Protecting our children’s future - body and mind

Lionel WIJESIRI

These are difficult times to parents with school-going children. For most of them the experience can be both an exciting and challenging one. There are many things for the parents to think when it comes to a child’s school years - doing well academically, making friends, managing finances, staying safe and planning for the future.

With all these opportunities and commitments, it is also important for the parents also to think about their child’s emotional health. A principal of a leading school revealed that in a survey done in his school last year, half of GCE (O level) students said they had been so stressed that they couldn’t get work done at some point during the last term and emotional problems are cited by students as a leading impediment to academic success. When unaddressed, such problems can have serious consequences - even leading to mental breakdown and suicide.

It is time that the authorities offer parents some resources that will help them learn more about their children’s emotional health and what they can do to support them if they are struggling.

This is very important today because research has proven that, in South Asian counties like Sri Lanka, parents are still a leading source of support and guidance for the children. Their influence is important during the school years and the transition into adulthood.

The bottom line is clear: there is inadequate attention given to the mental health needs of children. We lack a strategy to track and treat our children’s emotional and behavioural health.

Mental health check-up

Mental health check-ups for school children should be as widely accepted as dental checkups. This is an idea that has been discussed in the mental health community for some time; however, it has not received adequate attention among the public at large. When children start kindergarten, enter puberty and launch into adulthood they are prone to significant social and emotional upheaval. These transitions are widely believed to be critical time-windows in child development. Thus, every child would benefit from a regular standard psychological check up program.

We currently have remarkably useful, scientifically validated tools at our disposal which differentiate normal developmental struggles from clinical symptoms. Commonly used behaviour rating scales compare a parent’s ratings about their child to thousands of other parent ratings. This provides the psychologist with data about how extreme a particular problem may be. For instance, a psychologist can quickly let a family know if their ratings about, say, aggression or thought problems were at the 50th, 75th or 90th percentile compared to other children the same age.

Symptoms that can be assessed in this manner can be social problems, attention problems, mood problems, anxiety, adaptability and the like. Check-ups could yield valuable information to the parents and teachers alike. Parents could be told if a child appears to be growing up normally, is at-risk, or requires formal assessment and treatment. This would not, as some people fear, lead to an overwhelming trend of labeling healthy children.

Psychologists are well trained to appreciate the signs of adaptability and health in children and families. Well-trained clinicians recognize that children and families thrive when their competencies are validated and praised.

Interventions

If recognized early, many moderate ‘warps’ in a child’s personality can be improved with simple interventions. Children have overcome school phobias, cease aggressive behaviour, pull up failing grades and begin using respectful language at home after only a few therapy visits.

Problems such as these can often be treated quickly, protecting children from unnecessary suffering. We must also recognize that there are children facing severe and chronic mental health conditions requiring intensive and long-term treatments.

Even children in this category need systems in place to reassess their progress at critical ages. Psychologists, who are trained in a scientist-practitioner model, can use validated measures to assess if clients are maintaining a healthy developmental trajectory.

Children are frequently brought in to see their pediatrician or family doctor because of symptoms such as phobias, temper problems, sleep difficulties, learning problems, or attention problems.

Unfortunately, it is rare for families to be granted reasonable time frame to discuss these matters and it is even less common for families to receive a multi-modal assessment that combines interview, play observation and psychological testing.

Resource guide

Given the importance of maintaining high standards of mental health among adolescents, it is more urgent than ever that we apply our limited resources to develop a resource guide to outline different strategies. To that end, our Public Health Service has a major role to play.

Following are few salient points to be considered based on the guidelines adapted by the National Alliance on Mental Illness (NAMI), USA.

* School Teacher Training. A program should be directed at teachers and other school staff to help them identify students at risk of mental health and refer them for help. These programs also teach staff how to respond in cases of crisis in the school.

* Community Training. This type of program should provide training to community members such as clergy, police, merchants and recreation staff. This training should be designed to help these people identify youths at risk and refer them for help.

* General Education. These school-based programs should provide students with facts about good mental health, alert them to warning signs, and provide them with information about how to seek help for themselves or for others. These programs should incorporate a variety of self-esteem or social competency development activities.

* Peer Support Programs. These programs, which can be conducted in either school or non-school settings, should be designed to foster peer relationships, competency development and social skills as a method to prevent suicide among mentally high-risk youth.

* Crisis Centers. These programs should primarily provide emergency counseling for suicidal people. Hotlines are usually staffed by trained volunteers. Some programs offer a ‘drop-in’ crisis center and referral to traditional mental health services.

It is said that one in eight of our young people may have depression and two-thirds of youth and young adults who have mental health problems do not get the professional help that they need.

Increased access to mental health check-ups could lead to early diagnosis and treatment of these disorders and thus prevent worsening conditions.

Central and Provincial Governments already play a pivotal role in a range of prevention efforts to protect the health of young including child immunizations, alcohol and drug abuse prevention, and diabetes and nutrition education.

We should now call on policy makers to provide this same coverage for mental health check-ups for school children. The Government should promote access to voluntary mental health check-ups for all of our school children after Grade 5 and should also support a national education effort to increase public awareness about mental health check-ups for young people and the impact of detecting mental disorders early.

The Public Health Service should accept the importance of access to both medical and mental health check-ups as a public health imperative. It is also a good public health policy.