Mental health problems affect 10–20% of children and adolescents worldwide and are a leading cause of health-related disability in this age group with long-lasting effects throughout life. The mental health of children belonging to this age group remains precarious because of the multitude of stresses they face – pressure to succeed in school, peer pressure, bullying, to name a few. Like most struggles in life, mental health problems too are compounded by poverty. Children from underprivileged sections have increased exposure to many risk factors that can impact their mental well-being – child labour, violence, forced displacement, immigrant status, discrimination, abuse, lack of stability, and neglect. Undernutrition and micronutrient deficiencies, that are highly prevalent in low-income settings, are also associated with behavioural deficits. Lack of awareness prevents parents from being able to identify or contribute towards improving their children’s mental well-being, while lack of resources prevents access to mental health facilities in a country where neither the society nor policy makers accord the same importance to mental health and mental disorders as physical health.
Schools can be the strongest social institution for intervention in promoting mental health in situations where families might be unable to assume leading roles. Children’s ability and motivation to stay in school, to learn, and to utilize what they learn is affected by their mental well-being. To start with, school authorities should ensure that children receive nutritional food and micronutrient supplements, so that easily preventable deficiencies do not lead to crippling mental disorders. More importantly, there is a need to have broad strategies that promote general mental well-being, improve coping skills and self-esteem. This can be achieved by promoting psychosocial competence, or the ability to deal effectively with the demands and challenges of everyday life.
Accommodating lessons based on life skills like communication and interpersonal relationships, self-awareness and empathy, decision-making and problem solving and managing emotional stress can go a long way in preventing depression, anxiety, low self-esteem, anger, and interpersonal conflict. Another crucial facet of the same approach is mental health education that imparts knowledge about risk factors, mental disorders, emotional development and where to seek assistance. These are important ways of preventing mental health issues as well as promoting mental well-being in a positive and non-stigmatizing way.
These broad psychosocial strategies need to be coupled with specific, problem-focused interventions. This includes identification of psychological problems and mental disorders and their treatment by professional counsellors. While most private schools have at least one counsellor available for students every day during school time, there are only 213 of them for over 1100 government schools in Delhi that cater to over 15.5 lakh students, which means that one counsellor is covering 5 schools. Given how lack of specific interventions leads to long-term negative effects on educational attainment, chronic disability, and lost productivity, urgent action is needed with respect to recruitment of mental health professionals in schools.
The aim of these school-based interventions is to strengthen abilities to counter environmental stress and disadvantages which children from low income settings face. We need to combine these efforts with a sensitive and empathetic attitude among teachers and students, with regard to disadvantaged children, especially in private schools where instances of institutional discrimination against these children are not uncommon. Often, the apathetic administration makes no bones of its view of children from EWS category as a ‘burden’. Comments for underperformance may sound like “you’ll also pull a rickshaw like your father” making them easy targets of bullying, and discrimation. Needless to say, this class-based discrimination harms their self-esteem and sense of competence and negatively impacts their mental health. Interventions will improve mental well-being only if children find the school environment welcoming and inclusive. If we aim to improve academic success and lower dropout rates with school-based interventions, we first need to create an inclusive classroom, where everyone feels that they belong.
As the pandemic deepens, class divide worsens mental health, young children lying at the intersection of this dual disadvantage are among the worst affected. Besides the argument of reducing economic costs by early intervention, there is also an ethical responsibility towards the most vulnerable young people to create possibilities for them to lead happier, more fulfilling lives.
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3 Smith EA, Swisher JD, Vicary JR, Bechtel LJ. “Evaluation of life skills training and infused-life skills training in a rural setting: Outcomes at two years.” Journal of Alcohol and Drug Education. 2004.