Suffering in silence
A growing number of tweens and teens are showing signs of mental distress. Therapy is important, not just for children but also for parents
At first sight, she’s like any other nine-year-old in her class. Yet she’s different—she goes through extreme mood swings, cries inconsolably, binge-eats, has unexplained tummy aches, and refuses to go to school. At 9, she has been diagnosed with clinical depression, which is linked to her being overweight.
Overweight children never have it easy, says Mini Rao, a Chennai-based psychologist. They are bullied by classmates. Most suffer silently, finding it hard to explain their daily torment to their parents since they are scared that any action against their classmates could backfire.
And it is not just overweight children, or those who are bullied, who head to psychiatrists and psychologists to be treated for anxiety and depression. In 2012, 2,738 children under the age of 14 committed suicide, according to the National Crime Records Bureau (NCRB). Mental illness was cited as one of the causes. In 2013, 2,891 children below the age of 14 committed suicide, says the NCRB; failure in exams was cited as one of the main causes.
In its 2014 report, “Health For The World’s Adolescents”, the World Health Organization says “depression is the predominant cause of illness and disability for both boys and girls aged 10-19 years”. This global report, based on published evidence and discussions with 10- to 19-year-olds worldwide, states that “half of all people who develop mental disorders have their first symptoms by the age of 14”. If they are treated at an early age, lifelong suffering and deaths can be prevented.
Deepak Gupta, child and adolescent psychiatrist, Sir Ganga Ram Hospital and Centre for Child and Adolescent Well Being, and president, Delhi Psychiatric Society, says many schools in the Capital now recognize the importance of having an in-house counsellor, and are even partnering with psychiatrists to help children in need. “In clinical terms, yes, today we see more children being brought in to our clinic by parents for depression. Of course, parents don’t realize it is depression,” he says. “Bio-psycho-social factors contribute to mental health issues in kids. Biological factors like genetics and a family history of depression are a cause. Psychological factors like what the child feels about him/her self and how events or issues affect the child psychologically also are a factor. Social factors like their peer group, school and environment outside school, can also lead to depression. When a child’s coping mechanism is compromised, s/he gets depressed. Today, depression in children is a growing problem,” says Dr Gupta.
Vasant Mundra, consultant psychiatrist, PD Hinduja National Hospital and Medical Research Centre, Mumbai, adds: “Though parents today are more receptive to their child’s problems, what they need to realize is that children’s depression doesn’t present itself with the same features as adult depression.” Aside from bullying, a change of class or even school bus, can lead to anxiety and depression.
Solving the problem
Once parents realize their child has an issue, the next step is diagnosis and proper treatment. Dr Mundra says one needs to observe the child over a few weeks and look for persisting changes in behaviour and attitude. Look for factors in the environment that could have triggered it by speaking to your child’s friends, teachers and others with whom they interact. If the child doesn’t open up to you or there’s no change even after the discussion, then it’s time to approach a mental health professional.
The social stigma associated with mental health issues is still quite prevalent however, and parents prefer to keep such issues under wraps.
The good news is that more parents are willing to get their children treated today. The bad news: Some of them just want a quick-fix solution.
Dr Gupta says: “Not all parents are open to therapy. Some don’t believe in it at all as a form of treatment—they ask what is this talking? How does it help? Others have constraints like distance or money to get regular treatment. Unfortunately, some parents only want us to prescribe pills so they don’t need to make multiple trips or spend too much money.”
While it’s important to counsel children, it’s also important for parents to receive counselling. Dr Gupta says: “Usually, the family comes together, so we address the parents and child together. When we feel we need to speak to them separately, we do so. But we take the permission of the child before we speak to him/her separately. Sometimes, they want their parents with them and in some cases, we ask the guardian or parent to be present if the issue is delicate or sensitive.” Rao adds, “When it’s a female child, I find that parents are more comfortable taking her to a female psychiatrist.”
Psychiatrists say it’s necessary to involve parents in therapy because some of them are not able to recognize that their child has a mental health issue, and often contribute to it. “Parents put too much pressure on their children academically, socially, emotionally and want them to excel at studies, sports and cultural activities. When the parents take so much interest and effort, the child is ridden with guilt when he/she doesn’t match their expectations. He/she is unable to cope, leading to depression and suicidal thoughts,” says Rao. Experts stress that parents need to be less demanding, empathize with what their children are going through and learn to deal with them gently.
The money barrier
People today are coming forward for treatment, but it’s unfortunate that mental health treatment is not covered by health insurance, say experts. “Anti-depressants are expensive and need to be taken for life. It will make a significant difference in the treatment of mental health if anti-anxiety, anti-psychotics and sedatives are covered by insurance. The common man just can’t afford them on a long-term basis,” says Rao.
As for therapy, psychiatrists and psychologists say people here don’t think of long-term therapy unlike in the US. With the cost of a therapy session ranging from Rs.500 to several thousand rupees per hour, depending on the therapist, not everyone opts for it. Often, people here think that four-five sessions will cure them, but in severe mental illnesses, a combination of therapy and medicine works best over a longer period of time, says Rao.
One of the major hurdles in the effective prevention and treatment of mental health disorders in children remains lack of data. “Though there are more children coming to my clinic for treatment, we don’t have enough studies or data to suggest that there has been an increase in mental health disorders in kids. They could be coming for treatment today only because of more awareness. We need national mental health surveys every five years. As of now, we have none,” says Dr Gupta.
LOOK OUT FOR THE SIGNS
How to identify anxiety and depression in children
u Extreme mood swings (irritability, persistent crying)
u Unexplained physical complaints (persistent stomach aches)
u Social withdrawal and isolation
u Refusal to attend school
u Change in sleeping pattern
u Change in eating pattern
u Change in academic performance
u Poor self-esteem and self-worth.
—Deepak Gupta, child and adolescent psychiatrist, Sir Ganga Ram Hospital, New Delhi, and Vasant Mundra, consultant psychiatrist, PD Hinduja Hospital, Mumbai.