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 Table of Contents  
INVITED PERSPECTIVE
Year : 2021  |  Volume : 37  |  Issue : 1  |  Page : 10-13

Mental health crisis among children: A parallel pandemic


CEO, Railway Children India, New Delhi, India

Date of Submission11-Dec-2020
Date of Decision11-Feb-2021
Date of Acceptance15-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Mr. S Navin Sellaraju
CEO, Railway Children India, B 1, 1st Floor, Arjun Nagar, Harsukh Marg, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_36_21

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How to cite this article:
Sellaraju S N. Mental health crisis among children: A parallel pandemic. Indian J Soc Psychiatry 2021;37:10-3

How to cite this URL:
Sellaraju S N. Mental health crisis among children: A parallel pandemic. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Aug 2];37:10-3. Available from: https://www.indjsp.org/text.asp?2021/37/1/10/312799



Over the past 9 months, while reports have shown that the coronavirus has let children off easily as far the development of the COVID-19 is concerned, the mental health and the psychosocial impact on children in need have been significant and mostly overlooked. The focus on spread of the virus and the associated morbidity and mortality have overlooked the extensive psychosocial impact of the pandemic. The 'lockdown', closure of schools, decreased access to digital education, loss of play have all restricted the development of children for nearly a year.

Organizations working with children (on the issues of child care and protection; health; nutrition; mental health), parents, families and teachers have all acknowledged that the mental health of children is being impacted significantly. To the extent, that it may be fair to say that it is a parallel pandemic unfolding silently. Every home and every child is likely to be affected.

A sharp rise in the mental health conditions of children was contributed to by many factors; however, together, they point at one staggering finding – Children today are more vulnerable than ever. With the protective shield of education being taken away, unemployment, violence at home, disempowered parents, and unsafe migration are all still relevant and will influence how these children who lived in times of a pandemic fare as they grow.


  Doubly Vulnerable: The Plight of India's Street Children Top


There are 23.7 million child workers below the age of 18 years,[1] over 11 million[2] children live on the streets, 60,000[3] children go missing every year, and close to 135,000[4] children are trafficked each year. The exact numbers are a matter of debate and could very well be higher given the underreporting. Several studies and media articles reveal that, every 5 min,[5] a child arrives at a railway station; in numbers, this could be 70,000–120,000. All these data indicate that millions of children in India and across the world have only known a life on the streets. Challenges they fight on a daily basis are many – homelessness, lack of nutritious food and clothing, inaccessibility to education and healthcare, limited family support, increased exposure to violence, abuse and exploitation, often pushing them into a vicious cycle of poverty, crime, and long-term mental health challenges.

Having witnessed violence, neglect, and deprivation at home or on the streets, they often have significant developmental delays and attachment disorders that can manifest in a range of challenging behaviors; anxiousness, distress, aggression, and anger issues, developed as coping mechanisms. There is an increased risk of substance use amongst children and also increased risk of being in conflict with law amongst children who have had such adverse life experiences.

By the time, the state services, child rights' organizations, or social workers reach these children, their psychosocial development is layered with experiences of rejection, neglect, judgment, and apathy from the adults in their environment. Most such instances are often overlooked or ignored, leaving children with few means for an outlet, resulting in internalized feelings reaching levels of stress that can be very damaging to their mental health.[6]

With the onset of the pandemic, this highly susceptible population became doubly vulnerable. Children living on the streets lost their support systems and became invisible. Families who were previously able to provide basic meals for their children, and send them to “public” schools, now had no resources as the jobs were lost and income decreased drastically.[7] Children were deprived of basic means of fullfilling basic developmental needs. Children without smartphones at home had no access to online classes. Playgrounds were out of bounds. There was no socializing with peers, Violence and stress at home increased. There was insecurity about the next meal. There was role reversal on parenting, with parents being preoccupied with everyday survival, the youngest members of the family carried the burden of uncertainty too. Children faced a developmental stagnation in a life of poverty. Even the option of running away from a traumatic environment was not there.

Largely, the development sector which usually would be able to reach out to children in need of care and protection had to make a switch overnight and work in the context of COVID-19. Social distancing, lockdowns, decreased access to community, decreased financial resources, and limited human resources were the new normal. COVID-19–related interventions were at the forefront of their daily work, in addition to addressing preexisting social issues. Research, stories, and news reports were all indicating that the need for psychological and mental health support was one of the real and leading challenges being faced by families and their children. However, mental health interventions that should have been a critical ingredient of the response were missing from most development programs.[8]


  Children Stories Leading to Conclusive Evidence Top


”Half of all mental health conditions start by 14 years of age, but most cases are undetected and untreated,” revealed the World Health Organization on adolescent mental health.[9] In India, limited data, investment, and trained resources, teamed with an unaccepting culture for mental health issues, only meant that the real picture was still to be seen and understood.



During the lockdown, Railway Children India's team reached out to 7300 children who had been rescued by it and reunified with the families in the past. These interactions provided conclusive evidence that uncertainty of the future, social isolation, violence and parental angst, loss of stabilizing forces such as school, among other factors, were impacting the mental health of children in different degrees. Some of the common themes in the narratives as shared by the children and their families included: Children not being happy to be at home for long periods; frustration due to not being able to meet or play with their friends; feelings of home arrest and uncertainty about their future; fear of contracting the virus; worry related to meeting the gaps of their studies and stress of facing physical and emotional abuse by their parents.

Of the 3.07 lakh calls received by the “CHILDLINE 1098” helpline for children in distress across the country between March 20 and 31, covering the 1st week of the lockdown, 30% (92,105 calls) were about protection against abuse and violence on children.[10] The increased risk of incidents of trafficking, child labor, child marriage, school dropout, child abuse, and violence were the consequent psychosocial impacts of the pandemic. This was also reiterated by our experience, evidence, and engagements with children and their families.[11]

While the stories were many and the evidence alarming, the country remained under-equipped and under-prepared to address a predominantly impending issue.


  Mental Health Initiatives and Way Forward Top


“Ravi goes to the best school in town but struggles to wake up every day due to fear of taking the bus. Kavita eats nutritious home-cooked meals but is anxious every time her father leaves for work. Varun quit being captain of his cricket team because the boys in his colony bully him.”

These stories go to show that in order for the basic rights of children such as education, food, shelter, and clothing to be fulfilled, the right to mental health must be prioritized. The time to acknowledge and act for the mental well-being of children was a thing of yesterday. While mental health issues have always existed, new contexts and a new age added a considerable number of challenges that many children were not equipped to handle. In a country that spends <1%[12] of its health budget on mental healthcare, it was unrealistic to expect preparedness for such an impact on children's mental health.

As the childcare and protection networks gear up to strengthen their response to cope with long-term impact of COVID-19, mental health interventions should form the spine of such a response. Four broad recommendations are being made based on the Railway Children India experiences to address the mental health needs of children in times of COVID-19.

Innovating for children

A range of interventions have evolved during the past year, from remote storytelling platforms in every corner of India, online material for learning, games and digital books, telecalling psychosocial support, helplines and hotlines to share and talk, endless WhatsApp videos and messages, and self-help toolkits for parents and families[13] to support children at home. These interventions seem to have played a protective role for children. Further focus on developing and disseminating information on skills to cope with the psychosocial impact will strengthen children's resilience.

Railway Children India reached out to children through a “check-in” process. Children were able to to reach out to someone if they find themselves at risk or in stress. Railway Children India's effort to connect back with >7300 families of children reunified in the past helped the organization to work intensively with 4100 vulnerable children and their families. A check-in process together with increased awareness of the government helpline 1098 among children, district-level civil society organizations working in tandem with the District Child Protection committees will help strengthen safety nets for children in need.

Strengthening families to protect their children

Families need to be supported and strengthened, or children would not be safe. This includes continued support through the Public Distribution System to provide food security. Provision of dry grocery supports multiple points of contact for village and urban poor, linking people with social protection schemes, direct cash transfers, and helping them get access to skills, jobs, or alternate livelihood options. All these will support the children's mental health and not just access to phonelines.

Railway Children India's experience shows that many parents did not acknowledge mental health needs of children, some did not want caregivers to interact with their children multiple times, while there were few who develop unrealistic expectations from the caregivers to be surrogate parents. To address these gaps, parents need to be sensitized to the mental health needs of children and the collaborative interactions between parents, educational systems, and childcare and protection networks to address the mental health needs.

Developing a cadre of trained psychosocial support providers

Not all people who work with children are trained to identify and support their mental health needs. There has to be a curriculum approach to providing positive mental health services and all people who interact with children need to be able to provide mental health first aid. Mental Health and Psychosocial Interventions need to include standard operating processes as to how to provide support to parents on how to talk to children about the pandemic; how to manage their own mental health and how to address the rising stress that children were facing. The tele-counseling services by provided trained mental health professionals who are aware of the psycho-social context is critical. It is also equally important to strengthen the child care and protection processes and personnel to be mental health sensitive and have skills to address the mental health impact. Resources also need to be strengthened to support service delivery organizations in the form of NGOs for providing community-based de-addiction support. Government hospitals' General Hospital Psychiatry Units with mental health infrastructure need to be supported to build capacity to address the needs of children. Counselors attached with District Child Protection Units need to be increased in numbers and competence. A referral mental health network at the block and district level needs to be built and supported to accept timely referrals.

Advocating for mental health rights of children

Lack of resources including finance and trained workforce has left with no choice but for civil society, government, and nongovernment mental health experts and systems to leverage each other's strength and create a mental health protective net that covers children across the nation. On medium to long term, the development sector has to influence government to allocate adequate resource not only to address mental health needs of children but also for child protection as a whole.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
India Census. Census 2011 Table: C-13 Appendix-B Single Year Age Returns by Residence, Sex, and Work (India & States/UTs); 2011. Available from: http://www.censusindia.gov.in/2011census/Age_level_Data/C13/DDW-C13APPENDIXB--0000. [Last accessed on 2020 Dec 26].  Back to cited text no. 1
    
2.
Das U, 2013 Lost Childhoods: A study on platform children and other children in distress in India. PHF India.  Back to cited text no. 2
    
3.
The National Crime Records Bureau (NCRB) Data; 2016. available at https://ncrb.gov.in/en/crime-india-2016-0. [Last accessed 2021 Feb].  Back to cited text no. 3
    
4.
Lal N, 2016 Jun 20, Children of a Lesser God Trafficking soars in India. Available at: http://www.ipsnews.net/2016/06/children-of-a-lesser-god-trafficking-soars-in-india/. [Last accessed 2021 Feb].  Back to cited text no. 4
    
5.
Carol D The railway children of India, Friday Magazine, March 14 2013. Available at: https://gulfnews.com/world/asia/india/the-railway-children-of-india-1.1158235. [Last accessed 2021 Feb].  Back to cited text no. 5
    
6.
Bhagat A Railway Children India Programme Quality Framework 2016. Available from Railway Children India.  Back to cited text no. 6
    
7.
Railway Children India Needs Assessment of 4100 families across 9 communities 2020. Available from Railway Children India.  Back to cited text no. 7
    
8.
Availale from: https://idronline.org/but-what-about-mental-health/. [Last accessed on 2021 Feb 07].  Back to cited text no. 8
    
9.
Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. [Last accessed on 2021 Feb 07].  Back to cited text no. 9
    
10.
11.
Ramaswamy S, Seshadri S. Children on the brink: Risks for child protection, sexual abuse, and related mental health problems in the COVID-19 pandemic. Indian J Psychiatry 2020;62:S404-13.  Back to cited text no. 11
  [Full text]  
12.
13.
Available from: https://www.unicef.org/india/media/3401/file/PSS-COVID19-Manual-ChildLine.pdf. [Last accessed on 2021 Feb 07].  Back to cited text no. 13
    




 

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