While the process of Mental Health normalcy and de-stigmatization gradually moves forward, there has yet to be seen a proportionate positive outcome of the plethora of ‘awareness’ generated. One of the most vulnerable age groups, the adolescents, suffer largely from mental health crises all around the world. It is estimated that around one out of five adolescents report mental health problems, with depression being the most prominent one.
For a more comprehensive study, we can look at several findings including (but not limited to), worldwide estimates of behavioral and emotional issues, estimates related to specific disorders (anxiety disorder, schizophrenia, and so on), suicide, and utilization of mental health services. These studies show an alarming increase of emotional distress reported yearly on a national level.[1]
Mental health care is a right of every young adult and working towards it can not only improve one’s quality of life, but also nourish human capital, foster socioeconomic development, and help us all head to a more equitable world. Then, what is the situation of Mental Health concerns and issues in Nepali adolescents? How are they being treated? If you’re someone of the said age group, how can you look for help?
State of Mental Health in Nepal
With a population nearing 30 million, Nepal is a densely populated South Asian country. Around 42% of its population consists of children and adolescents, a significant portion of which are at risk of developing mental disorders of varying types.[2] The Ministry of Health and Population of Nepal has given an estimate of about 15–20% of this population to experience some form of mental disorder.[3] The most commonly reported being as anxiety disorders, behavioral disorder, and mood disorders seen across cultures.
The state of Mental health in an individual is greatly shaped by social, economic and environmental factors. When a child is exposed to a variety of environmental adversities, it tends to increase the risk of disorders in them through the biological embedding of environmental risk. It has been proved that poverty, indicators of low social hierarchy, exposure to violence and war have all been shown to have negative implications on the nature and development of child psychology. It is very unfortunate that many children and adolescents in Nepal are exposed to these factors, and often in higher numbers than the people of the same age group in high income countries.
Taking poverty, for instance, around 42% of all children in Nepal are living below the standards stated in multidimensional poverty, being measured across health, education and living factors. The children from poorer backgrounds have more likelihood of being exposed to evils such as child labor, domestic violence, exploitation, sexual abuse and human trafficking.
More recent information has shown that the changing family structure due to divorce, shift from joint families to nuclear families, parental neglect and substance abuse also puts children at a higher risk of mental health issues—a trend that has exponentially grown over the past few decades. Similarly, the effects of natural disasters like earthquakes, foods, and landslides have shown concrete data on the degrading mental health of children and adolescents.
The Gorkha earthquake of 2015 resulted in directly affecting 1.7 million children in Nepal.[2] These disasters lead to a number of problems, including but not limited to, displacements of settlements, disappearances of family and community, injuries and death in the families, which greatly impact adolescents and their mental well-being. However, despite this knowledge, children and especially adolescents have their mental health issues and disorders remain unacknowledged for many years in Nepal.
It is only very recently that some light has been shed on the purpose of identifying and treating mental disorders in children. However, lack of data and political importance on the magnitude of child and adolescent mental health issues in Nepal have caused the situation to not be clear. While the reasons are numerous, it can mostly be attributed to the following:
- absence of a child (and adolescent) mental health policy,
- poor service availability for children and adolescent’s mental health,
- alarming shortage of child and adolescent psychiatrists and allied professionals.
To make this even more difficult, there is no availability of specialized postgraduate training in child and adolescent psychiatry in Nepal, let alone the subsequent research. The total health budget for mental health in Nepal is allocated to be less than 1%, with child and adolescent-centric mental health services receiving negligible amounts.
How to recognize Mental Health symptoms and what to do, next?
It is a challenge to understand mental health disorders in adolescents because the nature of development is a process that involves many variables. In addition, the symptoms of mental illnesses may be different depending on the age, and young adults may have issues with articulating their feelings and behaviors. There are also inherent concerns regarding the stigma attached with mental illness, more specifically the cost and use of medications, and logistical challenges of treatment that might deter guardians from seeking professional care for an adolescent who has a suspected mental illness.
Primarily, it is vital for guardians, family, or friends of a concerned adolescent to consult their regular doctor. It can start with elaborating on concerning behaviors displayed by the adolescent. For guardians, it can also be helpful discussing with the adolescent’s teachers, close friends, relatives, etc. to see if they’ve observed a change in behavior. Gathering and sharing this information to the doctor will help in targeting the problem more accurately and allows the doctor to direct towards further help in a more concise manner.
Generally, mental health issues and disorders are diagnosed and treated based on signs and symptoms and how it is affecting the adolescent’s daily life. For the purpose of diagnosis, the doctor might recommend the adolescent be evaluated by a specialist, for example: psychiatrists, psychologists, clinical social workers, etc.
For people unable to access Mental Health services due to financial barriers, firstly, enough data should be addressed under poverty studies to figure out what disorders or issues are most prevalent. This means that under anti-poverty or anti-stigmatization programs already in the community can look at including mental health services in the package, taking assistance from government and non-government institutions that provide mental health services at a low fee or for free.
Conclusion
Adolescents require safe, compassionate and supportive environments to grow and develop ‘healthily’, build interpersonal relationships, adapt to change and deal with everyday challenges. The young individuals who have good mental health are more likely to have a happier and more positive outlook on life, capable to easily deal with ups and downs, develop healthier relationships with friends and family, be involved physically and mentally in a variety of things, etc. It is as important to be mentally healthy as it is physically for adolescents.
The same can be applied for the complicated interlinking between economic inequality (poverty), and poor mental health. The service providers need to execute a multi-level, prevention-oriented approach that focuses on upstream causes. Alongside careful screening, clinical services, assistance of social services and psychosocial programs, and community- and national-level policy advocacy, the mental health community can work collaboratively with clients.
The purpose, to work in a strengths-based manner, to improve health for all. This implies the need for a focus on mental health of adolescents from policy level to familial one – as it is a natural responsibility for everyone to look after the adolescents around us and provide them with love and support, as well as necessary help to treat and deal with numerous mental problems.
References:
[1] Knopf, Park, & Mulye (2008). The Mental Health of Adolescents: A National Profile.[2] Chaulagain, & Kunwar (2019). Child and adolescent mental health problems in Nepal: a scoping review.
[3] Ministry of Health (2017). Draft National Mental Health Policy. Nepal.
Written By:
Pradatta Thakuri