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The Law and You: Mental Healthcare in Educational Institutions

October 15, 2017

By Vandita Morarka

Childhood and adolescence are without doubt the most important phase of one's developmental life, which is why focus on mental and physical well being is the only way to ensure holistic development. Internationally, several developed and developing nations have adopted wide-based mental healthcare practices in educational institutions. It is time for India to pay attention to this aspect of its public health problem.

THE LAW

In India, there is no law mandating the staffing of trained counsellors at schools or colleges, though some states, like Madhya Pradesh, Goa, do have some regulations in place. 

The Mental Healthcare Act, 2017 does not specify any guidelines for educational institutions to follow with reference to mental healthcare. The Rights of Persons with Disabilities Act, 2016 (PwD Act) does make some provisions geared at inclusive education, that includes rights of those with mental illnesses. S. 16 of the PwD Act binds educational institutions with the duty of providing inclusive education for children with disabilities. The Act also looks at training and awareness regarding disabilities for its teachers and other staff, along with sensitisation for any other associated individuals. The National Curriculum Framework, 2005, briefly touches upon mental health.

The fallacy we often see is a tendency for policy-making bodies to only see mental health and well being as an all or nothing state.

There is a lack of recognition for basic mental healthcare practices, e.g., stress management training, provision of counselling services or incorporation of self care practices into everyday schedules, to ensure the mental well being of all students.

The Founder of Red Elephant Foundation* Kirthi Jayakumar, tells the Health Collective, “Mental healthcare facilities in educational institutions in India are frugal at best. The counsellor-to-student ratio is low, most often with the position being staffed in order to check a box. There is also a patent lack of sensitivity -- many instances exist where students have reached out for help but have received judgment instead.” 

GRIM REALITIES & A PRESSING NEED

Every hour, one student commits suicide in India, according to 2015 data from the National Crime Records Bureau (NCRB).

In 2015, 8,934 students committed suicide. In the five years leading up to 2015, 39,775 students killed themselves.Anchor India has one of the world’s highest suicide rates for youth aged 15 to 29, according to this 2012 Lancet report.

Also Read: Coping With Extreme Thoughts

These alarming figures show a picture of a youth population that is grappling with its mental health needs and finding no support. Schools and colleges lack adequate support mechanisms and in the case of public institutions, an additional issue of funding exists. Recent cases of the deadly Blue Whale Challenge also show how susceptible young people can be. Teenagers can be severely affected by body image issues, by bullying and more.

Also Read: Media Watch: Portrayal of Mental Illness and Suicide


Health Collective
The Health Collective: Quote by Arpita Anand in Ask the Experts

 

BRIDGING THE RURAL-URBAN, PRIVATE-PUBLIC DIVIDE

Yashasvini Rajeshwar is a high school teacher at a private rural school, who says she has observed an increased awareness and conversation around issues of mental health in educational institutions over the years.

“Words like 'counsellor' are no longer alien and this is a welcome move towards acceptance. There is, however, a gap in actual healthcare delivery," she tells The Health Collective.

"With teachers as a clan usually being overworked and stretched thin, empathy, understanding adolescent/young adult psyches, avoiding the morality spectrum, and being able to truly provide tangible tools for mental health management becomes a different ball game altogether. Perhaps it is safest to say that conversation is on the upswing though classroom realities are yet to catch up with all the talk. Supportive classrooms that recognise mental health issues are still a long-term goal.”

Also Read: Ask the Experts: Child and Adolescent Mental Health

Private institutions tend to have in-house counsellors for students. Most public institutions have a teacher step into the role of a counsellor or don’t have one at all. Public educational institutions also lack support, equipment and staff for testing and diagnosis of mental health issues, learning disabilities etc. at an early age, though best practices and funding are also not very widespread in private institutions either.

Jerin Anne Jacob, Assistant Teacher, Gundecha Education Academy tells the Health Collective, “The Indian educational system has recently been seen to accommodate the needs and concerns of mental health in educational institutions. But that is the case with just a few of them. The truth is that a majority of these institutions are yet to catch up with this positive trend.”

Francis Joseph, Co-founder School Leaders Network concurs, “Schools in India have evolved over the years. The school examinations led by a strong academic push has become the biggest stress for a child and teacher likewise. Schools have realised that they need to go beyond just content. They have started realising that a student is just not a roll number, but a growing human soul. A child's mental and physical (health) is extremely crucial to counter the academic pressure of our highly intensive education system. Though schools have slowly been able to cater to the physical needs, we are very far away from handling the mental healthcare of children. The challenge is that schools feel it's the parents’ responsibility and vice versa. But both don't realise it needs to be done together with the child in the centre.”

Jacob adds, “We majorly follow a system of strict, common and militarised instructional learning... The fault, I feel lies in the failure of the system to integrate the academic, mental and physical well being of students. The focus is solely on their academic well-being, which is in itself superficial and burdensome for the recipient. The nurturing of the sound mental health of educators and educatees alike by building up the system to deliver an integrated education is the need of the day.”

Joseph helps us identify some of the key challenges at hand:

  • A shortage of mental health professionals willing to be a part of the school system
  • Schools required support from parents and teachers
  • Needs to be prioritised in teacher education
  • Stigma in approaching counsellors
  • Training of staff and teachers who have more frequent contact with students

“The mental health of teachers and parents are also equally important as they impact the students someway or the other,” Joseph says, and adds a fairly radical prediction, too. “There is so much discussion happening today amongst educators about the child’s brain, types of brain, its development, etc … This strengthens my thought that schools could be an extension of a medical/research centre, (going forward). They would need to include mental & physical healthcare professionals to decide how and what to teach. The focus would then be an healthy mind, heart and body’ and not content or information.”

SOLUTIONS/ THE WAY FORWARD

  1. Reduce the Stigma: Awareness and sensitisation is important, because until the stigma is removed, available care will also not be accessed and will remain under-utilised
     
  2. Normalise Mental Healthcare: Mainstream conversations around mental health, emphasise that healthcare includes both physical and mental wellbeing
     
  3. Train More Personnel: There is a severe lack of trained practitioners in general, but especially educational institutions. Along with such mental healthcare professionals, all school and college teaching and non-teaching staff must be trained in the basics, eg in learning to recognise signs of such distress so that effective intervention can be done
     
  4. Set up Support Groups: Schools and colleges can initiate mental health support groups for students, with peer counsellors
     
  5. Increase funding: Training of staff, sensitisation programs, all require money. India has abysmal budgetary allocations to mental healthcare, so public funding is a remote possibility. Build on private support and sponsorship to take mental healthcare to all educational institutions
     

Call to Action: Parents and educators, work together to ensure mental healthcare services at the educational institution where your child is studying at. Students, demand mental healthcare services at your campus as a part of your right to a conducive learning environment. Write to us with stories of the action you take to build change in your communities.
 Tweet @healthcollectif @vanditamorarka with your thoughts using #RightToMentalHealth


Views expressed are personal. 

Anchor http://www.hindustantimes.com/health-and-fitness/every-hour-one-student-commits-suicide-in-india/story-7UFFhSs6h1HNgrNO60FZ2O.html

*Note: Vandita Morarka has worked as a legal researcher for The Red Elephant Foundation.

Severe Side Effects: One Woman’s Journey Through Antidepressants

October 10, 2017

By Bee Rowlatt

Antidepressants can save lives, but they made me want to kill.”

Katinka Blackford Newman learnt the hard way. When the British film-maker’s marriage fell apart in 2012 she began having sleepless nights. She went to see her family doctor, who diagnosed anxiety and prescribed escitalopram (Lexapro in the US; sold as Cipralex, Nexito or Prasilex in India). This drug is an SRRI (Selective-Serotonin Reuptake Inhibitor), a widely prescribed type of antidepressant.  

The official advice from the NHS in the UK is that: “Side effects such as nausea and headache are common. They are usually mild and go away after a couple of weeks...Serious side effects are rare and happen in less than 1 in 1,000 people.” But Katinka suffered an adverse reaction. She went into what she calls “a toxic delirium” during which she turned into, in her words to The Health Collective, “a self-harming, hallucinating suicidal wreck.”

This episode lasted for four days. She started to have visual hallucinations and became paranoid, believing that she had killed her own children and that she was being filmed. She ended up attacking herself with a knife although she has no recollection of this. Finally she was hospitalised, but no one realised that she was suffering a reaction. She was put onto more antidepressants and antipsychotic medication. Unfortunately for those who can’t tolerate this type of medication, the results can be disastrous, as she was to find out.

Health Collective Side Effects
(The Health Collective)

 

It was the start of a year-long descent for the mother of two. Her glamorous life of film-making and socialising vanished. She became a shadow of her former self, “suicidal; unwashed, undressed, smoking, drinking, shaking, dribbling, unable to leave the house.” Her children couldn’t bear to see her, and her emotions were so numbed that she didn’t even care.

ALSO READ: Your Stories on The Health Collective

Everyone’s experience of antidepressants is different, and extreme reactions are rare. But if Katinka’s case had been recognised sooner as one of drug toxicity she and her family would have been spared the ordeal. And this risk is worsened when people take medications without having sought adequate medical advice.

Both the use and abuse of antidepressants is on the rise in India, says Dr. Sanjay Chugh, a senior consultant neuro-psychiatrist based in New Delhi. “Doctors prescribe these medicines with gay abandon,” he observes, adding: “I know for a fact that pharmacists in India are self-styled doctors and often prescribe these medicines on their own!”

What is the solution? “People must be aware of the fact that medicines need to be prescribed and supervised by the concerned specialist,” Dr Chugh emphasises to The Health Collective, “that (the) specialist is the only person who knows what the right medicine is for you, the correct dosage, the correct duration of treatment and how the medicines have to be tapered off.”

Without seeking professional expertise people run the risk of undiagnosed drug toxicity, and of going through what happened to Katinka. Her story took a turn after almost a year, when her private health insurance ran out and she was taken in to an NHS hospital. Katinka was detained, perceived as a risk to herself, and abruptly taken off all of the medications at once.   

After weeks of withdrawal, all of a sudden Katinka was her old self again. She had lost a year of her life, and nearly lost her children too. And yet, Katinka calls herself “lucky.” Why? As she recovered, she began to research the drugs that had caused her reaction. She went on to discover what she calls “a hidden epidemic of lives ruined by these drugs”.

“I found cases around the world where people with no history of mental health had become acutely psychotic and killed their children or close relatives,” she tells The Health Collective.

Katinka says it is “pure chance” that she did not do the same. Her findings became a best-selling book The Pill That Steals Lives and its research was made into a BBC Panorama programme and a campaign.

 

But even as India becomes more open about mental health and its management, people are still learning to approach the topic with sensitivity. Could connecting depressed people to these homicidal cases be unhelpfully adding to the stigma?

Katinka argues that on the contrary, people just need to find out the facts, especially against a background of spiralling use: “These drugs can be a life saver for some, but a small but significant percentage of people can become a danger to both themselves and others. Lives could be saved if people understood the signs of drug toxicity.”


Editor's Note: Please reach out to your psychiatrist or get a second opinion if you feel you or a loved one might be experiencing signs of drug toxicity. Views expressed are personal; Material on The Health Collective cannot substitute for expert advice from a trained professional. 

ALSO SEE: Contacts and Helplines in India


About the Author: Bee Rowlatt (@BeeRowlatt) is a journalist, the author of In Search of Mary, Mentor at @SHEROESIndia Mother of 4 and chair of @maryonthegreen

 

 

Your Stories: Sticks and Stones

October 10, 2017

 

Kishore Mohan/ Health Collective

Art by Kishore Mohan/ Health Collective

Mental Health in the News

October 1, 2017


 

The Headline: Multi-gene Test May Better Predict Who Will Suffer from Dementia
(NDTV) 

What you need to know: According to an article in the Annals of Neurology, it is now possible to predict who will suffer from dementia or cognitive decline. The test called the Polygenic Hazard Score (PHS) combines the effects of over two dozen gene mutations, that individually lead to only a small increased risk of Alzheimer’s Disease, that can help predict dementia or cognitive decline in an individual.

The test was done on 1081 participants, out of which some carry the APOE E4 genetic variant, and some who do not carry even one copy of APOE E4 genetic variant (used to identify the risk of Alzheimer’s). The results showed that some people even without APOE E4 genetic variant had a higher PHS. Meaning: a higher level of amyloid plague, which is a protein that marks the presence of Alzheimer’s disease in the brain of the individual.


The Headline: Early Diagnosis Tough for Alzheimer’s: Doctors
(Deccan Chronicle)

What you need to know: The incidence of Alzheimer’s disease in India is 125 new cases per population of 1 lakh, above 60 years of age. Approximately 40.31 lakh people are believed to suffer from Alzheimer’s in India. and the number will increase to 67.43 lakh by 2030, as predicted by The Alzheimer’s and Related Disorders Society of India.

And yet, awareness is fairly low. As one grows older, symptoms of forgetfulness, anxiety, and delusion are assumed to be normal. But this could actually be the first sign of Alzheimer’s disease. Most patients seek medical help only once the disease has reached stage 2 and 3 because that is when the signs become more extreme; like forgetting home address, forgetting names and faces of family and friends.

For Further Reading/ Watching:
A Ted Talk by Lisa Genova, a neuroscientist and author of “Still Alice” says that Alzheimer’s disease affects everyone. How? Because if you don’t have it, someone you know will have it, which might make you a caregiver. Awareness of early signs is key to getting a timely diagnosis and learning how to care for a loved one.


Also Read: On DementiaAn Interview with Himanjali Sankar, Author of Mrs C Remembers


The Headline: Smartphone Apps May help Alleviate Mild Depression
(Huffington Post)

What you need to know: According to research published in the journal World Psychiatry, smartphone mental health apps may help reduce depression. Australian researchers examined more than 3,400 adult men and women who lived with conditions like depression, anxiety, and bipolar disorder for the study. The participants were asked to use 22 different smartphone mental health programs for some weeks/months depending on the requirement of the apps.

The results? It was noticed that there was a significant reduction in the symptoms of mental health illnesses in these participants after they used these mindfulness, and cognitive behavioural therapy apps. Some of these apps include Headspace and MoodHacker. Of course, these apps cannot replace therapy, but it is important in understanding how technology can be used to move past economic limitations that one may face while trying to get mental healthcare. 


Also Read: Mental Healthcare and the Need for Insurance Cover
 

The headline: Will Psychedelic Therapy Transform Mental Healthcare?
(NBC News)

What you need to know: Research on drugs like LSD, MDMA, ayahuasca has sparked conversation around treating mental health illnesses using these “off-limits” and illegal drugs. It is noted that psychedelic drugs can be effective on treating eating disorders, OCD and even depression. The practice of using these drugs is still not allowed, of course, but the research (strictly limited to certain institutes) shows that classic psychedelics (LSD, psilocybin, and ayahuasca) work on releasing receptors are associated with feelings of wellbeing.
A study published in 2011 showed how some of these drugs help reduce anxiety in patients who were getting treated for advanced stage cancer.  But, given cases of drug-induced psychosis, not to mention legality issues, it's most likely that the jury is out on this one. (Disclaimer: The Health Collective does not endorse the use of illicit substances) 

Reporter: Sukanya Sharma

The Health Collective is delighted to feature a curated a news feed, but cannot independently verify the third party content. Feedback is welcome – tweet @healthcollectif with your comments and stories you think we should include.

Your Stories: Anorexia

September 30, 2017

 

Kishore Mohan/ Health Collective
(Art by Kishore Mohan/ Health Collective)

 

Editor's Note: If you or anyone you care about might be at risk of anorexia/ bulimia/ body image disorders, please reach out to a trained professional for help. You will find a list we're building out of therapists and other mental health professionals is on our Contacts page

The Law and You: Mental Healthcare Insurance in India

September 25, 2017

The Health Collective

By Vandita Morarka

An India Spend report highlights that 60 million Indians suffer from mental disorders, this is about 6.5% of the country’s population.

The World Health Organisation also estimates that around 57 million Indians suffer from depression. A recent survey by the National Institute of Mental Health and Neuro Sciences (NIMHANS) states that 13.7 % of the adult population in India suffers from some form of mental illness. And yet, India spends only about 0.04% of its health budget on mental healthcare.  

Mental health and healthcare in India come with a set of taboos and stigmas, which is perhaps why mental healthcare insurance has never been a priority for providers.

The new Mental Healthcare Act, 2017, under the right to equality and non discrimination, S. 21 (4), states that: “Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.”

This provision effectively makes it mandatory for all providers of insurance in India to have certain policies and provisions in place that also account for mental illnesses. It also imposes that such provisions must be at par to those for physical illnesses. Considering the placement of this clause, non adherence to it would amount to discrimination.

Also Read: Is India Ready to Tackle a Mental Health Crisis? 

India currently does not have any distinct insurance coverage for mental health disorders. Several policies may cover mental health illnesses briefly or as under other aspects.


Understanding Therapy: Multiple Challenges

Kishore Mohan for The Health Collective
Art by Kishore Mohan for The Health Collective

 

Why is there a need for mental healthcare insurance?

Mental healthcare insurance at the very onset provides for expenses coverage for related treatment and care, which can often be crippling and the reason behind reduced access to such services. For e.g., a single consultation with a leading therapist can be around 1,500-2,500 Rs. in major cities. Consultations with psychiatrists can be even more expensive, additional costs of medication also raises monthly expenditure on mental healthcare drastically.

Alongside, it also helps fight the stigma surrounding mental health by normalising the existence of mental health needs and disorders, as seen with physical health. Having such insurance schemes also provides for an effective channel for information dissemination relating to mental healthcare and related regulations in general to a large audience and reduce ignorance.

Also Read: The Law and You: Mental Health and Minors

India is also extremely short on the number of mental health professionals in reference to its estimated needs, especially those that are well trained and verified. According to the Ministry of Health and Family Welfare, there were 3,800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1,500 psychiatric nurses nationwide, as of December 2015. (Source: IndiaSpend)

Having efficient insurance policies in place by leading providers will make mental healthcare more accessible for many and will drive a market drive shift towards more and better trained mental healthcare professionals and education/training programs. The attached regulatory measures with such policies will help weed out quacks as well.
 

Also Read: Mental Health in India: Which Treatment Model Works Best?

Dr Avinash De Sousa from the De Sousa Foundation says that the main problems that insurance providers state makes them reticent about providing mental healthcare coverage under insurance policies are:

  • Long term treatments

  • Varying costs of treatments

  • Diagnostic dilemmas with many psychiatric problems

  • The lifelong course of many psychiatric disorders

He also says that the cost of psychological treatments like psychotherapy and other psychological treatment show a high variation and the medical cost per month is quite high in case of psychiatric disorders. However, he says that the same is true for other medical problems as well, which are covered by health insurance.

Crucially, more people would get the help they need.

Dr. D’souza feels that covering mental healthcare under insurance would lead to more people seeking help for psychiatric problems, more patients seeking inpatient rehabilitation programs, and that this could also help break the stigma against psychiatric help.

Mental healthcare should be treated on par with general medical health care.

As Dr De Sousa points out, we need to have uniform tiers of costs of treatments so that mental health care can come under the ambit of insurance. None of the insurance providers The Health Collective reached out was willing to comment officially on the subject. On condition of anonymity, one representative did tells us that there is apprehension about including mental healthcare in insurance packages, because of a lack of understanding of how mental health diagnostics and costing works. (This post will be updated if we get an official statement from an insurance provider.)

What are some international best practices?

International best practices differ in terms of coverage, extent of coverage and implementation and implementing body.

Canadian healthcare is largely funded by the federal government and thus the provinces and territories are mandated to provide medical facilities for its citizens. While Canadian healthcare systems function well, in terms of mental healthcare, they lack coverage of therapy and majorly psychiatric treatment is covered by insurance. With waiting lists at psychiatrists for patients being extremely long, several patients are unable to get timely help. Several of these patients would benefit greatly from therapy as well, but that isn’t covered by the medicare policies.

In the USA, the parity law or the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, 2008 (hereinafter MHPAEA), states that insurers are to treat mental health cover at par with general medical health cover. The introduction of the Patient Protection and Affordable Care Act, 2010, also known as the Affordable Care Act (hereinafter ACA), 2010, further led to an amendment in the MHPAEA which extended the provisions of the MHPAEA to individual health coverage, it helped improve the penetration of insurance but treatment received by adults suffering with mental illnesses in America still remains low. Due to varying State laws and implementation, these measures do not always achieve full effect.

The UK offers quite a comprehensive coverage system in relation to mental health illnesses, including medical, surgical, psychological and psychiatric services, through the National Health Service. Discrimination on the basis of mental health issues while providing insurance services is punishable.

Many countries, like Indonesia, may have systems where while the public insurance would cover physical and mental illnesses, private insurance providers would mostly not cover mental illnesses.

What most countries, including India, need is a comprehensive insurance policy that accounts for mental health across spectrum as they do for physical illnesses and for governments to build systemic alternate plans for individuals to access good quality affordable mental healthcare.

 

Solo's Sadventures: Episode 2

September 20, 2017

 

Sadventure by Solo
Art by Solo for The Health Collective 


Solo is a writer and cartoonist from Bangalore. She likes reading, playing video games and binge-watching Netflix. Her life would have been rather unremarkable had it not been for her BPD-fuelled imagination... Read more of her Sadventures here

 

Ask the Experts: Fighting Against Child Abuse

September 19, 2017
 

Child Sexual Abuse is a subject many parents find difficult to talk about, let alone educate their children about. While there is no question that experts feel you must have the conversation with your child sooner than later, do read on for insight from the Aarambh India Initiative, which works in the field of child protection. Do visit their site for more information and free resources on tackling child abuse. Sidharth Pillai, co-director of the Aarambh India Initiative speaks to The Health Collective.


1) How prevalent is the problem in India? Some parents might think they're protected/ their children are safe etc. What do you say to them?

The statistics on sex offences against children in India are grim. A staggering 53% of children reported suffering sexual assault, according to a 2007 report on Child Abuse by the Department of Women and Child Welfare (i.e. one in every two Indian children).
In 2016 alone, according to the National Crime Records Bureau, 8,800 cases of rape against children were reported – that's one case every 60 minutes every day of the year. 
Despite these already high numbers, it is accepted by experts that, for various reasons, there are many more cases of sexual abuse and exploitation of children which go unreported.

FIND HELP: CHILD SEX ABUSE HELPLINES 

2) You're very particular about using the phrase child sexual abuse - why do you choose not to use the term 'child pornography'?

We prefer to use the term 'child sexual abuse imagery' instead of child pornography to refer to content which features sexually explicit images/videos of children. The word 'Pornography' has several connotations. 'Pornography' as a term is largely considered to be legally acceptable. It is associated with adult pornography in which it is assumed that:

  • The act is being performed and recorded among consensual adults
  • The viewer is a mere consumer and not complicit in the act in any way

However, when it comes to sexually explicit content that features children, it is important to remember that:

  • The act that is being performed and captured, is primarily an act of child sexual abuse. It is a document that is capturing, not pornography but rather, a heinous criminal act
  • The child has probably been groomed (forced/tricked/bribed) into the act
  • By viewing it and not reporting it, you are creating demand for criminal content (in the production of which more and more children will be harmed) 
  • By not reporting it you are also delaying the healing process for the victim, the child whose video continues to be available online. Each time the video is watched it is a crime that goes against the rights and dignity of the child.

ALSO READ: LOST VOICES: TRAUMA AND ABUSE

3) Why should parents have 'the talk' with children -- and how early?

If you won’t do it, somebody else will. And then you have little control over the kind of information your child is receiving. It may be inaccurate, incomplete or even misogynistic. Having ‘the talk’ fosters the bond of trust that already exists between you and your child. Unlike other adults like teachers and counsellors, as a parent, you are most likely to be with your child as they enter different phases of their life.

Thus you can ensure that ‘the talk’ is an age-appropriate and continuous process. Also, experts are of the opinion that talking about the basics of sex and sexuality with your child at a young age can lay the foundation for dealing with more complex issues later in life. Even as we may try to deny it, the fact remains that we live in world where sex is everywhere. It is on the internet and in movies, songs, TV shows, newspapers, & magazines. A growing child is bound to be curious. It is time to acknowledge this and act accordingly.

Information is the first step towards safety. By keeping the child informed, you are enabling them to be self-aware and confident. Thereby, empowering your child to protect themselves from harm including abuse, under-age pregnancy, STDs among other risks.

How early? The basics of personal safety and sex-sexuality education can begin from early childhood. It is important to ensure that the talk is age-appropriate. For example, for a pre-school child the ‘talk’ may consist of just teaching them the proper name for their body parts including genitals. Talking to them about the details of intercourse would be unnecessary and inappropriate. There is no one right age to start ‘the Talk’. Each child is unique and as parents you are best placed to judge and know a good time to have the conversation. You can base your judgement on the questions your child asks you.

4) Aarambh India Initiative and the Internet Watch Foundation have set up a reporting portal you can access to report (even anonymously) explicit images or video of children, which will then be removed. Are there any anecdotal cases you can share?

An anonymous report was made through the Indian Portal (last December). It was for content hosted on a cyber-locker (which) showed baby girls and baby boys from a range of ethnicities. Worst of all, the most severe abuse was happening to them; rape and sexual torture. Although the report was made by someone in India, the webpage was actually hosted in Russia and it contained over 200 videos. The time taken between the report being sent from India, to the time we notified the Russian Hotline was 1 hour and 7 minutes.  The Russian hotline acted swiftly and the content was removed in less than 24 hours.

Views expressed are personal. Material on The Health Collective cannot substitute for expert advice from a trained professional.

 

Comics and Art for Mental Health: Depression

September 16, 2017

Art by Pig Studio for The Health Collective

ALSO SEE: ANXIETY by Pig Studio

Workplace Stress and the Need for Me Time

September 9, 2017

By Sukanya Sharma

Stress is everywhere you look these days -– a fairly generic term, it’s something most people can relate to, given the fatigue, exhaustion, and extreme levels of multi-tasking while trying to maintain some sort of balance.

“The corporate world thrives on the theory of survival of the fittest - physically, mentally and emotionally. But this balance becomes overwhelming after some time”, Navneet Sharma, senior vice president for a leading lighting company, tells The Health Collective.

Surya Namaskar
By Camino (269703) [GFDL CC-BY-SA-3.0 via Wikimedia Commons]


Recent noted facts in India: 

- In 2016, Optum - a health guidance company - surveyed 2 lakh employees working in 30 large firms across in India and found out that almost half (46%) were dealing with some form of stress 

According to NewsBytes, 2,500 employees across 150 organisations reached out to 1to1help.net with suicidal tendencies*, with 70% of this outreach observed in the past 5 years

(*Please reach out for professional help if you or anyone you know demonstrated suicidal tendencies. You will find some contact numbers and helplines on our Contact Page)

ALSO READ: Media Watch: Portrayal of Mental Illness and Suicide

Another study by Chestnut Global Partners India also revealed productivity loss. As The Financial Express reports“A recent study ‘Workplace Stress: Impact and Outcomes: An India Study 2016’ showed that the total organisational productivity loss per year (because of absenteeism due to stress) adds up to approximately R49.6 crore in the the IT/ITeS sector (for an organisation with an average employee base of 10,000). That figure was R105.48 crore for the finance/banking sector...”

ALSO READ: Ask the Experts: How Does Therapy Work

How do we analyse the generational data? It looks like Indian millennials spend an average of 52 hours at work per week, compared to their peers in Japan, which spends on average 46 hours a week, according to a Manpower Group study. And we know the drill – we’re usually incessantly checking or sending or replying to emails round the clock, no matter how late the hour, it’s something bosses here in India tend to expect at the bare minimum. It takes a toll!

“Coming from a sales and marketing background, even though I have a team of experts, I still have to personally maintain a healthy relationship with our dealers and distributors all over India. If you ask my work timings, I don’t have any! Communication is so open these days that anyone can contact me at any time, which means even on a Sunday,” says Sharma.


ALSO READ: What's Work-Life Balance Got to Do With Stress?

Meera Alva, a psychotherapist based in Bangalore points out how our work has become our identity, which can be challenging. Increasingly, our professional identity takes over the personal.

Dr Bhavana Gautam concurs. She tells The Health Collective that this need to be “perfect”, “better than anyone else” is so pre-occupying that we don’t realise its unhealthy nature until it’s too late.

As dialogue on mental health opens up, some companies have chosen to outsource health and wellness programs to various trained agencies. The World Health Organisation describes workplace health programs as some of the most significant programs that keep employees free from physical and mental work stress. An efficient workplace health program not only benefits the employee but the organisation too.

In India, some companies are working in yoga to help keep employees fit and fine. ‘Our office trips always have “yoga time” included in our itinerary. Regardless of where we are going, be it in India or abroad, our chairman instructs us (to) kick off the day with yoga and meditation,’ says Sharma.

Dr. Gautam tells The Health Collective that it is critical for any employer to invest time and energy to ensure employees are not just physically, but mentally fit as well, not least because of the workloads they’re handling. “Emotional Quotient is just as important as Intelligence Quotient,” she reminds us

 

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What It's Like to Live With Anxiety and Depression

Do check out this incredible comic (created by Nick Seluk of The Awkward Yeti). I first saw it on Upworthy and was blown away by it -- like so many others have been. It is reproduced here with the kind permission of The Awkward Yeti.

 

 

This incredible comic was created by Nick Seluk, creator of The Awkward Yeti, based on a story told by Sarah Flanigan, and published on taptastic.com 

It is reproduced here with kind permission from The Awkward Yeti

 

Adolescents, Relationships and Stress

In India, year after year, we are almost inured to stories of students driven to extreme stress by board exams. At times, in the absence of learning coping mechanisms or other ways of releasing these incredibly high levels of stress, a significant number of them choose, tragically to cut short their young lives.


YOUNG SUICIDES

The National Crime Records Bureau report looking at Suicides in India (2004-2014) analyses the 'Percentage Distribution of Suicide Victims by Profession during 2014' to find that 6.1% of suicide victims in 2014 were students. (Another shocking statistic: 15.3% of suicide victims were found to be housewives; find an analysis of the data and concerns about under-reporting here on IndiaSpend)
 


There doesn't seem to be enough attention paid to causes of suicide -- often a web of causes, not just one simple cause.

Nonetheless, many counsellors I had spoken to over the years, including some manning exam helplines for Indian students, mentioned that frequently callers dial in to talk about relationship issues and relationship pressures. It's not just the stress of exams/ Board exam results and the massive pressure we've been socially conditioned to accept as normal, that is.
 

RELATIONSHIP PRESSURE AND ADOLESCENTS

Noted child and adolescent psychiatrist Dr Amit Sen had told me years ago, about how kids are in relationships at ever younger ages -- think tweens or pre-tweens -- and aren't always able to navigate the complications of this; often relationships of course are due to peer pressure.


FROM THE ARCHIVES:
 Dr Amit Sen's own words on the context in India: 

"For the longest time we have found correlations between exam stress and rising depression in adolescents. There is no doubt in my mind that study and exam pressure takes a heavy toll on the minds and well being of teenagers in India. It robs them of other experiences that are vital for adolescent development. Paradoxically, as they begin to slip under the pressure, the system exerts even more pressure.

More recently, we have become increasingly aware of the close relationship between romantic relationship and depression. And indeed, as the article suggests, it is not only to do with break ups but also ongoing/"serious" relationships that often become too complicated for the mid-teens to handle. The cause and effect relationship is,however, not always clear. Its also true that depressed teenagers make themselves more vulnerable and tend to get into messy relationships more easily. A lot depends on the readiness/maturity of the person and clarity about what the relationship means and where the boundaries lie. In India, and perhaps in all places, teenagers often get widely conflicting messages about romantic relationships. This is where life skills and sex education (that is sustained and ongoing) might be preventive/protective of the many ills that plague our children today."

-- This was in response to this article in The Huffington Postwhich, among other things, raised some key points from a startling survey of more than 8,000 American adolescents on issues of depression and romantic relationships.

  

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