Adolescent mental health: pay attention

Some 15 crore people in India are in need of mental health interventions and care, yet mental health is seldom part of the conversation on public priorities. Early intervention is particularly important: globally 10-20% of children and adolescents experience mental health disorders, and three-quarters of all mental illnesses emerge by the mid-20s.

Whilst the importance of physical health of adolescents, especially adolescent girls, has been gaining ground in recent years, mental health remains a neglected and often taboo area. Now, a research paper, containing the first-ever attempt to estimate both the costs and benefits of focusing on adolescent mental health in India, reveals considerable advantages to treating this as a serious health problem.

The research was commissioned by partners Tata Trusts and the Copenhagen Consensus, which approached stakeholders from civil society, business, politics, and beyond, to identify India’s biggest challenges and their solutions, before working with researchers to assess the effectiveness of policies and interventions for each rupee spent.

In the paper, researchers SD Gupta, Md Mahbub Hossain, Neeraj Sharma, PR Sodani and DK Mangal from IIHMR University, Jaipur, note that a lack of awareness about mental health often means that people do not access the services that they need, and only those patients with severe mental disorders are diagnosed and treated.

Untreated mental health conditions in adolescence can carry forward and worsen. It is important to identify signs of trauma or disturbance and offer counselling before these develop into a more serious condition requiring medication. Abuse and violence often cause trauma and mental health conditions, and evidence shows that domestic violence is one of the strongest predictors of suicide among girls.

While there are gaps in the evidence on adolescent mental health, the 2016 National Mental Health Survey of India showed mental disorders among 7.3% of children aged 13-17, with prevalence in urban metros nearly double (13.5%) that of rural areas (6.9%). Major illnesses include depressive disorders (2.6%), disabilities affecting intellectual status (1.7%), agoraphobia (2.3%), autism (1.6%), psychotic disorders (1.3%) and phobic anxiety disorders (1.3%).

To examine the costs and benefits of approaches to helping adolescents, researchers propose a screening, referral and treatment intervention for Classes 6-12 at private and public schools, covering children aged 11-17. Participation would be voluntary, requiring the consent of the adolescent and their parent or guardian. Costs would include human resources for screening, material development and dissemination, along with clinical assessment, linkage to specialised care providers and mental health services.

Taking Andhra Pradesh (AP) as an example, and assuming that 80% of adolescents took part, enrolment and screening would reach 32.57 lakh young people, and about 5.86 lakh youths would be expected to require clinical evaluation.

Including treatment for the roughly two lakh adolescents that would be anticipated to require it, the total annual cost of the intervention amounts to about Rs 122 crore. This would save lives. Just in AP, it is reasonably expected to stop about 164 young deaths from self-harm each year.

Mental health also adversely affects the learning, education and social development of children. Interventions on this front would therefore also considerably reduce mental and physical disability, meaning that people can lead more fruitful, productive lives, and contribute more to society, including economically. The authors calculate that, put into monetary terms, all these benefits are worth Rs 296 crore to Andhra Pradesh economy.

Each state has different demographics and underlying conditions, but using AP as an example, the research shows that investment in adolescent mental health not only ‘breaks even’ but is a solid investment. In AP, it generates returns to society worth more than two rupees for every rupee spent.

Adolescent physical health is also crucial, and researchers highlight the benefits from focusing on anaemia, which affects many girls. Iron deficiency reduces physical fitness, which affects academic performance.

In the long run, this affects maternal and child health and further increases the burden of disease. A notable measure to address this among 10-19 year-olds is the Weekly Iron and Folic Acid Supplementation, which includes supervised consumption of iron and folic acid supplements with biannual deworming medications.

The researchers conduct a cost-benefit analysis for a programme similar to this, but focused just on girls, for whom anaemia is a larger problem. Using AP as an example again, more than 30 lakh adolescent girls suffer from anaemia, and 80,000 from severe anaemia. The intervention is expected to reduce prevalence of all forms of anaemia from 69% to 40%, averting 13 lakh cases. With a total programme cost of Rs 44 crore each year, benefits would be worth nearly 15 times more.

India has a large adolescent population: about 243 million. This research makes a strong case to take adolescent physical and mental health seriously.

(Vakil heads the Policy and Advocacy unit of Tata Trusts; Lomborg is president of the Copenhagen Consensus Centre)