A study published in the Lancet has found the efficacy of “brief lay counsellor delivered, problem solving intervention” for mental health problems in adolescents from government schools in Delhi. The mental health of school children between classes 9 and 12, studying in six government schools from a low income neighbourhood in national capital were monitored for the purpose of the study.
The study, conducted over a year, was carried out by researchers from across the world associated with the Premium for Adolescents (PRIDE) programme: a six-year research programme dedicated to making psychosocial interventions for improving the mental health of adolescents in India. The programme is implemented in association with the Public Health Foundation of India (PHFI), the London School of Hygiene and Tropical Medicine and Sangath, while it was funded by a UK-based research charity Wellcome Trust.
“The study established that with limited resources and counselling intervention, we can give practical tools to adolescents to manage and deal with their mental health issues. This also makes mental health treatment accessible to those from underprivileged sections of society,” says Dr Kanika Malik, a clinical psychologist working with Sangath, a Goa-based not profit organization that works towards improving public health in India.
More than 250 adolescents were enrolled for the programme between August and December of 2018. Out of them, 125 were allocated to a group, which received intervention solely through a problem solving booklet, while the remaining half of the group received limited counselling from a lay person along with the problem solving booklets.
Though this study was conducted over a span of a year, the Lancet study records observations made after 12 weeks of the programme’s initiation in Delhi. “At the end of it we found that both methods were effective in treating mental health issues in these adolescents, but the group which received limited counselling sessions along with the problem solving booklets fared better in terms of improving their mental health by the end of 12 weeks,” says Dr Malik.
The problem solving booklet was based on a form of counselling in adolescents where basic problem solving exercises facilitates learning how to deal with mental health issues on their own. The booklets were made in a comic book format. “We placed the characters in situations which we knew would be relatable to these students. The problems which the characters talk about in these booklets are based in the socio-economic context of these students,” explains Dr Malik. “For example, one panel in the comic book deals with how to tell your father that he is being violent or loud and aggressive. Domestic life can be a major source of stress for these students and they don’t have the resources to tackle these situations but the comic book gives them tools to work through them,” adds the psychiatrist.
Apart from distributing the booklets to the adolescents, the team of researchers hired and trained members of the community to counsel students. Those trained had no prior experience in psychological counselling and did not even necessarily have a degree in psychology. Instead, these were community members who were dedicated and sensitive to the issues faced by these students. They were trained for a few weeks before they began the programme.
“In this way not only did we give employment opportunities to locals, but we also ensured that these were people who related and empathized with the socio-economic background of these kids, the stress they faced, the abuse they might face at home and the anxieties that plague them. These are also very accessible people for the children, who feel more comfortable speaking to them,” says Dr Malik. Furthermore, the doctor explained that since most government schools in low income localities do not have the resources to hire professional counselors for their students, developing this model of intervention will allow more students to receive treatment despite limited resources.
More than 99 per cent of adolescents and children with mental health problems remain undiagnosed in India. Dr Malik adds that if these students received adequate treatment at this stage of their lives they are less likely to develop more serious mental health problems at a later stage in life. “In fact, around 75 per cent of adults with mental health issues can source the root of their problems in childhood and adolescence, adds the doctor. The Covid-19 pandemic has only augmented the burden of mental health disease in India, hence developing feasible models of intervention has become even more crucial objective for the researchers.
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