Interview
Dr. Abdul Mabood, Director, Snehi, shares
his views and concerns regarding child and adolescent mental health in India, in an interview with Chitra S. Shankar.
1. Please define mental health. What is the difference
between mental health and mental illness?
In
We have tried to define mental health
in the Indian context as, “a state of successful performance of the mind,
resulting in productive activities, fulfilling relationships, and the ability
to adapt to change and cope with adversity.” Mental health is indispensable
to personal well-being, family and interpersonal relationships, and a positive
contribution to society.
2. What are the estimated figures for those affected by mental health
problems in
It has been estimated that there
are about 65 million children and young persons suffering from a range of
mental health problems. There is no accurate data.
There is only one study by the Indian
Council for Medical Research (I.C.M.R.), which till date has not been formally
published. The study says that between 7 to 12 per cent children and adolescents
suffer from mental disorders ranging from the moderate to the severe.
As per W.H.O. 10 to 15 per cent
children and adolescents around the world suffer from mental health problems.
3. What are the major mental health problems that children and adolescents
face?
Attention deficient hyperactivity
disorders (A.D.H.D.) play a very deterrent role in the development of a child
in the area of learning. Children and adolescents also suffer from a lot of
adjustment and anxiety problems. Violence is another area, and children are
the worst affected in states such as Jammu & Kashmir, Andhra Pradesh,
Nagaland, etc. In case of natural calamities such as Tsunami, eighty per cent
children suffer from one or other mental disorder.
Unfortunately, the dichotomy of
our society is that our whole thrust is on physical needs, while emotional
or psychological needs are totally neglected. Studies have shown that if you
do not cater to mental health problems they also translate into physical problems.
4. Is there any specific area or state in
Yes. The incidence of mental
health problems in
5. What are the Government policies and the legal
provisions that exist with regard to mental health in
In
We are so shameless that we have
signed the U.N. Convention on Child Rights, promising to take care of their
physical, educational, mental and psychological well-being whatever be the
circumstances, but have done nothing to take care of the psychological, emotional
and mental suffering of our children and adolescents.
There is a Mental Health Act 1987, which only deals with
mental illness, hospitalisation, and mental asylum. Moreover, there is no
provision for rehabilitation even under the Mental Health Act. In effect,
this country does not have any legal provision on mental health.
6. What are the Government interventions with regard
to prevention, treatment and rehabilitation of people suffering from mental
health problems?
The Indian Government has done nothing.
Their policies only deal with psychiatric department and mental asylum. Even
in the Rural Health Mission Programme 2005, there is nothing on mental health.
In the Integrated Child Development Service (I.C.D.S.), they have talked under
protection of the child, a bit on psychological well being or counselling.
But counselling is a very small part of mental health care and management.
With regard to treatment, there
is nothing very conducive. There is no test or method to pinpoint a particular
problem or symptom that has become a syndrome, etc. Unfortunately there are
not many medical psychiatric professionals.
As for rehabilitation, everyone knows the situation of the mental asylums. Thanks to the National Human Rights Commission and the Supreme Court, the Ministry of Health is at least now discussing the subject.
7. Could you tell us about funds allocated for child and adolescent mental
health under the Tenth and Eleventh Five Year Plans?
Not a single rupee has been allocated
till date for child and adolescent mental health. Even under the Tenth Plan
there was no allocation.
In policy plans they only talk about mental illness. Even in this area there has been no Government action. But after the Erawadi incident in Tamil Nadu, they thought people might react. Further, the Supreme Court came down heavily on them. So the Health Ministry was given around 190 crores as budgetary support. You will be surprised that even 10 per cent of that amount has not been spent for the purpose it was allotted. A reliable source also told me that a good part of that money was transferred to physical health care.
We are now lobbying with the Planning
Commission for fund allocation in the Eleventh Five Year Plan, but the demand
should also go from the Health Ministry. They must ensure that child and adolescent
mental health is made a part of the school curriculum.
8. Mental health is one of the most neglected areas
in
The main reasons are social and cultural. The Indian attitude
is such that you are considered normal till you behave according to the expectation
of the society. The moment you stop behaving as per the social norms, social
culture and show any deviation, you are tagged as not only abnormal but ‘mad’
- “Yeh to pagal hey!”
The Government is also run by people who are part of the same society. That’s
why the ignorance and ultimately the neglect. Social stigma is another major
reason.
Awareness is low on this issue.
People tend to interpret mental health as mental illness. If you see historically
and socially, in our society, any issue related to mental disorders or behavioural
disorders, has always been equated with mental asylum and an issue to be pushed
under the carpet.
9. What remedies do
you suggest to create awareness regarding mental health problems?
First, there should be a very effective
mental health policy. It must be divided into three or four components. Community
mental health programmes should go up to the panchayat level, and should mainly be based on awareness,
whether it is in the urban or rural setup. It should be a part of the educational
syllabus in schools, where school teachers should be sensitised and trained in this area. They should observe the
children and the moment any child has a moderate or even minor mental problem,
they should be able to identify it and send the child to the counsellor or a mental health professional.
There is a need for effective training
programmes for mental health professionals as well. The number now is negligible.
There should be more professionals such as para
counsellors, para mental
health professionals, and community mental health professionals.
10. Is there representation from the Mental Health
sector on any Steering Committee or Working Group that has been set up by the
Planning Commission?
There is absolutely no representation.
11. What about the Health Ministry?
Fortunately, for the first time
in history, they called two N.G.O.s, Snehi and Sanjeevni, for a meeting
held in April 2006. The reason was that the present Secretary of Mental Health
Authority of India is a very concerned person.
The meeting was basically to discuss
ways to implement district mental health programme vis-a-vis
the Supreme Court order. The Supreme Court has given a stricture to the Ministry
of Health on the situation of the mental hospitals and mental asylums. Since
then, three months have passed and even the Minutes have not yet reached me.
The meeting itself was on district mental health programmes but those present,
including experts from N.I.M.H.A.N.S., etc., were talking only about mental
illness.
12. What is the way forward?
In mental health, the best approach
is that of prevention rather than cure, and prevention is only possible at
the childhood and the adolescent level. Once you are an adult it is very difficult
to contain it. Thus mental health should be part of the panchayati raj system, part of our
social development and part of our child development. The attitude of the
policy makers has to change. And this is the responsibility of not just one
organisation, but all organisations and every individual of this country.