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World Suicide Prevention Day: Connecting with the young, before it’s too late

  • Poor mental health literacy of children’s psychological issues proves a major stumbling block   

BY Sumudu Chamara

To a lot of us, the Covid-19 pandemic is the most disastrous event we have experienced in our lifetimes, and dealing with the changes and challenges it has caused has been an uphill battle. As a result, there is now a pressing need to protect not only our physical health, but our mental health as well.

Today (10) marks World Suicide Prevention Day, a day dedicated to raising awareness on suicide prevention. Internationally, this day is observed by the International Association for Suicide Prevention (IASP), in collaboration with the World Health Organisation (WHO) and the World Federation for Mental Health (WFMH), in addition to countless other groups around the world. It has been observed since 2003.

Last year, World Suicide Prevention Day was observed under an extremely stressful environment due to the Covid-19 pandemic, and the situation is more or less the same this year as well. According to mental health experts, the pandemic has affected people’s mental health in various ways, leading to difficulties such as domestic violence and substance abuse, among others. Therefore, it would not be an overstatement to note that the need to address mental health issues, a common factor leading to death by suicide, has increased.

According to the WHO, more than 700,000 people die by suicide every year, making it the fourth-leading cause of death among the global 15-19-year-old population, thus highlighting it as one of the age groups that requires more attention concerning mental health.

But do we pay enough attention to the children and adolescents confined to their homes, dealing with disrupted education and limited outdoor activities due to the pandemic, in a context where the adults looking after them are also going through a difficult time? How should our discourse about their mental health improve? These are questions that merit discussion. 

Today’s Spotlight looks into these matters.

Awareness 

To discuss mental health issues affecting children and adolescents during the pandemic and lockdowns, The Morning spoke to Colombo North General Teaching Hospital, Ragama Consultant Child and Adolescent Psychiatrist and Kelaniya University Medical Faculty Senior Lecturer Dr. Miyuru Chandradasa.

He emphasised that Sri Lankans’ basic understanding of psychological concepts does not come from Sri Lankan culture, adding that since most of the people are not aware of basic psychological concepts, their capacity for psychological mindfulness (a person’s capacity for self-examination, self-reflection, introspection, and personal insight) is also limited. He noted that this issue is not limited to Sri Lanka, and that it is prevalent in the South Asian region as well, adding that looking into mental health literacy would be the most important step in creating an environment where parents (homes) and teachers (schools) are conscious of children’s mental health.

Not having identified the said inadequacy, however, is a challenge in Sri Lanka, according to him.

“When we discuss mental health literacy, we are mainly talking about adult psychological issues. However, as far as children’s mental health issues are concerned, literacy is extremely low,” Dr. Chandradasa said.

Adding that a recent local study, which has not been published yet, has also shown this situation, he noted: “Once, we did a study in Ragama about mental health literacy on children’s mental health among preschool teachers and parents, and it has shown that mental health literacy about children’s psychological issues is extremely low.”

Therefore, he said that there is not enough dialogue to educate teachers and parents about children’s mental health issues. Cultural stigma about mental health disorders, which is a result of the fact that people are scared and embarrassed to talk about mental health issues, is one of the barriers that continue to affect this dialogue, according to Dr. Chandradasa.

He added: “When addressing this issue, rather than trying to change adults, whom we can change is teenagers, because those in their teenage years still have not embraced the traditional negative outlook about mental health. If we can approach them, and if we can educate them through social media, newspapers, and electronic media, then we can at least raise awareness among them about basic concepts such as emotional awareness. That would be a huge step forward.”

When queried about his opinion about introducing mental health as a school subject or as a part of a school curricula to raise awareness among children, he added: “Rather than introducing mental health as a school subject, what we need to do is change the education system from the exam-driven education system to a skills and competencies-based educational system. When it comes to a competency-based education system, there should be time allocation to learn relaxation, empathetic response, time management skills, and problem-solving techniques, rather than teaching mental health as a subject. Some psychological skills should be taught to children. That is more useful in the long run.”

Attention 

According to Dr. Chandradasa, the basic way to detect and understand mental health issues in children and adolescents is to understand changes in their behaviours, thoughts, and emotions.

He explained that behavioural changes usually involve changes in children’s activities for the worse, which usually involve negative thoughts in a child (usually of a child who had positive thoughts). Emotional changes, according to him, are usually indicated by a negative change in children’s emotional stability and patterns. He stressed that instead of trying to deal with these changes in a child at home, parents should seek professional support, as mental health issues can be extremely complex.

“In a context where children spend more time with the internet than they did before due to the pandemic lockdown, parents should also be attentive about what children do on the internet, especially when they spend excessive time on gaming, which is likely to affect children’s mental health,” he said, adding that such mental health conditions, especially those involving addiction to computer and video games, are recognised by the WHO and the American Psychiatric Association as well. 

Discourse and standards

As per Dr. Chandradasa, one of the reasons Sri Lanka is giving considerably less attention to mental health is because the country has not identified it as a priority due to other basic needs. 

“Mental health becomes a topic when basic human needs are fulfilled. According to psychologist Abraham Harold Maslow’s hierarchy of needs (a concept that focuses on different needs of humans such as physiological needs, safety needs, love and social belonging-related needs, esteem-related needs, cognitive needs, aesthetic needs, and self-actualisation-related needs), if the basic needs such as food, safety, belongingness, and relationships are fulfilled, people start thinking beyond that. So that is why in affluent, developed countries, mental health is a daily topic. But in countries such as ours, people have had to focus on other matters such as fulfilling the basic needs.”

He stressed that due to a higher importance assigned to other basic needs, mental health-related matters are usually not viewed as important as other topics, which in turn makes it difficult to have a productive dialogue on mental health.

In this regard, Dr. Chandradasa explained that Sri Lanka can learn from what has been done in other countries.

“I think that one thing that needs to happen in Sri Lanka is celebrities coming forward and talking about their own mental health issues, especially targeting the young generation. Many young people admire that and they would be inspired to talk about their mental health issues without fear. We can take many examples from other countries. Celebrities openly talking about their own mental health could be a first step in strengthening the dialogue about mental health.
“Secondly, even though Sri Lanka’s situation is not very promising in this regard, politicians should also accept the importance of mental health policies and give more support for mental health services like that which takes place in other countries. Also, we need to provide more backing to uplift the country’s mental health services. If a teenager talks about his/her mental health situation, the next question that arises is whether our mental health services are equipped to assist them. In Sri Lanka, at the moment, there are only eight child and adolescent psychiatrists, and they alone cannot cater to the mental health needs of eight million children and adolescents. Therefore, we need to provide more human resources and allocate more funds for this purpose. There is a concept called ‘parity of esteem’ (a concept advocating for equal attention for mental and physical health). If we look at the allocation of resources for mental health in developed countries, the percentage allocated for mental health-related matters itself indicates whether it is a developed country.”

When questioned as to whether any changes need to be made in terms of local mental health service-providing systems, he added that child and adolescent psychiatrists in Sri Lanka are well qualified and that their qualifications are up to international standards. However, he stated that owing to the lack of resources, there may be some issues pertaining to standards, as due to the lack of human resources in the field, the time that can be spent on one child may be limited. 

“In that sense, our standards may not be up to their level, but the expertise is equal to those of other countries,” he noted.

Mental health needs during pandemic, lockdowns 

According to leading mental health services provider, Sri Lanka Sumithrayo, during the first two quarters of this year, a considerable number of individuals had sought mental health services from the organisation.

Sri Lanka Sumithrayo statistics showed that in addition to traditional face-to-face counselling, people show a considerable interest in obtaining services including counselling via other communication methods such as phone, electronic mail, and Facebook, especially during lockdowns during the same period. Of the total number of cases, the majority of individuals had sought support via such non-physical methods.

In January, February, March, and April of this year, Sri Lanka Sumithrayo had assisted 196, 195, 227, and 149 persons, respectively. In the same four months, the number of people contacting the organisation to obtain assistance for suicidal ideation was 25, 32, 34, and 20, respectively. However, no details about the number of people who had sought assistance regarding such matters in May and June were available.

In addition, a large number of online training and knowledge-sharing sessions had been carried out from February to August, and some of these events focused on dealing with mental health-related matters during the pandemic and lockdowns, statistics issued by Sri Lanka Sumithrayo showed.

Even though Sri Lanka has been identified as one of the countries with the highest suicide rates, according to the Directorate of Mental Health, from 2011 to 2016 (the latest available data), deaths by suicide have declined.

According to the WHO, 77% of global suicides occur in low and middle-income countries. Sri Lanka being a middle-income country, which, according to some reports, has reported high suicide rates in the past, should perhaps pay more attention to augmenting the available mental services and encouraging those in need of support to actually obtain these services. 

However, more than the act of dying by suicide, it is the factors that drive people to do so, that should receive our attention, and that is why, as the expert who spoke to The Morning underscored, an open discourse about mental health, especially that of children and adolescents, is necessary. It can start from home.

If you feel that you or someone you know may be dealing with mental health issues and/or suicidal thoughts, the following institutions would assist you to deal with it.

Sri Lanka Sumithrayo: 0112 682 535

The National Institute of Mental Health: 1926

Shanthi Maargam: 0717 639 898

Courage Compassion Commitment (CCC) Foundation: 1333