The kids are not all right – the challenges of youth mental health in India

India is young, vibrant and growing. With over 350 million people below the age of 30, India has one of the world’s largest youth populations. Divided by caste, class, region and language, this young population represents enormous promise but also significant challenges. An unaddressed thought often discussed on social media is their mental health.

Their mental well-being is significant as it can potentially affect not only the country’s demographic dividend but also the quality of life, economic and social ability and the social cohesion of India’s vast, diverse multi-ethnic, multi-religious and linguistic social structure.

India has had a mental health epidemic for decades.

Statistics on mental health show that one in seven Indians encounters mental health problems, some of them as early as adolescence. It is much higher than the global average.

Due to stigma, limited access, affordability and shortage of services, by some estimates, there is a glaring gap in the treatment of mental health concerns. As per India’s own estimates, the treatment gap for mental disorders ranged between 70%-92% for different disorders: common mental disorder 85%; severe mental disorder 73.6%; psychosis 75.5%; bipolar affective disorder 70.4%;,alcohol use disorder 86.3%, tobacco use 91.8% .

There are also critical disorders including learning, speech, visual, hearing and personality disorders that are not diagnosed and treated. Moreover, care for these is not easily available, mostly unaffordable and often concentrated in urban India.

Though dismissed and seen as “elitist”, the mental health of the youth is critical for their well-being. Poor mental health influences an individual’s relationships with themselves as well as their families, peers and society as a whole. With significant mental health challenges, it can be challenging to make cohesive and informed decisions – personal, professional and also political.

Why are the young facing so many health challenges?

It isn’t as simple as one might assume. Poor mental health can be due to internal and clinical reasons but there are also environmental and social factors, such as poverty, caste, class, gender, physical and mental abuse among others.

For the youth, there are many factors are associated with poor mental health, including domestic violence, child abuse, bullying, peer pressure, substance use and the toxic influence of social media. It is often not realised but an unhealthy adolescence and youth will affect health and well-being later in life.

Take the example of cyberbullying or technology privilege. There has been an increase in cyberbullying and abuse aimed at youngsters. There are also digital addictions where youngsters absorb everything on digital media uncritically or without analysis. This, combined with who controls digital media and who has access to technology, causes greater mental stress and dissatisfaction among youngsters. Along with the faultlines of caste and class, structural discrimination and violence, youngsters are more vulnerable with increasing triggers for mental health challenges.

Most individuals do not have access to either the ability or the vocabulary to articulate these challenges. Nor do they have any supportive, well-rounded mental health services within their immediate networks, families, communities or educational institutions.

Putting aside the online discourse that seeks to destigmatise mental health, there remain immense hurdles around mental healthcare within immediate environments. Even when a young person realises that they may be dealing with a mental health challenge, there are social, economic, cultural and also health system barriers in seeking care – if at all any is available.

These challenges are exacerbated in small towns and rural India where conversations on mental health are virtually absent, like mental health services. Youngsters in these regions are more vulnerable to long-term mental health challenges, low economic growth, poor quality of life and limited wellbeing. This can lead to a delay in diagnosis and effective treatment, sometimes for years. Due to the underreporting of cases, these gaps are likely wider among Indian youngsters.

Toxic masculinity is also a significant problem as it straight-jackets gender roles while stigmatising and punishing behaviour that wavers from the norm. This is especially a burden for youngsters of all genders who struggle with expressing their feelings.

A good place to start is by identifying the mental health burden among the young. This will help acknowledge the challenges and also help create a comprehensive policy that addresses the many issues of youth mental health.

Policy-makers should evaluate where things stand and draft a comprehensive youth mental health policy as well as programmes with participation from all stakeholders. Although India has a mental health policy, the provisions for youngsters need greater focus.

For example, globally, comprehensive school and university programmes that engage, inform and build capacity among youngsters as well as faculty and staff have been found to be helpful. In India, such programmes will need digital, multilingual components that help mainstream youth mental healthcare while making information and resources accessible .

India also needs strategies for the development of specific mental healthcare for youngsters and integrate it with the health system, ie, primary healthcare, to bridge the urban-rural divide in accessibility. These programmes need to consider factors such as poverty as well as urbanisation as mental disorders are observed to be more prevalent among lower-income groups due to factors that increase distress. Similarly, those from urban areas have a greater prevalence across different disorders.

Cultural diversity and social connections are important in India. Thus, it will be critical to bring in the participation of families and communities in programmes to improve youth mental health through engagement and community-based initiatives. Moreover, open conversations on the determinants of mental health among youngsters as well as reducing risk factors is needed.

Perhaps most germane, but urgent, is the expansion of the workforce on mental health. India needs more mental health personnel and planning for it should be a priority. The country faces a severe shortage of mental health professionals, with as little as 0.3 psychiatrists per 100,000 population, most of them concentrated in the southern and western regions of the country.

This shortage is exacerbated by the migration of psychiatrists to high-income countries. Counsellors are overworked and unaffordable. . Even today, India spends less than 1% of its total health budget on mental health. How can systems be strengthened then?

India needs preventive programmes for not just its youth but all populations. The protection of the rights of the mentally-ill remain inadequate with poor quality of care and violation of rights being common.

Building resilient systems that integrate mental healthcare with the larger public healthcare infrastructure based on evidence is pivotal. The examples of Kerala and elsewhere are instructive. In Kerala, integrating mental healthcare with primary healthcare began in 2011. Primary doctors as well as health workers were trained in mental healthcare at government facilities.

Finally, the most important aspect is the lack of awareness and stigma around mental health – it is one of the biggest barriers to diagnosis and care. India needs to talk about mental health in schools, in colleges and in textbooks. Well-being, self-care and normalising mental illness is urgently needed. We need to make it acceptable for youngsters to say “I am not ok”. Otherwise, this silence will stifle our youth and the well-being of generations to come.

Chapal Mehra is Director at The Rahaat Project and a public health specialist.