A, 21, once walked out on her parents and contemplated suicide at a railway station. She cried, broke down, and came home and told her parents that she wanted to see a psychiatrist. It didn’t go down well with her family who, in addition to being baffled and wondering where they had gone wrong in their parenting, didn’t have a clue about how to find a psychiatrist.
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S, 23, was diagnosed with borderline personality disorder and had to lie to his reporting manager that he has “doctor’s appointments” every week to avoid becoming the subject of office gossip. The fact is that he attends counselling sessions. His family is ashamed to support him, either emotionally or with the fees for his sessions.
There are plenty of similar stories, common across Indian households. Going by the profusion of mental health affirmations and posts on social media, it may seem like Young India is ready to talk about and get help with mental illness than previous generations. But that’s a fallacy, as the findings of a recent UNICEF study reveal: only 41 percent of young Indians feel it is okay to seek mental health support.
Most experts unanimously agree that youth today don’t lack awareness but the information and knowledge they receive is half-baked. “Awareness doesn’t guarantee breaking of stigma, which is an important factor impacting the pursuit of therapy by youth,” explains Jigyasa Tandon, Trained Mental Health Educationist and Counselling Psychologist (Sensitive Groups), NIMHANS, Bengaluru. “Stigma is a very important factor that defines the behaviour of the person; they want to avoid being tagged ‘mental’, ‘crazy’, ‘incompetent’. Also, when someone starts to develop a mental health problem, it’s met with a lot of confusion and challenges their confidence from inside as well as outside. The people surrounding the individual with mental health issues often make it worse and take the behaviour and actions as deviant to the authorities.”
Dr Kedar Tilwe, Consultant-Psychiatrist, Fortis Hospital Mulund & Fortis Hiranandani Hospital, Vashi in Mumbai agrees, saying that stigma associated with mental health is perhaps the biggest barrier that the youth face. “Anxiety and worries about it being perceived in the right way, or the fear that they will be ostracised and misunderstood causes most of them to remain quiet,” he says.
Young people are curious to learn more about their mental health but financial barriers and lack of family support often keep them from trying to learn more about their wellbeing. Vikram Thaploo, CEO, Apollo Telehealth says that not everyone has enough privilege to access help from private practitioners, and a majority rely on government healthcare infrastructure and schemes. “The need for better public infrastructure and policy is evident,” he says.
Tanvi Jajoria, Counselling Psychologist, BetterLYF Wellness, elaborates: “In our culture and the kind of education system we have, people as old as 24-25 years of age are dependent on their parents for their financial needs, and don’t have an independent source of income. This is a huge challenge—either they can’t afford therapy or their family members won’t support this choice, which makes it even more difficult for them to seek mental health support.”
In a country like India where social and cultural values and beliefs are ingrained, there is a lot of misinformation such as mental illness being contagious, or witchcraft being a cure. “Culture influences many aspects of mental illness, including how patients express and manifest their symptoms, their style of coping, and their willingness to seek treatment,” Thaploo says. Further complicating the issue is the widespread existence of negative stereotypes about individuals with mental health problems: they are considered dangerous, unpredictable, and difficult to talk to. “These negative stereotypes can have detrimental consequences on the users of mental health services through processes of public stigma, self-stigma and stigma expectations,” he says.
Jajoria says that culturally, we have normalized a lot of issues such as relationship problems post marriage, conflicts with parents, and academic or career problems. “When we do not see something as a problem, we won’t even look for a solution. For a person who has normalized the idea of being scolded or beaten by parents, they won’t see the impact it is having on the child in the longer term and hence, won’t reach out for support.”
Role of schools and teachers
The National Mental Health Survey (NMHS), conducted by Nimhans, estimates that nearly 9.8 million adolescents aged 13-17 years are in need of active mental health care intervention and that this number would be greater if the entire age spectrum of childhood and adolescence is considered. Several studies conducted at the community level have shown the prevalence of child and adolescent mental disorders varying from 1.06% to 5.84% in rural areas, 0.8% to 29.4% in urban areas. With studies showing an alarming increase in the number of children and teenagers who experience mental health issues, the pressure is mounting for schools and educational leaders to provide adequate support. A huge part of mental health support in schools starts with awareness.
“Integrating mental health education into the curriculum will increase knowledge and understanding of those experiencing difficulties, removing any stigma or social misconceptions and replacing these with an atmosphere of positivity and acceptance,” says Thaploo.
Tilwe believes that schools are a great medium for spreading awareness and should be at the forefront of the battle against stigma. “Conducting life-skills training, bullying prevention programs and facilitating access to counselors if needed, are some of the areas which can be addressed,” he says.
While schools and learning institutions have a huge potential to play in a child's mental health, the problem is that these institutes aren’t ready to invest in these initiatives. As per government policy, it’s mandatory for schools to have a counsellor and special educator. But Tandon says it isn’t being implemented across the board. “Every year there are a humongous number of school counsellor posts which go vacant just because schools don’t feel it's an active requirement.”
Beyond schools and colleges, Jajoria advises having conversations about mental health with friends and family, encouraging them to talk about their problems, and normalizing the concept of seeking help within one’s interpersonal circles. “Imagine if everyone is well aware of the importance of mental health and starts talking and educating people around them…. A lot of our mental health issues stem from systemic oppression, and we need to work on such root causes to bring about a sustainable change,” she adds.
Tandon says mental health should be treated like physical health. “If regular health check-ups can be organised for children, why can’t parents and teachers take steps to check on mental health too?”
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