What Kind Of Public Policies Do We Need To Address The Mental Health Of India’s Youth?

Written by: Dr Simi Mehta, Anshula Mehta, IMPRI 

The IMPRI special lecture on the mental health of India’s youth focused on the eminence of the burden of mental health disorders, be it at an individual level or the challenges faced by family and friends.

The lecture was delivered by Professor Vikram Patel from the Department of Global Health and Population at Harvard TH Chan School of Public Health, USA, who is also the co-founder and member of managing committee of Sangath, an NGO in India. His work on the burden of mental disorders, their association with poverty and social disadvantage, and the use of community resources for the delivery of intervention for prevention and treatment has earned global recognition. The Chair of the session was Professor Prabha Chandra, who is Professor and former Head of Psychiatry at NIMHANS, Bengaluru.

The discussion began with Prof Chandra highlighting the importance of creating services that are youth-friendly and helping young people who are otherwise physically healthy and feel that they do not need to seek help. She emphasised on the need for the youth to co-create services to address mental health challenges, especially in India. This becomes especially relevant in times of crises, such as during the Covid-19 pandemic — the youth are facing several challenges in their education, social connections and lack of employment opportunities. This also highlights the need for the government to think of policies that would aid the mental health of the youth at this critical juncture.

In his presentation, Prof Vikram highlighted that the youth constitute the largest demographic proportion in India and form the foundation of not just the economy, but also society. Hence, as a corollary, their health and wellbeing become critical — not just for them as individuals but also for the overall national interest.

What comes as a serious concern is that there are more than 60,000 youth deaths every year (based on the data of National Crime Records Bureau, India, 2014). The more recent data of 2018 shows a year-on-year increase in the number of suicide cases of young people. This means that India is the epicentre of global suicide. Between 1990 and 2016, the proportion of male suicides shot up from a fifth to a quarter and for females, it shot up to more than a third of total female deaths. This implies that suicide is the leading cause of death in young Indians for over a decade now. Sadly, in spite of this data, no suicide prevention programme has been implemented in India, especially for the young people.

Professor Patel further explicated the psyche of young people during his presentation. He said that the youth are biologically and evolutionary ‘primed’ to take risks and behave impulsively. This is an essential advantage of this phase of life because it constitutes a transition from being dependent on parents/guardians to becoming autonomous. Instead of blaming young people for being mischievous, it is important to realise that risk-taking and impulsivity is a positive aspect of a person’s childhood and adolescence. However, if a child’s environment is not conducive and nurturing of this, then risky behavioural tendencies become imminent, which may lead to dangerous implications.

One of the prevalent reasons for high suicide rates in India includes the growing gap between aspirations regarding sexuality and occupation, and their social norms and expectations. Other reasons include adverse childhood experiences, violence, substance use, discrimination, peer influences and comparisons on social media.

A fundamental aspect of being a young person is the need for having interpersonal experiences, which has not been quite a challenge during the pandemic. Ironically, the youth are the least affected by the virus itself and they have had to deal with the burden of containment policies even though they are least vulnerable to the actual virus.

It has been observed that the younger one is, the worse is your mental health. This is paradoxical because for the longest time it was said that elderly people have worse mental health. But the reality of the coronavirus pandemic and lockdowns has demonstrated just the opposite. Older people have weathered this pandemic much better than younger people have.

Prof Patel highlighted three important initiatives that could help improve the youth’s mental health. These are World Bank’s disease control priorities programme with a focus on mental health; Lancet Commission’s global mental health and sustainable development, and the Lancet Commission’s adolescent health and well-being.

The common yet important thread that connects all these three initiatives was that promoting youth’s mental health is everyone’s business. Mental health is affected not because of biology but because of the world we live in. Thus, the world of homes, society and educational institutions need to promote a healthy environment for children to strive in.

Some challenges that prevent the youth from addressing their mental health issues include narrow binary biomedical framing of mental health, lack of tailoring to the needs of the disadvantaged youth, lack of attention to mental health programmes to social determinants, lack of skilled providers, and reluctance to seek help from professionals.

Thus, it is imperative to reimagine youth mental health. This can be done in many ways.

• Firstly, there is a need to look beyond narrowly defined and diagnosed mental illnesses offering a range of interventions with a focus on the “base of the pyramid” through task-sharing of psycho-social interventions.
• Secondly, it is important to balance individual clinical interventions with social and cultural determinants across the life course.
• Thirdly, it is important to have digital tools for the workforce, health systems, and affected persons.
• Lastly, we need to ensure that the youth is at the centre of all decisions, from what matters to how it needs to be addressed.

The guiding principles of action include providing young people with information, restoring hope that things will improve, enhancing their own agency so that they are empowered, respecting their dignity and rights, and focusing on the science and art of what works.

Urvashi Prasad, public policy specialist, at the office of Vice-Chairman, NITI Aayog, addressed the policy initiatives that are required to help the youth’s mental health in India. Apart from ensuring that data is regularly and accurately available, there is a need to look into how they play out across socio-economic groups and geographies.

For policies to be more effective, granularity is necessary. Another important point she highlighted was that mental health needs to be included in the primary healthcare space and public health in India. The interdisciplinary approach in public health in India has been missing that and this needs to be addressed. With this, mental health, particularly that of the youth, would be brought to the forefront and also reduce prejudices and stereotypes.

Dr Aparna Joshi, project director of iCALL, provided a multi-faceted perspective. She argued that within the section of young people there are different categories like gender, caste, sexuality, geography among others. She informed that most of the conversations by the youth on the iCALL platform relates to simple things like problems of everyday life, inability to manage emotions, discuss relationship issues, deal with conflicts, concerns about sexualities and gender, education and career, suicide, and self-harm. It is important to remember that the Indian youth is bombarded with transitional messages of modernity, collectivism and so on. Thus, it is necessary to listen to young people and not just focus on adults or children.

Dr M Manjula, Professor at the Department of Clinical Psychology, NIMHANS, Bengaluru, highlighted the importance of addressing issues in an issue-specific and not just broader programmes. Mental health professionals think that there is a lack of conversation on mental health wellness and that all stakeholders are not considered. Various policies also have contained components of mental health, but whether India has a sufficient system to implement or address these concerns in a decent manner, becomes questionable.

Sadam Hanjabam, Founder of Ya_All, The Youth Network, focussed on how there is a huge divide of information and resources between the northeast and mainland India. When it comes to the population on the margins, they do not easily connect with programmes implemented by the Union Government, thereby becoming a huge challenge.

The existing government programmes also do not show any interest in the mental health of the youth. Young people do not feel included because these programmes are not inclusive. At the Youth India Network, efforts are being made to localise the support system by teaching and training people to help provide localised support to youth.

Dr Paulomi Sudhir, Professor at Department of Clinical Psychology, NIMHANS, Bengaluru, focused on employment-related issues and relationship problems of young people. A lot of young people faced employment issues, including the urban and semi-urban youth who have been displaced due to job loss during the pandemic.

It is important to enhance their sense of agency, especially when you involve them in the change-making process. Dialogue with relevant stakeholders is imperative to keep them included. Dr Sudhir further elaborated on her observation that there has been an increase in the number of young people taking charge and developing interventions to help other youth. This is certainly a positive development.

Dr Soumitra Pathare, Director at Centre for Mental Health Law and Policy, Indian Law Society (ILS), highlighted some pertinent issues. First is the suicidal rate because broad numbers hide diversity, especially regional diversity. Secondly, we cannot discuss these issues without thinking about caste and its impact on young people. Especially in times like this, when opportunities are few, the marginalised end up becoming further marginalised.

While gender is a huge issue, caste-based discrimination must not be ignored as it leads to differential impact and thus, an increase in suicide rates in India. Social determinants of mental health have become so overwhelming in multiple ways that to an extent, what the healthcare space is trying to achieve becomes inadequate. Long-term solutions to mental health triggers, therefore, assume critical importance.

There is an urgent need to embrace the multi-dimensional nature of mental health and mental health problems that we have all faced at some point in our lives – from wellness at one end to disability of our mental health at another. Thus, mental health needs to be understood more deeply, and it can be done by moving away from the binary approach to mental health and understanding that there are several dimensions to it.

“Genuine understanding, commitment and appreciation of differences may well become the starting point towards strengthening the mental health of all, especially the youth.”

Acknowledgment: Sajili Oberoi is a researcher at IMPRI and Marketing and Communications Lead at BrainGain Global, New Delhi.