The youth plays a very important role in the development of a country. UNICEF estimates the world's youth population (aged under 18) to be 1.2 billion – and India enjoys its largest share. As per the 2001 census, India's under 14 population accounts for 35.3% and under 18 population for 41%. However, the nation doesn’t seem to pay this phenomenon the attention it deserves. If one presumes that at least 20% of our youth are susceptible to mental issues, the number of counsellors we have fall extremely short of our requirements.
Herein, we present you our conversation with Dr. Rajesh Sagar, Professor, Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Delhi, whose work on adolescent mental health, among other mental health issues, for the many years of his professional tenure, is noteworthy. He has contributed extensively to many national and international periodicals. Recently, a highly revealing report titled “India State-level Burden Initiative” on the mental health of Indian children published under his guidance in the well-known periodical LANCET Psychiatry, on December 2019, has received much attention. The report is available on the following link:https://www.thelancet.com/journals/lanpsy/article/PIIS2215- 0366(19)30475-4/fulltext
Q: Given the state of affairs in our country, and also globally, should mental health be taught as a subject at the school level? If yes, then at what stage ought it begin?
A: It is an extremely vital issue. In my view, mental health must be incorporated in the school curriculum. Mental health is an important subject that needs to be studied from the very beginning. The earlier the school going children are introduced to emotional health and associated information, the better. It should address their day-to-day practical concerns like how to keep away from substance abuse, how to share mental problems, how to control anger etc. Today, every child must be aware of mental health. In order to include mental health in the school curriculum, the Health Ministry has prepared a booklet that includes 18 chapters, a fruit of great efforts, for classes 6th to 10th. Different chapters deal with mental health and associated issues in detail; but it has not yet been included in the curriculum. Against the prelevant view that school children are already overloaded with their curriculum, adding one more subject would prove quite a challenge
Q: In 2018, the Delhi government introduced Happiness Curriculum in around 1000 government schools from nursery to class 8th, in which one period of 45 minutes was allocated for Happiness period. Do you feel that this one period can play the role of a counsellor?
A: See, I have heard of it, but I haven’t looked into the content of that course. One need to know several aspects to be able to pronounce meaningful observations. For instance, what scientific methods have been adopted? What philosophy informs it? What is its outline? Who all are involved in its preparation, and what is their credibility? Has in-depth analysis gone into it or not? I think of happiness as an instant feeling, and that it cannot really be measured. As far as the question of happiness Curriculum replacing the School Counsellor is concerned, no opinion can be offered in the absence of complete information on all the aforementioned aspects.
Q: Do mental health issues associated with children from private and government schools differ?
A: No such study or research work has yet been undertaken in India as to enable one to make an authoritative statement in this regard. But, all over the world, it has been observed that some of the issues of the children from economically weaker sections are different. However I do not feel this to be case in India. The standard of education has improved in government schools, and children from middle class families are getting enrolled there. At the same time, many from middle class families are quite able to afford private schools’ fees, and are attending their classes. Seen in this perspective, the gulf between the two types of schools with regard to the standard of education and resources is being bridged. In my view, it is more important to emphasise the need to focus on mental health of adolescents than quibble about private versus government Schooling.
Q: Do you consider it essential to impart training to school teachers with regard to mental and emotional health from time to time?
A: I think it is very important to give more training to teachers in this regard, notwithstanding the fact that psychology is already taught as a subject under the present B. Ed. Curriculum.I subscribe to the view that each one of us has a designated role. The primary task of the teacher is, of course, to teach, and s/he cannot replace a counsellor. Teachers must be trained in the regard, but not as to have them play the role of counsellors.
Q: A happy child does not need to see any counsellor. Would it be therefore proper to presume that a happy and well-to-do child does not need any counsellors’ advice?
A: It could be that a happy child may not need any assistance. But in an ideal condition – which is seldom obtainable in practice – the child is provided a healthy , positive environment and its upbringing has been done keeping the child’s mental make-up and real-life conditions in view. Invariably, at one time or the other, everyone needs help. It is, thus, very important to learn how to cope with a mental health issue. Instead of visiting a doctor when confronted with an illness, it is better to avoid creating a situation that needs a doctor’s intervention. In our country, sadly, not much attention is paid towards prevention. And I cannot stress enough the need to check the incidence of mental health issues in advance.
Q: Is there any alternative remedy available to a child, who, owing to its lower economic background, cannot afford the treatment for mental ailments?
A: The issue of lower or higher economic strata does not arise here, as the complete treatment, including medicines, is available free of cost at government hospitals.I would also like to add that the recent law on mental health puts the onus of treatment of any needy person on the government, and this is to be implemented soon. As compared to children, more adolescents need medicines as part of their treatment. Psychotherapy is also used. In addition, yoga and meditation are employed as well, but these cannot replace medication. Yoga and meditation work as external supplements.
Q: Mental Healthcare Act, 2017 talks about treatment, rights and rehabilitation of the people living with major mental health issues; but what could be the reasons that it does not seem to deal, in any detail, with children below 18 years.
A: It is a correct observation that the law does not explicitly mention the children, and so does it not the women and the elderly. This law is for all. It does discuss about certain rights and special provisions, but these could have been dealt with in greater detail. Our country also has a National Mental Health Policy, which discusses this section of the population. If adolescents are to be specifically focused, then a new programme, in addition to the existing ones, dealing with children less than 18 years, needs to be launched.
Q: In our country, there appears to be a lack of comprehensive policies and schemes for mental health of adolescents. This issue assumes greater importance in the light of the LANCET report released last year, in which it has been clearly brought out that, especially in the southern states, people as young as adolescents commit suicide.
A: This observation is absolutely right. In fact, in India, prevalence of suicide amongst adolescents is a major problem. Even the earlier report published in LANCET in 2004 categorically stated that amongst those committing suicide in our country, 75% were girls in the 15-19 age group. Here, I would also like to inform that a policy dealing with suicides is being framed at the moment, and it is hoped that schools and colleges would also take note of it. But, yes, a lot more needs to be done in this direction. Q: Today, we have laws, policies and programmes. However, who are the other important stakeholders, and what are their respective roles? A: I am of the view that the role of other stakeholders is very important, and everyone must play their respective role for better results. One feels that mental health is a limited issue concerning the health of the individual, but we must learn to look at it through the arenas of education, sports and society as well. In addition, the participation of different ministries of the government, such as Sports, Youth, Social Justice, and Education can prove to be of great help. This is a complex issue that goes beyond the limited domain of health, and addressing it would require the cooperation of many.
Q: It is often seen that the government policies are framed with an optimistic outlook and good intentions, but great expectations are belied during implementation due to small deficiencies. How much hindrance is caused by such small deficiencies?
A: It is often true that much success is thwarted due to small deficiencies. It is true that in the present order of things in the government, there is a great burden of work on the employees. For instance, there is no substitute to replace a counsellor on leave. The present contract system and lack of infrastructure etc. adversely impact the outcome. In our country, mental ailments have not been given the seriousness they deserve. But a good thing is that such things are openly discussed now.
Q: What is your view about the stigma and shame the society associates with mental ailments?
A: See, it cannot be denied that there is stigma associated with the mental ailments. But it has definitely lessened with time. There are many problems on the way; but we will have to keep moving forward, undeterred. Only then can we succeed.
Q: Through Corporate Social Responsibility (CSR), AIIMS is going to start Mental Health Awareness Programme. Please enlighten us about it.
A: This project, involving all types of Delhi schools, is yet to commence. All stakeholders are being included in it. Efforts will be made to advance it further and make it a model programme in the coming times. We will discuss it in detail after it gets launched.
Narjis Husain
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