Why India needs comprehensive school mental health programmes
The National Mental Health Survey 2015-2016, though about a decade old, revealed alarming statistics: approximately 10.6% of the population has grappled with mental health issues at some point, with 13.7% currently affected as of then.
Scope of the issue
A study published in a journal, Scientific Reports (2022) on mental health status in students revealed that 27% of children and adolescents experienced depression, 26% had anxiety disorders, 7% exhibited hyperactivity, and 9%, 19%, and 15% experienced emotional, conduct, and peer problems, respectively. Moreover, the student suicide rate reported in this study is 9%, which surpasses the rate reported by the National Crime Record Bureau (2022), standing at 7.6%. There has been a staggering 32% increase in student suicides from 2017 to 2022.
Depression and suicides are not the only mental health issues of rising concern in the country: a study published in General Psychiatry (2021) found that internet addiction among students in 19 states of India ranges from 19.9% to 40.7%. This high prevalence highlights the growing issue of internet dependency among young people in the country. Further, recent clinical and community-level observations underscore the rising tide of behavioural addictions among Indian youth, most prominently related to excessive use of social media, video games, online pornography, and mobile phones.
These addictions are often linked with poor academic performance, sleep disturbances, emotional dysregulation, and familial conflict. Data from de-addiction clinics like SHUT Clinic at NIMHANS shows that technology-related behavioural issues now constitute a significant proportion of youth mental health concerns. Despite this, such addictions are often under-recognised and under-treated, due to stigma, lack of awareness, and insufficient inclusion in mainstream school mental health discussions. This emerging pattern necessitates urgent attention in policy and programming.
How far have we reached?
In the past, India has taken some necessary steps to tackle public mental health issues. Now, it is crucial to carefully assess these actions' scale, strategy, and impact. This assessment will guide us in taking further steps that are both effective and efficient, ensuring maximum benefit for all. One such impact of our decision is India's relative success in curbing suicide rates compared to other countries.
A study published in the journal, World Journal of Psychiatry (2022) examined and compared suicide rates globally, regionally, and nationally from 2000 to 2019. An analysis of the published results of this study demonstrated significant progress in India in reducing suicide rates from 19.1 to 12.9 per 100,000 persons over the last two decades (2000-2019). This decline surpasses Japan's reduction to 5.9 per 100,000 persons and South Africa's to 3.1 per 100,000 people. Canada and Australia saw marginal decreases of 0.4 and 0.5 suicides per 100,000 persons, respectively, while the United States experienced an increase to 4.5 suicides per 100,000 persons.
Proactive steps to tackle mental health issues include initiatives like the National Mental Health Programme running since 1982, the District Mental Health Programmes, and the newly-introduced National Tele Mental Health Programme.
Gaps persist
Despite these efforts however, a stark treatment gap persists, with the National Mental Health Survey revealing that only 29% of individuals with psychiatric disorders receive treatment, leaving 71% untreated. This gap underscores the mismatch between demand and supply in mental health services.
To bridge gaps, policy-makers must focus on community-based services and school mental health initiatives. Urgent investment in mental health is crucial to reduce disparities and address this escalating crisis. It is essential for stakeholders, such as governmental bodies, policy-makers, educational institutions, parents, students, media, and researchers, to prioritise mental health care. Integrating mental health education, resilience building, and coping skill training into regular school and college activities and school curricula will create a supportive environment to promote mental well-being in educational institutions in India.
Why do schools hold strategic importance?
A mental health study published in another reputed international journal in 2024 on students' suicide in India provides insight into how to tackle this public particular mental health challenge. It identifies patterns, trends and crucial risk factors, emphasising the urgency of improving school-based mental health interventions in India to tackle rising suicide rates.
Global mental health agendas, such as the World Health Organization's Comprehensive Mental Health Action Plan 2013–2030, emphasise the pivotal role of schools in promoting mental health awareness and supporting adolescents. School-based suicide prevention, early socio-emotional skills development and anti-bullying programmes are essential components of comprehensive mental health strategies.
The World Mental Health Report (2022), WHO, emphasises the vital role of schools in addressing mental health issues through education, supportive environments, and collaboration with health services. By enhancing mental health literacy, training educators, and involving parents and communities, schools can effectively promote the mental well-being of young people.
Key strategies in implementation and call for action
Given India's vast student population, integrating digital mental health services like the nationwide helpline Tele-MANAS (1-800-891-4416) in educational institutions is essential. Establishing a Mental Health Advisory Board (MHAB) comprising trained teachers under institutional leadership can facilitate structured mental health initiatives.
Schools must conduct mental health orientations for teachers and students, fostering resilience through workshops and peer support. Providing structured psychological support before, during, and after exams can help students manage anxiety and distress. Also, parents and teachers should adopt stress-free communication strategies to foster a positive environment, emphasising that education is just one aspect of personal growth and development. Institutions should promote helplines such as Tele-MANAS and others to ensure students seek timely support. Embedding these mental health initiatives in education will foster student well-being, resilience and academic success, creating a more inclusive learning environment.
Therefore the main recommendations are : establishing a Special Task Force on Mental Health in Educational Institutions to prioritise the well-being of students and staff; integrating mental health services in educational institutions through district mental health services, Tele-MANAS and other possible alternative ways and having district mental health teams train ASHA and Anganwadi workers in illness identification, psychological first aid for children and mothers and to recognise the need for referral to advanced mental health services if needed.
Role of educational regulatory bodies
To prioritise mental health in education, mental health audits should be included in the accreditation process of educational institutions from primary to higher education. Integrate tele-counselling skills into master 's-level psychology and social work courses to prepare students for remote mental health support.
The establishment and implementation of Mental Health Advisory Boards (MHABs) as per directives from the National Council of Educational Research and Training (NCERT), and the Government of India agencies should be mandated.
A team of school counsellors trained and led by mental health professionals (e.g., psychiatrists, clinical psychologists, and psychiatric social workers) should be formed. This team could collaborate with the institute's MHAB to train teachers and students to promote mental health in educational institutions.
Media also plays a vital role -- publishing weekly editions of educative, informative and skill-building editorials, along with dedicated sections in local language newspapers, to enhance mental health awareness; providing insights into treatment options, and improving accessibility to mental health services can go a long way. Hosting weekly programs on television, news channels, radio, YouTube and Instagram featuring discussions, mental health bulletins and informative shows for parents and students will help.
In conclusion, school mental health programmes play a crucial role in promoting mental well-being, preventing mental illnesses, and reducing stigma. With comprehensive efforts and national implementation, these programmes can potentially transform mental health outcomes for students and communities across India.
(Dr. Manoj K. Pandey is professor & head, department of clinical psychology, Post Graduate Institute of Behavioural & Medical Sciences, Raipur, CG. manojpandey813@gmail.com; Dr Manoj Kumar Sharma is professor, department of clinical psychology, SHUT Clinic (Service for Healthy Use of Technology), National Institute of Mental Health & Neurosciences, Bengaluru. shutclinic@gmail.com)
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