|PRESIDENTIAL ADDRESS PRESENTED AT ANNUAL CONFERENCE OF IPSWZB, PUNE, 2018
|Year : 2018 | Volume
| Issue : 2 | Page : 76-79
Challenges for young people and mental health in today's changing world
Department of Psychiatry, North District Hospital, Mapusa, Goa, India
|Date of Web Publication||30-Nov-2018|
Department of Psychiatry, North District Hospital, Mapusa - 403 507, Goa
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhume R. Challenges for young people and mental health in today's changing world. Ann Indian Psychiatry 2018;2:76-9
| Prelude|| |
Adolescence and the early years of adulthood are a time of life when many changes occur, for example, changing schools, leaving home, and starting university or a new job. For many, these are exciting times. They can also be times of stress and apprehension, however. In some cases, if not recognized and managed, these feelings can lead to mental illness. The expanding use of online technologies, while undoubtedly bringing many benefits, can also bring additional pressures, as connectivity to virtual networks at any time of the day and night grows. Many adolescents are also living in areas affected by humanitarian emergencies such as conflicts, natural disasters, and epidemics. Young people living in situ ations such as these are particularly vulnerable to mental distress and illness.
| Young People and Suicide|| |
According to the World Health Organization (WHO), approximately 1 million people commit suicide each year worldwide, that is, about one death every 40 s or 3000/day. For each individual who takes his/her own life, at least 20 attempts to do so. Suicide has a global mortality rate of 16/100,000 people. India, a nation with 17.5% of world population had an increased suicide rate from 7.9 to 10.3/100,000, with higher suicide rates in Southern and Eastern states of India between 1987 and 2007. Suicidal behavior is a major health concern in many countries, developed and developing alike. At least a million people are estimated to die annually from suicide worldwide. Many more people, especially the young and middle-aged, attempt suicide.
Over the last few decades, while suicide rates have been reported as stable or falling in many developed countries, a rising trend of youth suicide has been observed. In 21 of the 30 countries in the WHO European region, suicide rates in males aged 15–19 rose between 1979 and 1996. For females, suicide rates rose less markedly in 18 of the 30 countries studied. Various possible explanations for these rising suicide trends such as loss of social cohesion, breakdown of traditional family structure, growing economic instability and unemployment, and rising prevalence of depressive disorders have been presented.
Some worldwide analyses of suicide trends and rates in the world have been published,, but very little is known worldwide about the causes of death and suicide rates among young people aged 15–19.
Factors that increase the risk of suicide among teens include a psychological disorder, especially depression, bipolar disorder, and alcohol and drug use (in fact, about 95% of people who die by suicide have a psychological disorder at the time of death) feelings of distress, irritability, or agitation. Although psychological disorders may well explain suicidal ideation, simple issues in life could cause the youth to suicide. The number of attempted suicides, many unreported, is likely to be much higher. India has one of the world's highest suicide rates for youth aged 15–29, according to the 2012 Lancet report, illustrated the need for urgent interventions for this demographic. In 2015, Maharashtra reported most student suicides of any state: 1230 of 8934 (14%) nationwide, followed by Tamil Nadu (955) and Chhattisgarh (625). Maharashtra and Tamil Nadu are among India's most advanced states and their high rate of suicides could reflect the pressures of economic growth.
Unfulfilled aspirations, the inability to cope and find help
Conversations with counselors revealed that young people find it difficult to cope with failure in examinations and careers and neither families nor other social institutions offer adequate support or solace.
What pushes youngsters to the edge? Stressed families, failure, substance abuse
Family background, it would appear, has an important role in determining how young people cope with despair. The deaths result from poor relationships with parents, excessive expectations, the feeling of being unwanted, and poor understanding of their peer/romantic relationships. These result in an impulsive decision or a long thought out deliberate suicide has been or observation at casualty level in public hospitals.
What should be done to curb student suicides?
India does not spend enough on mental health. Currently, it spends 0.06% of its health budget on mental health, which is less than Bangladesh (0.44%). Most developed nations spend above 4% of their budgets on mental-health research, infrastructure, frameworks, and talent pool, according to this 2011 WHO report.
Little help for those in distress
India faces an 87% shortage of mental-health professionals. There are 3800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers, and 1500 psychiatric nurses nationwide, according to a reply by the ministry of health and family welfare in the Lok Sabha in December 2015.
| Young People and Substance Use|| |
The epidemic of substance abuse in young generation has assumed alarming dimensions in India. Changing cultural values, increasing economic stress, and dwindling supportive bonds are leading to initiation into substance use. According to the WHO, substance abuse is persistent or sporadic drug use inconsistent with or unrelated to acceptable medical practice. Today, there is no part of the world that is free from the curse of drug trafficking and drug addiction. Millions of drug addicts, all over the world, are leading miserable lives, between life and death. India too is caught in this vicious circle of drug abuse, and the numbers of drug addicts are increasing day by day. According to a UN report, one million heroin addicts are registered in India, and unofficially, there are as many as five million. What started off as casual use among a minuscule population of high-income group youth in the metro has now permeated to all sections of society.
Goa had a mining economy until few years back. When the mining activities stopped on a Supreme Court order, the Goan rural economy collapsed. Cannabis which was a high class and coastal phenomenon permeated to the hinterland leading to increase of sale and consumption in rural population. Furthermore, sporadic instances have been reported, wherein farmers along the foothills of the Western Ghats started growing cannabis in the forested areas.
Comprehensive strategy involving specific programs to bring about an overall reduction in the use of drugs has been evolved by the various government agencies and nongovernment organizations and is further supplemented by measures such as education, counseling, treatment, and rehabilitation programs. Substance abuse can be addressed at the individual level, at the local level (society, national, etc.) and at the cross-national level. At the individual level, there has to be a synthesis of biological understanding with the exploration of background sociocultural factors. At the national and cross-national level, there has to be a concerted effort of all the countries in managing the issue of substance abuse, taking into account the local sociocultural and political scenarios.,,
| Young People and Emerging Issues in Education, Employment … Reservation, Job … Frustrations and Disharmony|| |
The Indian policy of reservation was propagated during the time of independence with the view to end discrimination and promote equal opportunities. At that time, it was meant to be timebound and with progressing years the reservation was meant to be reduced. Things came to a head in 1989–1990 when Mr. V P Singh's government tried to implement the recommendations of Mandal Commission which had advised that not only reservation should be continued but also actually should be increased. Since then, this debate has been raging in the society with growing discontent and causing more division within society. Most of the school/colleges/universities see groups between General/SC/ST/OBC's causing more division than unity and integration.
Yes, the idea was good, but it is doubtful that anybody had calculated the human cost of this in current context. There were people who self-immolated in 1990 against this policy, but students are still committing suicide secondary to this policy and numerous more are left damaged and mentally scarred by this that their lives are ruined.
In our hospital too, we see 2–3 young people every week, who present with low mood, depression, anxiety, and suicidal thoughts due to the same. The disturbing thing is that most of these younger people belong to humble backgrounds and although I do not know their caste, they would not be classified as creamy or privileged layer. It will be wrong to assume that reservation is the only cause of these young people not doing well as other factors will also need to be considered such as family dynamics, family structure, and person's own ability. However, there is no doubt that reservation does play a significant part with this.
These young people face an uncertain future, some of them (with help) will recover to make something out of their lives but a lot of them will struggle throughout their lives with guilt, hopelessness, and a minority may commit suicide. These struggles will never be part of any statistics. Their families too, struggle for rest of their lives. People who may be a part of privileged/creamy background will find ways to get their children to do something, however, the unprivileged or minorities will struggle more and cause a further downward economic spiral.
Reservation in postgraduation and beyond in medical field hurts at two fronts. First, if you look at a medical graduate who has to choose a different medical specialty from what he wants to do because of reservation, he would have less motivation to excel or would simply move abroad or take up other associated fields such as medical administration. This leads to the phenomenon of ”Brain Drain” and a less motivated doctor will have poorer outcomes in terms of patient satisfaction.
Reservation was always meant to be a short-term fix, but it has been so politicized that governments are scared to even contemplate reducing it. At the very least, it should be on economic basis and limited to graduation level only and I believe that this will have a huge support from modern India.
My son a bright student scored 96% in Std X and wanted to pursue Science stream with French as the second language. We applied in Panaji where admissions were purely on merit. We later found that the Minority School has an internal criterion, of giving admissions to its own student or students of parent who studied in that school and those who belonged to that religious faith. I could not answer the questions raised by my son as I remained helpless and speechless.
| Young People and Social Media, Fake Profiles, Trolling, Facebook Insults, Fake Identities Cyber Relationships, and Cybercrime|| |
Primarily, social networking was created for people who seldom talk to each other, to be in touch all year long. It was created to bring the people closer regardless of the distance and difference in the opinions and it was also a place where one could find like-minded people and indulge in healthy discussion. One could easily peep into other people's lives with just one click. But lately, the entire meaning of social media has taken a different shape. Presence on social media has replaced, being physically present in a social forum. Real presence and the warmth associated with it have been replaced with online presence. Popularity is judged on online presence; the more platforms on which one is present currently define the social status of many young people. It is perceived as uncouth or regressive not to be on social media.
One of the biggest uses of social media so far has been to stalk other people and to figure out who is doing what in their personal lives. They have this urge to compare their lives to others' and need constant gossip.
Fighting over opinions
With the whole Aamir Khan fiasco, we all figured out one thing – that even if we don't have any opinions of our own, we are certainly not ready to listen to others'.
Dating and social media have become like milk and water. They are inseparable! There are also a few sites that have come up for the sole reason of making people meet their soul mates.
Who wore what, who fought with whom on which reality show, and which girl took offense to a stranger telling her something are the few things that are categorized as news on the social media.
Before you even see it, before the world even knows about it, everything gets trolled. Sometimes the trolls travel faster than light too. We have this hunger of turning everything into something fun and something that can be laughed about.
Social media has played a marvelous role in the evolution of the human race, but with that it has brought a set of woes too. Social media has become this space which can be shut out as and when required, giving people the convenience, they always wanted in real life. The problem is that such things cannot be done in real life, and this causes a major dislike for life outside the internet.
| Young People: Relationships and Issues|| |
Young adults, those in their early to late twenties, often have unrealistic expectations of life. This is not a negative statement but rather a result of moving from one living environment – being at home with the parents – to the rather unique lifestyle of college or university and then into the ”real” world.
The first experience that anyone has with relationships and marriage is within their family of origin. If Ma and Papa were great parents and wonderful spouses, kids of that relationship generally are likely to look upon marriage as a positive, essential component to their future. Young adults from dysfunctional, addictive, or abusive families typically also have low self-esteem and may, despite wonderful talents and abilities, feel they are not worthy of a ”good” relationship. They may, without realizing it, choose a partner who is very similar to an abusive parent and end up in a relationship that is hostile, dangerous, and abusive.
Similarly, when young adults have a history of dating so-called ”bad boys” and ”bad girls,” they may be signaling a lack of self-worth and self-confidence. They may not be selective in choosing a dating partner rather than be comfortable as a single person until they find a good match. Young adults who may not be comfortable and confident on their own may decide to enter into a relationship just to be part of what they see as the norm. This can be compounded if the young adult does not have a strong sense of who they are in the world and what they want in a partner and long-term relationship.
| Probable Solutions|| |
Growing recognition of the importance of building mental resilience
Fortunately, there is a growing recognition of the importance of helping young people build mental resilience, from the earliest ages, in order to cope with the challenges of today's world. Evidence is growing that promoting and protecting adolescent health brings benefits not just to adolescents' health, both in the short- and the long-term, but also to economies and society, with healthy young adults able to make greater contributions to the workforce, their families and communities and society as a whole.
Teaching problem solving to children has to start at a very young age. It is not the parents but overall the school and community who have to contribute. Children learn through observations and we as role models have to know what are we portraying in front of them. Today's parents are themselves confused about what they really want from their kids. On the one hand, they want him to excel in academics, and on the other hand, the skills and attitude to achieve this is not developed. On the one hand, they are pampered, and on the other hand, you want them responsible. Over-competitiveness, unrealistic expectations, and overindulgence without any guidance from elders have created a confused youth. We as role models are failing miserably as we do not have time and willingness to sacrifice our life for guiding them.
The education system also emphasizes only on academics. Children just move on in higher classes with grades but do not learn the basic skills of living. The education system does not look into imbibing value systems in students. Skill identification and training of children as per their interest for career choice are not done. We just create degree holders but do not produce a sensible workforce that is not only skilled but also at the same time equally happy and satisfied in one's job.
We as society and community too have failed to lead our youth. We have not given them a cohesive environment where you can focus on what you really need in life. The opportunities and the environment for the progress of youth as far as finances, health, etc., are hardly there.
The big workforce in youth that could have taken the country at a very different level is left at its own mercy and destiny new shapes its future as it likes.
Prevention begins with better understanding
Much can be done to help build mental resilience from an early age to help prevent mental distress and illness among adolescents and young adults and to manage and recover from mental illness. Prevention begins with being aware of and understanding the early warning signs and symptoms of mental illness. Parents and teachers can help build life skills of children and adolescents to help them cope with everyday challenges at home and at school. Psychosocial support can be provided in schools and other community settings and of course training for health workers to enable them to detect and manage mental health disorders can be put in place, improved or expanded. The magnitude of the issue needs to be understood. We have to see and accept that it can seep in many areas of not only the youth's life but also into the community at large. Acceptance and awareness of the core issues and an intention to work toward helping youth in all areas of their life will change the course of future.
Investment by governments and the involvement of the social, health, and education sectors in comprehensive, integrated, evidence-based programs for the mental health of young people is essential. This investment should be linked to programs to raise awareness among adolescents and young adults of looking after their mental health and helping peers, parents, and teachers to support their friends, children, and students. This is the focus for this year's World Mental Health Day.
| References|| |
World Health Organization. Technology Research Ser No. 886. World Health Organization; 1999. p. 48.
Miller WR, Sanchez, VC. Motivating young adults for treatment and lifestyle change. In: Howard G, editor. Issues in Alcohol use and Misuse in Young Adults. Notre Dame, IN: University of Notre Dame Press; 1993. p. 55-82.
Pal H. Prevention of substance abuse: The Indian experience. World Psychiatry 2005;4:35.
Pal H, Srivastava A, Dwivedi SN, Pandey A, Nath J. Prevalence of drug abuse in India through a national household survey. Int J Curr Sci 2015;15:E103-13.