experiences in the clinic, we can find a lot of children in Nepal struggling to deal with the drug problem. This is often initiated in adolescence and accounts for a substantial proportion of the disability burden faced by the school-going children.
Another major area of concern is internet addiction. More and more parents turn up to the mental health experts with the problem of excessive gaming, internet use and excessive screen time. If we want to deal with these problems effectively at a mass level, the schools can only be the only alternative.
Common mental health problems in school going children and adolescents are:
- Scholastic: related to academic performances like mental retardation and dyslexia
- Emotional: anger, anxiety, and aggressiveness
- Behavioral: truancy, disobedience and anger outbursts
- Drug/substance use problems
- Core psychiatric problem: depression, phobia, schizophrenia, bipolar disorder, and attention deficit hyperactivity disorder
- Personal problem: conflicts and problems in body image
- Family: behavioral and emotional problems related to the familial issues
- Problematic Internet Use
Apart from the aforementioned issues, children face a lot of adversities and they are associated with mal-adaptive family functioning (e.g. parental mental illness, child abuse, and neglect). These adversities are strong predictors of mental disorders. Mental health and emotional well-being of children and adolescents have an impact on their behavior, self-esteem, academic achievements, social connectivity and overall quality of health.
Thus, there is a strong need to intervene at an early age so that the adversities and simple emotional and behavioral problems do not turn into a disorder. In Nepal, around 40% of the total population is 16 years or younger, which is the group of school-age children. If we extrapolate the world wide data of mental illness to Nepal, it is virtually impossible to deal with the problem statement at the clinical level only. The public health model comprising of school administration, teachers and mental health experts at the premises of school is a must.