Foreword

I remember when I decided to pursue psychiatry after becoming a doctor and announced it to my family — my Didima/Nani (maternal grandmother), who was amongst one of my favourite persons, was aghast. ‘After all these years of hard work and toil, you want to become a pagoler dactar (Bangla for “lunatic’s doctor”)?!’ Back in the 1980s, psychiatry was a poor choice to make from every angle, whether it was social status, financial returns, or the cynicism with which it was viewed amongst our own medical fraternity.

A lot has changed since then, not least in the way mental health problems have sky-rocketed, but much more in the way the world has started looking at it. The notion that mental illness can only happen to another person or family and not me or mine, is beginning to shift significantly. Rather than seeing it as an incomprehensible experience happening to the other, people have started seeing it as a realistic possibility in their own lives. Media articles and stories, testimonials from famous people, cinema, literature, poetry and music have all started expressing and highlighting it as a real life experience that could happen to anybody. Mental health professionals too have started shifting their stance increasingly, from perceiving and interpreting mental illness from a purely medical and expert-driven model to a psychosocial model that is collaborative and respectful. There is a growing understanding that trying to manage mental health difficulties in hospitals and clinics by experts is going to only touch the tip of the iceberg, and that we need to reach out to the larger community to make a broader and deeper impact.

While there have been encouraging strides in adult mental health, including the new Mental Health Care Act, 2017 in India, which is sensitive, inclusive and empowering of people suffering from mental illnesses, the children of the country have not got their due. The laws of the land, including the Juvenile Justice Act (JJ Act) 2015, and Protection of Children from Sexual Offences (POCSO) 2012, which are guided by principles of child rights and protection, are comprehensive and robust, but their implementation is woefully lacking or short-sighted and punitive. The reason for this is a poor understanding of children’s needs and the abject lack of resources, I believe. The fact that healthy mental (and physical) development of a child is a dynamic process that depends upon the complex interplay between their temperament, their ever-changing needs as they grow and the turbulent world around them, is a challenging concept to grasp. The strife-ridden socio-political imbroglio that threatens to enter our homes today, coupled with the changing family structure, urbanisation, intense competitiveness in education, the impact of social media and the prevailing uncertainty that all this creates only makes it that much more difficult to understand.

Is it any wonder that one in four young people are now known to suffer from clinical depression before they turn 18, that cutting oneself has become a common method of expressing distress, that substance use is rampant in schools and colleges as a way of coping with stress, that body image and eating habits occupy young peoples’ minds in obsessive forms, that confusion surrounding gender and sexuality makes the young and the old take up polarised and litigious positions?

In India, the situation is particularly fractious, as we are confronted with disturbing events and statistics that shake the foundation of our collective belief that we are a family-oriented and child-centric society. How can we explain that, as a country, we have one of the highest rates of child sexual abuse if we are indeed protective of our children?! India also has one of the highest suicide rates amongst young people in the world; suicide is the number one cause of death in young people between the ages of 15 and 29 (38 per 1,00,000).

To say that the scenario is alarming would be an understatement. If we really hope that this young generation will take us to a promising future, all stakeholders will need to do something transformative to help them achieve it. What we need is a movement that will challenge institutions, revolutionise systems and change the very language that we use to speak to and about our children.

In this context, this book is timely and much needed. The fact that it has attempted to look at child and adolescent mental health from different lenses, both expert and non-expert, is refreshing, and provides the reader various choices to align to or learn from. While it has taken from research at esteemed institutions, it has also sensitively explored the story of an adolescent struggling with sexuality and depression. Innovative models created by young therapists and community based interventions reaching out to thousands and more are insightful and exciting. The authors have been able to successfully weave together a tapestry of ideas, experiences and evolving models of prevention and care that are relevant and inspiring. Their desire to inform and passion to transform is palpable.

 The biggest achievement of this book, I believe, is that it can arouse the curiosity in a sceptical adolescent as much as it can engage the cynical professional. I sincerely hope that it reaches tens of thousands, young and old, who need to go through this compelling book.

March 2020

New Delhi

Introduction

The idea behind the Mindscape series, which kicked off with the title Real Stories of Living with Depression, was to share stories of lived experiences that might resonate with others, and centre the narrative of mental health and mental illness firmly in India — that is, to look at stories, shared experiences and ‘expert’ views, with an India lens. We want to learn how to talk about mental health and mental disorders, about stress and emotional triggers, about complicated and often-life-altering diagnoses in a less complicated way.

We want to share stories and learnings and talk to experts, all the while understanding that there is an increasing push to focus on the psycho-social aspect of mental illness, that there is no one-size-fits-all model of diagnosis and care, and that the narrative needs to be centred around and led by those of us living with a given condition or diagnosis, who are as much the experts on their lives, as the psychologists and psychiatrists who have made it their life’s work.

We want to do this in a way that is accessible and conversational, not overwhelming the reader with technical jargon. We also want this book to provide an entry point for the layperson interested in mental health, focusing on Young Mental Health, and providing a fairly structured narrative, with links for additional reading and more resources at the end.

So how do we go about this admittedly daunting challenge?

First, by facing the facts.

You can’t start doing any research on mental health in India without bumping into startling, even painful statistics — the disease burden, lack of resources, and shockingly low numbers of trained professionals.

Speaking to Child and Adolescent Mental Health experts like Dr Amit Sen and co-author, psychologist and psychotherapist Meera Haran Alva, and looking at the available literature on the field of Young Mental Health, major topics that come up include:

• Depression, Anxiety and Stress (DAS)

• Bullying

• Learning and Behavioural Issues

• Suicidal Ideation

• Self-Harm

• Body Image and Eating Disorders

The need for intervention couldn’t be more critical. And yet, many of us don’t even know how to begin to have conversations before a situation hits crisis mode.

That’s what this book is here for.

What do we mean by ‘Young Mental Health’?

Young Mental Health usually covers child and adolescent mental health.

For the purpose of this book, we’ll be focusing on adolescents and young adults, relying on those with lived experiences, who look back on their journeys through childhood and adolescence, even young adulthood. We can use their stories, their words to learn what to look out for — and even — how to talk about some difficult topics.

We are covering major issues that arise in the field of Young Mental Health in the traditional sense, via interviews with mental health experts and through the experience of co-author, psychologist and psychotherapist Meera Haran Alva, who has worked as a school psychologist and in independent practice for more than a decade and a half.

As someone who has suffered (needlessly and pointlessly, I may add) from disordered eating and self-harm over the years, as well as someone who has (needlessly and pointlessly) suffered from the shame of these ‘aberrant’ behaviours and thoughts, and who despite the adolescent cynicism (and let’s admit it, the anger) could have used a hug or some sense of tribe or community back in the day, or even some reassurance that things were going to be okay … let me just say now to each of you, to any young folks reading this, and to each of our younger selves: We’re going to be okay. We can do this.

Together, we can learn or unlearn, as the need arises.

After all, we’re not born knowing how to talk about bullying, or relationship stress, or anxiety, or pressure. But we can learn how to recognise the signs that can be a cause for concern. We can learn to acknowledge that suicide is the leading cause of death in the age group of 15–29 years — that’s the first step in learning how to talk about the heart-breaking reality. We need to mainstream these conversations — together.

As for each of you, dear readers, take this at your own pace. Also, please be aware that there are trained counsellors and helplines operational in this country at any time that you feel you want to reach out. We have included a list at the end of this book and a reference link. If you are sharing from this book or talking to others, please be mindful of the best practice guidelines — with complicated issues like suicide, it is vital and even life-saving for us to follow protocols. Always let people know that help is available.

⋯

If you or anyone you know feels suicidal; or is talking about ‘ending it all’, please reach out to a trained professional for help. Know that you are not alone.

Some contact information and India-based helplines are here; more can be found at: http://www.healthcollective.in/suicide-prevention-helplines/.

Please note that these are third-party helplines

(verified as functional at the time of writing this book).

- Sneha India: 044-2464 0050/044-2464 0060 (24×7)

- Vandrevala Foundation: 18602662345 (24×7)

- iCall (TISS): 022-25521111 (Monday to Saturday, 8 am to 10 pm)

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