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 Table of Contents  
DEBATE/PERSPECTIVE/VIEWPOINT
Year : 2017  |  Volume : 33  |  Issue : 2  |  Page : 123-128

Prevention for child and adolescent psychiatry in low-resource settings


Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication30-Jun-2017

Correspondence Address:
Rachna Bhargava
Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_32_17

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  Abstract 

Preventive measures for mental health issues among children have received meager attention. Although the prevalence rates of mental disorders are significant, systematic focused efforts toward management specifically in this special population in low-resources settings have been markedly inconsequential. Certainly, unlike other medical conditions, policies, and services related to mental health of children and adolescent are not adequate and efficient to deal with the burden of mental disorders in children and adolescents. This article reviews the available resources and highlights the possible strengths that can be utilized in prevention strategies.

Keywords: Children, low-resource countries, mental health, prevention


How to cite this article:
Bhargava R, Sahu A, Bhattacharya D. Prevention for child and adolescent psychiatry in low-resource settings. Indian J Soc Psychiatry 2017;33:123-8

How to cite this URL:
Bhargava R, Sahu A, Bhattacharya D. Prevention for child and adolescent psychiatry in low-resource settings. Indian J Soc Psychiatry [serial online] 2017 [cited 2019 Jun 20];33:123-8. Available from: http://www.indjsp.org/text.asp?2017/33/2/123/209179

Child mental health issues and their management are laden with a number of complexities. Childhood and adolescence is a phase where they have certain innate vulnerabilities. Any mental disorder with a childhood onset has poorer prognosis compared to adult mental health disorders because it impedes overall cognitive, behavioral, and cognitive development of the child.[1] In children, as the concept of self is not completely developed, they are more inclined to be effected by lack of attachment, criticism, bullying, and abuse. The lack of attention to the mental health of children and adolescents may lead to mental disorders with lifelong consequences, undermines compliance with health regimens, and reduces the capacity of societies to be safe and productive.[2]

The prevalence rates of child and adolescence mental health problems in Asian countries have been reviewed and reported to be in the range of 10%–20%, which is a cause of concern.[3] The magnitude of mental disorders in child and adolescents varies in different countries, and comparisons are difficult as different age groups have been examined within pediatric population. The most common disorders seen in childhood and adolescent period are anxiety disorder, followed by behavior disorders, then mood disorders, and substance use disorders.[4] Neurodevelopmental disorders such as mental retardation and ADHD were other most common diagnosis in some countries.[5],[6]

Variation in the rates across the world can be attributed to the true cultural differences in the magnitude of childhood disorders. Vast differences exist in terms of dependence on parental figure, educational system, gender roles, and child care policies between Western and South Asian regions. Families are a cohesive unit among orientals and have a significant role in treatment and preventive measures in mental illnesses. The society is individualistic in the West, whereas in eastern region, dependency is not seen negatively, and hence, the preventive measures taken in this part of the world require indigenous approaches. Furthermore, the literacy rates are lower in low-income countries than other middle- and high-income countries.[7] Lack of awareness about mental disorders can lead to poor help seeking and that too in only active phase of disorders. Hence, it is important to examine the issues in preventive measures taken by low-income countries in Asian culture separately.

Few studies have focused on child and adolescent mental health services (CAMHS) in LMICs and have reported the shortage of CAMH professionals and poor accessibility and availability of CAMHS.[8],[9],[10] In addition, the WHO [11] has published “Atlas: Child and adolescent mental health services” that also reported that countries with the largest proportion of children and adolescents and less-developed countries have inadequate specific CAMH policies, few mental health professionals working specifically with child and adolescent population and grossly unmet mental health needs. Current scenario of available facilities for the prevention and promotion of child and adolescent mental problem in low-resource settings has been summarized in tabular form [Table 1] and [Table 2].
Table 1: Mental health services in low- and middle-income countries

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Table 2: Special provisions for mental health in low- and middle-income countries

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We can conclude that though low- and middle-income South Asian countries have some mental health policies and mental health services; however, these services and efforts are restricted to adult population. In addition, part-time/full-time mental health professionals and school-based activities in primary and secondary schools are not sufficient in dealing with the current burden of mental health problems in children and adolescents.

Considering the above challenges and gaps in mental health system, there is an urgent need to take steps in strengthening the mental health system for children and adolescent in terms of training of primary health-care physicians and primary health workers, empowering the existing outpatient and inpatient psychiatric facilities in the general hospitals, community setup and day care, ensuring the availability of mental health services at the regional, district, and peripheral levels, spreading awareness among parents and teachers because they are the primary source for facilitating adaptive behavior in children and promoting mental health programs in schools, etc. Efficacious programs for dealing with health issues among children such as polio vaccination (pulse polio) have required community involvement. Certainly, unlike other medical conditions, fund allocation in mental health area has always been a difficult task. Hence, there is a need to evolve strategies that require mobilization.

In addition, NGOs can play a significant role in bridging the gap between clinical care and families with mental health needs. Their role and functioning need to be strengthened, especially for childrens' mental health issues that can easily be dealt with nonpharmacological interventions. Training families at their footsteps and encouraging home-based interventions may overcome the lacunae of limited mental health professionals.

In summary, prevention of mental disorder in child and adolescents is somewhat difficult in South Asian countries because of poor availability, accessibility, and adequacy of resources. Here, there is a need to analyze the available resources to modify and develop mental health policies and resources for every country. [19]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Post RM, Altshuler LL, Leverich GS, Nolen WA, Kupka R, Grunze H, et al. Illness progression as a function of independent and accumulating poor prognosis factors in outpatients with bipolar disorder in the United States. Prim Care Companion CNS Disord 2014;16:10.4088/PCC.14m01677.  Back to cited text no. 1
    
2.
World Health Organization. Caring for Children and Adolescents with Mental Disorders: Setting WHO Directions. Geneva: World Health Organization; 2003.  Back to cited text no. 2
    
3.
Srinath S, Kandasamy P, Golhar TS. Epidemiology of child and adolescent mental health disorders in Asia. Curr Opin Psychiatry 2010;23:330-6.  Back to cited text no. 3
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4.
Merikangas KR, Nakamura EF, Kessler RC. Epidemiology of mental disorders in children and adolescents. Dialogues Clin Neurosci 2009;11:7-20.  Back to cited text no. 4
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5.
Jeevanandam L. Perspectives of intellectual disability in Asia: Epidemiology, policy, and services for children and adults. Curr Opin Psychiatry 2009;22:462-8.  Back to cited text no. 5
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6.
Mian A. Child and adolescent mental health in Pakistan. Adolesc Psychiatry 2013;3:14-7.  Back to cited text no. 6
    
7.
Kendall D. Sociology in Our Times: The Essentials. USA: Wadsworth Cengage Learning; 2008.  Back to cited text no. 7
    
8.
Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, et al. Child and adolescent mental health worldwide: Evidence for action. Lancet 2011;378:1515-25.  Back to cited text no. 8
[PUBMED]    
9.
Morris J, Belfer M, Daniels A, Flisher A, Villé L, Lora A, et al. Treated prevalence of and mental health services received by children and adolescents in 42 low-and-middle-income countries. J Child Psychol Psychiatry 2011;52:1239-46.  Back to cited text no. 9
    
10.
Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, et al. Human resources for mental health care: Current situation and strategies for action. Lancet 2011;378:1654-63.  Back to cited text no. 10
[PUBMED]    
11.
World Psychiatric Association, World Health Organization. International Association for Child and Adolescent Psychiatry and Allied Professions. Atlas: Child and Adolescent Mental Health Resources. Geneva: World Health Organization; 2005.  Back to cited text no. 11
    
12.
World Health Organization. WHO-AIMS Report on Mental Health System in Uttarakhand, India, WHO and Ministry of Health, Dehradun, Uttarkhand, India; 2006.  Back to cited text no. 12
    
13.
World Health Organization. WHO-AIMS Report on Mental Health System in Bhutan, WHO and Ministry of Health, Thimphu, Bhutan; 2007.  Back to cited text no. 13
    
14.
World Health Organization. WHO-AIMS Report on Mental Health System in Nepal, WHO and Ministry of Health, Kathmandu, Nepal; 2006.  Back to cited text no. 14
    
15.
World Health Organization. WHO-AIMS Report on Mental Health System in Pakistan. Islamabad: World Health Organization; 2009.  Back to cited text no. 15
    
16.
World Health Organization. WHO-AIMS Report on Mental Health System in Bangladesh, WHO and Ministry of Health & Family Welfare, Dhaka, Bangladesh; 2007.  Back to cited text no. 16
    
17.
World Health Organization. Mental Health Atlas. Geneva: Department of Mental Health and Substance Abuse; 2011.  Back to cited text no. 17
    
18.
World Health Organization. WHO-AIMS Report on Mental Health System in Afghanistan, WHO and Ministry of Public Health, Kabul, Afghanistan; 2006.  Back to cited text no. 18
    
19.
World Health Organization. WHO-AIMS Report on Mental Health System in Maldives, WHO and Ministry of Health, Male, Maldives; 2006.  Back to cited text no. 19
    



 
 
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