Dr N Heramani Singh (Assisted by Dr N Dhananjay Patro)
World Mental Health Day (October 10) is a day for global mental health education, awareness and advocacy against social stigma. It was first celebrated in 1992 at the initiative of the World Federation for Mental Health(WFMH), a global mental health organization with members and contacts in more than 150 countries.Since the early days, the Federation has chosen a theme to be promoted in its planning kit each year.
This year’s theme set by the World Federation for Mental Health is “Young People and Mental Health in a Changing World”.
Adolescence and the early years of adulthood are a time of life when many changes occur, for example changing schools, leaving home, and starting university or a new job. For many, these are exciting times. They can also be times of stress and apprehension however. In some cases, if not recognized and managed, these feelings can lead to mental illness. The expanding use of on-line technologies, while undoubtedly bringing many benefits, can also bring additional pressures, as connectivity to virtual networks at any time of the day and night grows. Many adolescents are also living in areas affected by humanitarian emergencies such as conflicts, natural disasters and epidemics. Young people living in situations such as these are particularly vulnerable to mental distress and illness.
Half of all mental illness begins by the age of 14
Half of all mental illness begins by the age of 14, but most cases go undetected and untreated. In terms of the burden of the disease among adolescents, the major illnesses are :
*Harmful use of alcohol and illicit drug abuse is a major issue and can lead to risky behaviours such as unsafe sex or dangerous driving
*Suicide is the second leading cause of death among adolescents
*Depression is the third leading cause
The importance of building mental resilience at an early age
Fortunately, there is a growing recognition of the importance of helping young people build mental resilience, from the earliest ages, in order to cope with the challenges of today’s world. Evidence is growing that promoting and protecting adolescent health brings benefits not just to adolescents’ health, both in the short-and the long-term, but also to economies and society, with healthy young adults able to make greater contributions to the work force, their families and communities and society as a whole.
Prevention begins with better understanding
Much can be done to help build mental resilience from an early age to help prevent mental distress and illness among adolescents and young adults, and to manage and recover from mental illness. Prevention begins with being aware of and understanding the early warning signs and symptoms of mental illness. Parents and teachers can help build life skills of children and adolescents to help them cope with everyday challenges at home and at school. Psychosocial support can be provided in schools and other community settings and of course training for health workers to enable them to detect and manage mental health disorders can be put in place, improved or expanded.
Investment by governments and the involvement of the social, health and education sectors in comprehensive, integrated, evidence-based programmes for the mental health of young people is essential. This investment should be linked to programmes to raise awareness among adolescents and young adults of ways to look after their mental health and to help peers, parents and teachers know how to support their friends, children and students. This is the focus for this year’s World Mental Health Day.
Mental illnesses in changing world
Bullying / Cyber bullying
Bullying is any unwanted aggressive behaviours by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated. Cyberbullying was defined as threatening or aggressive emails, texts or on-line posts, embarrassing or threatening pictures posted on-line, or using someone’s identity to send out or post embarrassing or threatening information.
Our world is indeed changing rapidly on a day to day basis, both in the physical world and in the virtual on-line world. Bullying and cyberbullying continue to have no boundaries and have confused guidelines in this changing world.
Technology has created a new sense of belonging. It seems to be easier to find a connection on-line. But is that on-line connection always the one we want? Is it real? Is it truthful? Is it really belonging if we don’t know the person at the other end? Remembering the term -‘a false sense of belonging’, does that phrase apply to technology in the 21st century? Bullying can affect everyone those who are bullied, those who bully, and those who witness bullying. Bullying is linked to many negative outcomes including impacts on mental health, substance use, and suicide. We need to realize that the ill-natured behaviours of some, deeply affect the lives of another. So it is our responsibility as role models, caregivers and bystanders to model appropriate behaviours for all to see.
*Suicide is defined as death caused by self-directed injurious behaviour with intent to die as a result of the behaviour.
*A suicide attempt is a non-fatal, self-directed, potentially injurious behaviour with intent to die as a result of the behaviour. A suicide attempt might not result in injury.
*Suicidal ideation refers to thinking about, considering, or planning suicide.
Suicide is the second leading cause of death among 15-29-year-olds. 78% of global suicides occur in low –and middle-income countries. Suicide is more common in males than females. Many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness. In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour.
Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners. Suicides also happen in mental disorders like depression (low mood, loss of interest in pleasurable activities, hopelessness and worthlessness feelings, etc.) and other mood disorders. By far the strongest risk factor for suicide is a previous suicide attempt. Ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally.
How can I help someone who has self-harmed or might be at risk of suicide?
Most young people who self-harm do not seek help beforehand, concerns about confidentiality and stigma have been reported by adolescents as barriers to seeking help for self-harm or suicidal ideation. Elements of providing support include letting the young person know that they are not alone and encouraging them to ask for professional help. Being as open as possible and ensuring safety in discussing feelings are important. Assessment should include asking a young person directly if she/he is considering suicide and, where relevant, calling the local hospital or mental health service. While this may be challenging, calling an ambulance or taking a young person to the nearest hospital emergency department may be appropriate if they need urgent medical attention. The available evidence tells us that a young person’s risk of suicide remains elevated for at least a decade after an emergency department presentation with self-harm. Therefore, self-harm during adolescence should be considered by friends, family members and health professionals as more than just a passing phase.
How to Prevent suicide
1. Reducing access to the means of suicide (e.g. pesticides, firearms, certain medications).
2. Reporting by media in a responsible way.
3. Introducing alcohol policies to reduce the harmful use of alcohol.
4. Early identification, treatment and care of people with mental and substance use disorders, chronic pain and acute emotional distress.
5. Training of non-specialized health workers in the assessment and management of suicidal behaviour.
6. Follow-up care for people who attempted suicide and provision of community support.
Gender Identity and Mental Wellbeing
Adolescence is a time of tremendous growth and change, physically, intellectually, and socially. It is during these years that young people most often develop their romantic and sexual attractions, as well as consolidating their gender identity. Most adolescents will identify as one of only two genders, boys or girls, and that gender will tend to align with the sex they were assigned at their birth based on observation (cisgender youth). However, a small proportion of young people will identify as the other of the two main genders, or as a different, non-binary option; this group is sometimes referred to as transgender youth.
Another 1% to 2% of the population will have differences in their bodies that are not clearly aligned as male or female, boys or girls, also known as intersex people.
Similarly, most but not all adolescents will develop heterosexual romantic and sexual attractions (boys attracted solely to girls, girls solely attracted to boys). Between 2% and 10% of young people will develop same-gender attractions (gay, lesbian, or queer) or attractions to more than one gender (also called mostly heterosexual, bisexual or pansexual), or no attractions at all (asexual). Given the many different terms and labels for sexual and gender minority people in different languages, the United Nations, WHO and other UN agencies use the acronym LGBTI, which stands for lesbian, gay, bisexual, transgender, and intersex people. As a small minority of the population, in most countries throughout the world LGBTI people are marginalized, and face stigma and discrimination, family rejection, and even violence. In more than 70 nations it is still illegal to identify as LGBTI, and in some of those countries, LGBTI people can face arrest, prison, or the death penalty. Even in places where they are fully protected by human rights laws, such as in Canada, LGBTI young people may face social disapproval and stigma, and they may be harassed or bullied in school. This stigma and discrimination contributes to stress and mental health challenges for LGBTI adolescents. In nearly every country where their health has been studied, including countries in North and South America, Europe, and Asia, LGBTI youth face higher rates of anxiety, depression, and emotional distress. They report 2 to 8 times the risk of self-harm, suicidal thoughts, and suicide attempts than their heterosexual and cis gender peers in the same communities.
How can I be supportive of transgender family members, friends, or significant others?
1. Educate yourself about transgender issues by reading books, attending conferences, and consulting with transgender experts.
2. Be aware of your attitudes concerning people with gender-nonconforming appearance or behaviour.
3. Know that transgender people have membership in various sociocultural identity groups (e.g., race, social class, religion, age, disability, etc.) and there is not one universal way to look or be transgender.
4. Use names and pronouns that are appropriate to the person’s gender presentation and identity; if in doubt, ask.
5. Don’t make assumptions about transgender people’s sexual orientation, desire for hormonal or medical treatment, or other aspects of their identity or transition plans. If you have a reason to know (e.g., you are a physician conducting a necessary physical exam or you are a person who is interested in dating someone that you’ve learned is transgender), ask.
6. Don’t confuse gender nonconformity with being transgender. Not all people who appear androgynous or gender nonconforming identify as transgender or desire gender affirmation treatment.
7. Keep the lines of communication open with the transgender person in your life.
8. Get support in processing your own reactions. It can take some time to adjust to seeing someone you know well transitioning. Having someone close to you transition will be an adjustment and can be challenging, especially for partners, parents, and children.
9. Seek support in dealing with your feelings. You are not alone. Mental health professionals and support groups for family, friends, and significant others of transgender people can be useful resources.
10. Advocate for transgender rights, including social and economic justice and appropriate psychological care. Familiarize yourself with the local and state or provincial laws that protect transgender people from discrimination.
Worldwide 10-20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. Neuropsychiatric conditions are the leading cause of disability in young people in all regions. If untreated, these conditions severely influence children’s development, their educational attainments and their potential to live fulfilling and productive lives. Children with mental disorders face major challenges with stigma, isolation and discrimination, as well as lack of access to health care and education facilities, in violation of their fundamental human rights. So the main objectives, with respect to child and adolescentmental health, are:
*To strengthen advocacy, effective leadership and governance for child and adolescent mental health
*To provide comprehensive, integrated and responsive mental health and social care services in community-based settings for early recognition and evidence-based management of childhood mental disorders
*To implement strategies for promotion of psychosocial well-being, prevention of mental disorders and promotion of human rights of young people with mental disorders
*To strengthen information systems, evidence and research.
Lastly the only message is that in this changing world , we have to pay a special attention for giving priority to mental health care of young people.
The writer is Prof and former HoD, Dept of Psychiatry, RIMS, Imphal, President, Indian Psychiatric Society, Manipur State Branch
Dr N Heramani Singh (Assisted by Dr N Dhananjay Patro)