Youth and Mental Health

Transcription

1 Youth and Mental Health Health is a state of complete physical, mental social well-beings and not merely the absence of disease or infirmity (WHO, 1948). Many people seek health services when they have physical problems however, not necessarily for mental health problems. Globally mental health issues are one of the leading risk factors for deaths among youth, and also a leading cause of lost DALYs (disability adjusted life years). Mental health problems affect 1 out of 4-5 children and adolescents worldwide. In 2011, the World Health Organization supported the World Mental Health Survey, which found that many mental disorders have their onset in childhood or adolescence, in fact half of lifetime mental disorders appear by age 14. However, diagnosis and treatment often start later in life. A global consultation by WHO found that mental health is considered the most important health problem by adolescents today and that they would like to have greater access to mental health care services. Common mental disorders in youth are depression disorder, bipolar disorder, schizophrenia and substance abuse. Many of these are a risk factor to suicide, which is one of the leading causes of mortality in youth. Few countries monitor suicide attempts in youth and none of the countries in the South Asia region ask about suicide attempts in school based surveys. Some data suggests that the prevalence of suicide attempts in the preceding 12 months for adolescents from 12 to 18 years old is around 15 percent in low and middle-income countries, however comprehensive data from SEAR is lacking. In Nepal, mental health is often overlooked and the vast majority of the population who needs mental health services does not know where to seek care or has no access to treatment. The UN Convention on the Rights of Persons with Disabilities - which was also ratified by Nepal, defines persons with disabilities as those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. The Convention specifically refers to the right to respect the physical and mental integrity of persons with disabilities on an equal basis with others (Article 17) as well as the right to Provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes (Article 25 (a).. These rights, unfortunately, remain largely unfulfilled in Nepal. 1

2 Mental health status of adolescents and young people in Nepal According to the Nepal Adolescent and Youth Survey (NAYS) 2012, mental health status among A&Y is linked with different conditions and situations and may be presented as subjective distress or disability. Furthermore: It is estimated that about 25% of the total population is suffering from mild to severe type of mental illness. The NAYS (2012) results reveal that 11% of A&Y reported that they felt sad and depressed for several days during 12 months preceding the survey. A higher proportion of A&Y from Mountain and Far-western region reported having psychological problems than those from other regions. Higher percent of females (12%) than males (9%) reported that they felt sad and depressed for several days. Among the respondents who reported having any type of psychological problem, 3/4 th A&Y (76%) suffered from anxiety and about 44% felt hopeless. Around 13% had also thought sometimes of committing suicide due to low socio-economic status. Girls were more likely to experience different stages of psychological problems than boys and were more vulnerable of suffering from mental illness. Studies worldwide have shown that there is a clear strong link between gender-based violence and key indicators of women s mental health, well-being and risk of suicide attempts. According to the Nepal Maternal Mortality and Morbidity Study (2008/9), suicide (16%) is a leading cause of death among women of reproductive age (15-49 years). Among them, there is an increased risk between the age group of years and after the age of 45. The review of the evidence: Suicide among women in Nepal (UNFPA, NHSSP, UKAID 2011) further indicated that suicide accounted for a far greater proportion of deaths among unmarried women than those married. Younger age groups (e.g. adolescents) are emerging as a high risk group as their psychological coping mechanisms may be inadequate to manage life s major stressors they might encounter for the first time. Health seeking behavior: NAYS (2012) showed that only 20% of a total 14,754 adolescent and youth surveyed sought medical treatment for their mental illness. Among those who sought treatment, around 43% of them visited government hospitals and about 4% visited Dhami/Jhankri (traditional healers) for treatment, with the vast majority being girls. 2

3 Policy, plans and services available in Nepal: The existing Mental Health Policy was approved in In addition, Nepal ratified both The convention on the Rights of Persons with Disabilities and the Optional Protocol in May For the very first time in Nepal, the National Health Sector Programme (NHSP- II) , has included mental health in the "essential health care" programme. At the policy level however, there is no mechanism to monitor human rights violations and inspect mental health facilities that persistently violate patients' rights as per Convention s guidelines. For mental health treatment, there is scarcity of resources such as trained human resources, service centers with proper infrastructures. The services that are available are concentrated in urban areas and are often costly and based for the most part on medication. There is only one government-run mental hospital (with 50 beds) in Lagankhel, Nepal. There are approximately 50 psychiatric clinics, 12 psychological counseling centers and 50 registered psychiatrists in the country. Some medical colleges are also providing psychiatric services. There are also a number of major NGOs working for mental health in Nepal in the area of counseling, services, training, and rehabilitation which have formed the National Mental Health Network : 1. Livelihoods Education and Development Society 2. Kopila Nepal 3. Elijah Counseling and Training Center, Jhamsikhel, Lalitpur 4. Ankur Counseling Center 5. Tansen Mission Hospital, Tansen, Palpa 6. United Mission to Nepal, 7. Mukti Network 8. Richmond Fellowship Nepal 9. Mental Health and Research Center Nepal 10. Higher Ground Counseling Center 11. Nepal Mental Health Foundation 12. ANTARANG, Psychosocial Research and training center, Jyatha, Ktm 13. Children and Women in Social Service and Human Righsts 14. KOSHISH Mental Health Self-Help Organization, Satdobato, Lalitpur 15. Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu 16. Center for Victim of Torture, Nepal 17. Maryknoll Nepal 18. Chhahari Nepal for Mental Health 3

4 In addition to the network of NGOs, the following organizations are also working on mental health issues: 1. AASHA DEEP, Chandol, Kathmandu 2. Mental Disease treatment and Rehabilitation Center, Mulpani, Kathmandu 3. Help-Nepal, Mahalaxmithan, Lalitpur 4. Manochikitsalaya, Kandaghari, Kathmandu 5. Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu 6. Medicare National Hospital and Research Center Ltd, Chabahil, Kathmandu 7. Kathmandu Medical College, Sinamangal, Kathmandu 8. Nepal Medical College, Jorpati, Kathmandu 9. Norvic International Hospital, Thapathali, Kathmandu 10. Punarijiva Hospital, Gwarko, Lalitpur 11. Aarogya mandir Hospital, Tilganga, Kathmandu 12. Community Mental Hospital, Nayagaun, Kathmandu 13. Tranquility Hospital and Research Center Pvt. Ltd., Khumaltar, Lalitpur 14. Patan Community based Rahabilitation Organization, Patan Dhoka, Lalitpur 15. Ankur Counseling Center 16. Bishraam Mental Health Center, Bhainsepati, Lalitpur 17. Down s syndrome in Nepal, Kapurdhara, Kathmandu 18. Down s syndromes Association of Nepal, New Baneswor, Kathmandu 19. Center for Mental Health and Counseling-Nepal, Thapathali, Kathmandu Advocacy issues: Educating the community and increasing the support obtained from policy-makers; Denouncing stigma and discrimination, and requesting more and improved services; Providing support to protect patient rights and raise awareness for improved services; Supporting advocacy activities with general health workers and mental; health workers, policy-makers and planners and the general population; Lobbying for mental health treatment and counseling services in peripheral level health facilities; Supporting the expansion of community mental health programmes; Increasing social mobilization for the prevention, treatment and rehabilitation of people with mental or psychosocial disorders and emphasizing families role as a primary care provider. Preventing and detecting mental health issues among young people through mental health awareness in schools. Often mental health disorders in adulthood are developed during childhood and adolescence. Awareness can also provide simple coping mechanisms for handling life crisis that can trigger extreme reactions among young people. 4

5 Ensuring that adolescents and particularly girls have the education and services they need to lead a healthy and happy life, free of mental illness, and fulfill their potential. Comprehensive sexuality education plays a role in building knowledge, skills and values for good physical and mental health and gender-equal relationships. Ensuring that young people have access to a comprehensive package of health services include sexual and reproductive health along with mental health prevention, diagnosis and treatment - including counseling for HIV and peer education. Youth participation strengthens the confidence of young people to participate in the social, economic and political life of their communities and countries - not only as a democratic imperative but at a personal level also strengthening young people's self-confidence and autonomy. 5