Traditionally, mental healthcare has been oriented to provide care to people, mostly adults, in crisis and emergencies arising out of the madness. Decades ago, when I was in school, we thought of mental disease to be a sickness that belonged to ‘a mysterious kind’. We all have come a long way after that and today even the children hold entirely different thoughts about mental sickness and are more open and accepting in this regard. Considering this positive approach of generation Z, (and also the rest of us today), the policymakers should formulate measures to control the impending mental sickness pandemic; and I believe comprehensive first-aid services to the troubled mind should top the list. The pressing need in today’s context is developing mental healthcare models for prevention and early detection of latent disease, as well as a more youth-focused approach for children and adolescents considering the Covid-19 school years, they have undergone for nearly two years now.
More than 50% of adult mental disorders have had their onset before the age of 18. Adolescence is a crucial period for developing social and emotional habits which in turn are important for overall mental wellbeing. It’s a time to learn interpersonal skills emotional management. Now that the schools are reopening, authorities should have disease screening, and counseling services in place in addition to having the right referral services for the clinically sick.
Considering the lack of mental healthcare resources, first aid in mental sickness, we believe, is what our healthcare system should focus on. The tools of first aid in handling issues of the mind are – patient listening, empathic talking and analyzing the victim’s situation, maintaining good communication and, lastly, help access clinical care when needed. It is seen that such first-aid intervention can successfully handle cases up to as high as 60%.
It is common knowledge that early addressed diseases have a better outcome and reduce the disease burden. Reducing the disease burden is all the more important in a country with scarce health resources; resource is even worse in the field of psychiatry at the current state. India has 0.75 Psychiatrists per 100,000 populations, while the desirable number is anything above 3 Psychiatrists per 100,000. Similar are the numbers for clinical psychology resources and paramedics. The better outcome of treatment pathways enables healthier working minds which have a direct impact on the growth and economy of the country. As per WHO estimates the economic loss due to mental health conditions in India, between 2012-2030, is estimated at USD 1.03 trillion.
Deinstitutionalization and provision of community mental health services mostly for the adolescent age group is what is the need of the hour. First aid in mental health can help salvage the looming disaster as this is believed to mitigate 60% of budding mental sicknesses. Such a preventive care model is most required now as the schools are reopening and children are returning to the school rituals. We must remember that 80% of all adult mental sicknesses have their origins in their teenage years. In today’s context, we must remember that this Gen Z, with whatever few years they have spent on the planet, has seen the worst. And Psychiatrists offices have seen a many-fold increase in adolescent visitors all over the country.
Historically, after disasters are over and physical disease is cured or controlled, the repercussions of the disaster control measures play in the minds of people in a long persisting tail. Considering the length of the COVID 19 pandemic and strict control measures this tail is going to persist even longer in this decade. And out of all age groups or stages of life, the adolescents with a developing mind moving rapidly from a childhood state to adulthood is the most vulnerable one. The COVID times have seen cases of depression and anxiety in children as young as 13 or 14 yrs. of age. The mental health experts’ offices reveal a skyrocketing increase of adolescent visitors, and the thoughts of depression and suicide in youngsters are the highest at this time in recent history.
I believe, we must consider promotion and prevention in mental health not just the responsibility of mental health professionals alone. Integrated multidisciplinary services are needed for effective interventions and improve disease outcomes which have a direct impact on healthcare system costs. However, we must remember that mental health professionals have the scientific, ethical, and moral responsibility to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs, especially during the youth years.
Mental Health First Aid should be an evidence-based curriculum that teaches participants how to recognize the signs and symptoms of mental illness and substance misuse. This should provide the trainees with the skills to respond when someone close to them is experiencing a mental health or substance use crisis. The training should be free and provide the trainee with a certificate for a comprehensive plan to create a mental health system for everyone. The curriculum should be rightly designed by mental health experts and should be of short duration (a few weeks) so that students and young professionals can come forward to learn and meaningfully contribute to society. It should be available in vernacular languages besides English and Hindi for better outreach and enabling people in small towns and villages as well.
These training curriculums focused on behavioral health should be like training for CPR. Many of those trained will save lives, and many more will help people, in schools, workplaces and, neighborhoods. Trainees for Mental Health First Aid must be taught about a variety of situations including helping someone through a panic attack and assisting an individual who has overdosed. The program also focuses on how to engage with someone who may be suicidal and identify the signs of suicide risks.
Preventive mental health trainee programs are seen as part of a comprehensive mental health support system in several parts of the globe which have been successful in early detection and first aid services to the needy. Such mental healthcare modeling studies suggest that 60% of the burden of mental disorders can be averted, even with optimal care and access to services. This points to the need to reduce the incidence of mental disorders, utilizing evidence-based prevention strategies and policy action. This also allows for more personalized care in terms of tailoring health interventions to the specific sociodemographic and health-related risk factors as well as activating interventions specific to the illness stage.
Mental Health First Aid should be an evidence-based curriculum that teaches participants how to recognize the signs and symptoms of mental illness and substance misuse. This should provide the trainees with the skills to respond when someone close to them is experiencing a mental health or substance use crisis. The training should be free and provide the trainee with a certificate for a comprehensive plan to create a mental health system for everyone. The curriculum should be rightly designed by mental health experts and should be of short duration (a few weeks) so that students and young professionals can come forward to learn and meaningfully contribute to society. It should be available in vernacular languages besides English and Hindi for better outreach and enabling people in small towns and villages as well.