14-year-old Shailesh (name changed) has been lagging behind his peers in academic performance since few years. He loves basketball and music. While his parents claim to not have expectations from him to perform well in academics, their actions say otherwise. During the pandemic, his schooling shifted to the online mode and his outdoor activities stopped. He has had no real access to friends in the last two years. He has stopped discussing anything with his parents since it usually ends in arguments. He hates being constantly told what to do. He feels the pressure of their expectations. The balancing structure is missing for him. He feels isolated and disconnected. All this has been weighing upon him and caused a break down.

Parents of 10-year-old Akash (name changed) consulted a psychiatrist for academic performance and behavioural concerns. The younger of the two siblings, Akash is sincere, active and loves fashion. He however faces challenges of disorganization and anger management. With the whole family house-bound last two years due to the pandemic, things have taken a serious turn. Akash can never seem to find any of his things amongst the clutter and mess at home. Any disapproval from his parents sends him in a shouting state stretching to half an hour. He has become inactive with a complete stop on going out or playing sports. He feels unheard and disconnected. This has impacted his academic performance as well.

Children and adolescents like Shailesh and Akash are not alone. Long before the Covid-19 pandemic struck, they faced several challenges and issues impacting their metal wellness.

These are some alarming statistics before the pandemic:

At least 50 million children and adolescents were affected with mental health issues of which 80-90% did not seek treatment. (Indian Journal of Psychiatry, 2019).

• As per WHO, half of all mental health issues started by age 14 – but most were undetected and untreated.
   
• Every hour one student committed suicide in India with about 28 such cases reported every day. (National Crime Records Bureau (NCRB)

However, this is just the tip of the iceberg. Thanks to this pandemic, existence of mental health issues is now being taken seriously.

Delhi based Dr. Mona Choudhary who has over 20 years of experience at various hospitals including R.M.L Hospital, states that there has always been a huge need of recognition of mental health and its disorders, its detection and management in India.  

Unfortunately, there is no discussion in families about mental health and wellness. It is a social taboo. People will accept that they have diabetes, dengue, and malaria and so on, but be in denial of mental health issues. Invariably these children also become a part of the above-mentioned statistical reality.

“Loss of interest in academic performance or an assessment asked by the school are mainly the reasons that a parent may consider consulting a psychiatrist for their child, despite observing other indications that justify a consultation. Also, it is not necessary that if a person’s mental health is not good, he or she has a mental disorder. Most people do not understand the difference between the two. For them it’s all the same,” she adds.

According to WHO, health is merely not an absence of disease. It is much more than that. It is one’s total well-being - physical, emotional, mental and spiritual. Mental wellness encompasses one’s mental state, their disposition and attitude etc. whereas mental disorders, like physical disorders, are classified as per signs and symptoms. They could be threshold categories for children such as depression and anxiety or other disorders such OCD, Psychosis, and Autism. The management of each differs along with therapy and medicines, just like physical disorders.

“It is important to note that there are lot of psychological, biological, environmental and sociological reasons that attribute towards mental health disorders unlike Dengue which one can blame on a vector mosquito! One can trace it back to some adverse situations or childhood events, biological issues or poor coping strategies, among others, which were already there since early teens, if not before, but were masked. In young adults these problems then reflect in failed relationships, inability to cope at workplace etc. The broken education system’s emphasis on marks, admissions in good colleges and ‘good’ career of doctors, engineers etc. have adversely contributed to high suicide rate among students.”, Dr. Choudhary explains.

Children’s mental health has further deteriorated, being holed up at home in these last 2 years. There has been a lack of personal space and time, opportunity to go out, connect and interact with peers and increase in screen time. Some children have also been victims of domestic abuse or violence which may be due to socio-economic impacts of pandemic. The cases have surely increased.

Recognizing that the huge gap between the people who have mental disorders and those who can provide its management, the Indian government has already started several national initiatives to integrate mental health services into general healthcare services through various programmes. Several helplines have also been opened across the country to address this burgeoning need during the pandemic.

Thus, the subtle signs may already have been there for a long time for many. The pandemic has merely been a trigger and an accelerator. The slowly fading stigma has been long overdue. Acceptance and seeking help for mental health concerns is a crucial step that will positively change the dire statistical reality.