India is a country teeming with more than 1.4 billion people, and is in the throes of a demographic transformation. Its adolescent population, aged 10-19 years, accounts for a substantial portion of the national total, some 253 million. This demographic segment is a significant part of what economists and demographers have come to call the ‘demographic dividend’.
These young minds hold the promise of economic prosperity and development – but few also acknowledge that this potential actually hinges on these young men’s and women’s physical as well as mental well-being.
Youth mental health out of focus
Adolescent health and well-being have become important in public health discourses worldwide. Acknowledging the adolescent cohort’s pivotal role in society, the governments of both the States and the nation have introduced numerous policies and programmes to protect and respond to the health-wise needs of these young individuals. However, a closer look reveals that mental health does not figure as predominantly as warranted in many of these policies.
Adolescence is a time of profound transformation. It marks the transition from childhood to adulthood, and is laden with challenges – including those related to the perception of one’s body and body image issues. Society’s expectations regarding the ‘ideal’ behaviour and body types can significantly affect physical and mental health. The weight of academic expectations, peer pressure, and concerns about the future also take a toll on mental health at this time.
The Rashtriya Kishor Swasthya Karyakram (RKSK) is a Government of India policy that deals exclusively with adolescent health. It was rolled out on January 7, 2014. But despite having been in operation for nearly a decade, the mental health strategies under this policy have been implemented painfully slowly.
Under the purview of the National Health Mission, State governments were responsible for implementing the RKSK policy – including setting up ‘Adolescent Friendly Health Clinics’ as part of its facility-based strategies.
But to this day, the RKSK has not shared data on its critical components, including (but not limited to) mental health, violence, injuries, and substance misuse. It has also initiated few discussions on the curative aspect of mental health. And despite having recruited and trained numerous counsellors (both male and female) dedicated to adolescent health within the first three years of RKSK, many district-level vacancies persist.
Other policies – like the Sarva Shiksha Yojana (focused on learning disabilities), the National Youth Policy (substance abuse), the National Mental Health Policy, the Yuva Spandana Yojana (only in Karnataka) – address various immediate and underlying factors that affect mental health. However, most policies that are centred on adolescents have regarded mental health as a secondary concern.
An epidemic in the wings
Adolescents in India are particularly vulnerable to mental health problems like anxiety disorders and depression. Official reports have stated that among Indians aged 13-17 years, the prevalence of severe mental illness was 7.3% (as of 2015-2016). Even three years after the onset of the COVID-19 pandemic, mental health disorders among adolescents – often concealed beneath the promise of prosperity associated with this demographic – continue to become more common and have their effects felt.
An informal survey conducted by one of the authors (Smriti Shalini) from the Tata Institute of Social Sciences, Mumbai, earlier this year revealed little awareness of RKSK among school-going adolescents, parents, and teachers in the urban slums of Mumbai – and less so of the digital interventions of RKSK, a mobile app called ‘Saathiya Salah’ and an e-counselling within that app. Further, during a focused group discussion, students attending a school that facilitated access to a school-based counsellor said that they had negatively labelled the counsellor as a “tension teacher”, and that they were reluctant to share their concerns with this individual, fearing that they might be reported and have their privacy violated.
In India, mental health disorders are underreported due to poor awareness, lack of help-seeking behaviour (stemming from stigma), a desire and/or expectations to be self-reliant, and insufficient prioritisation in the policy framework. Schemes designed to improve access to mental healthcare need to accommodate these factors.
In addition, through various studies, researchers have identified poverty, childhood adversity, and violence as the three main risk factors for the onset and persistence of mental-health disorders. They were also associated with poor access to good quality education, lack of employment, and reduced productivity. Educational failures and mental disorders in adolescence also interact in a vicious cycle.
Equity in healthcare remains a significant issue in India, and this also extends to mental health. Access to mental healthcare services is often skewed along the same lines – wealth, caste, location, gender, etc.
Gender disparities are particularly worrisome. Adolescent girls in India face unique challenges, including gender-based violence and discrimination, that can severely affect their mental well-being. Conversely, adolescent boys are commonly expected to conform to masculine ‘norms’ of stoicism and are victims of bullying and shaming. Many children from ‘broken homes’ also experience dysfunctional family relations and face discrimination within the family, often resulting in bottling-up as well as issues with managing anger and delegating authority.
A dividend beckons
Based on studies, surveys, and discussions with stakeholders, experts have identified the following solutions.
First, policymakers should endeavour to shift from the current “medical model” of mental health to the convergent model of mental health: the latter recognises the complex interplay of behavioural, environmental, biological, and genetic factors throughout an individual’s life, especially during the crucial stages of childhood and adolescence. To this end, well-meaning programs like RKSK can learn from the experiences of other countries to better implement its vision.
For example, the successful implementation of the ‘Whole School, Whole Community, Whole Child’ model in the U.S. embraces a holistic approach to children’s well-being by considering factors such as nutrition, physical activity, and emotional health within the school environment.
Initiatives like establishing peer support groups in schools and colleges and community-based interventions leveraging technology can also encourage help-seeking behaviour.
Second, a multi-sector approach that includes underlying factors like education and nutrition should be at the core of policies to realise the full potential of adolescents. India’s youth is aspirational and deserves a good education. We need better pedagogy and resources that provide well-rounded development as well as employment. A good education empowers youngsters to access resources, assert their rights, and tackle societal and family issues better.
Third, we must recognise that a healthy mind thrives within a healthy body. The government should continue to make the improvement of school environments and health-promoting conditions a priority in parallel with efforts to combat pressing health concerns like malnutrition and anaemia.
Our nation’s future is banking on evidence-based policy-making and unwavering political commitment to be able to move mountains.
Smriti Shalini is pursuing a Master of Public Health in Health Policy, Economics and Finance at the School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai. M. Sivakami is a professor here.