Best known for his work on child development and mental disability in low-resource settings, Indian psychiatrist and researcher Vikram Patel was recently involved with the launch of an online platform ~ It’s Ok To Talk ~ that deals with young people’s mental health. Currently Joint Director of the Centre for Chronic Conditions and Injuries at the Delhi-based Public Health Foundation of India, Dr Patel discusses with Ajita Singh depression, mental health and adolescence.

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Q: What is the status of mental health in India? A: These days, young people are more prone to suicides due to depression; in fact suicide is the number one cause of death among young Indians. Q: How different is it from earlier times?

A: The conversation has changed. The openness to discuss depression and other mental illness has lightened the burden of the disease, and made it easier for people to reach out and get help.

Q: Given that the conversation around mental health has gained mileage, how much has the environment surrounding mental health, especially depression, changed?

A: Compared with when I started work in this sector twenty years ago, there is a much greater openness to talking about mental illness. Even the Prime Minister talked about depression in his recent radio address to the people and our government has just passed one of the most progressive mental health legislations in the world. But now, the responsibility falls on all concerned sectors, not just in the government, but also in the health professional communities and civil society, to work together and with commitment to leverage the Bill and use it to transform the lives of people affected by mental health problems in this country.

Q: Does adolescent mental health often get confused with teenage rebellion?

A: Occasionally it does, and this is not surprising. Adolescence is a period of life when dramatic physiological and psychological changes coincide with unique developmental changes in the brain and a variety of social expectations and aspirations. It is for this reason that adolescents can experience a range of emotional states and experience a range of stressors which are unique to this phase of life. Indeed, impulsivity, risk-taking and reward-seeking behaviours are considered normative in adolescents. In extreme situations, this can translate into a mental health problem; in fact, most mental health problems emerge in adolescence and young adulthood. As one example, a teenager could feel deeply unhappy if they have been denied the right to love someone of their choice, which may evolve into a clinical depression and result in selfharming behaviour.

Q: What are the signs that parents and guardians should look out for?

A: Parents and guardians should remember that everyday ups and downs in mood, impulsivity and risk taking should be dealt with maturity and understanding; this is a normal part of growing up and will ultimately pass if managed with patience, love, respect and guidance. A consistent change in harmful behaviour, deteriorating academic performance, or sustained withdrawal could be a cause for worry.

Q: Is there a relation between sexual and reproductive health and rights and the incidence of depression among adolescents and young adults?

A: Yes, and this is not surprising for two reasons: first, this is the phase in life when an individual achieves sexual maturity with the dramatic physiological and psychological changes which characterise puberty; and secondly, this maturation is accompanied by profound changes in expectations which are heavily influenced by social norms and values related to gender. All of these can interact to lead to mental health problems, for example in young women whose freedoms are denied. Further, we also know that poor mental health is associated with early marriage and child-bearing, which are more reasons why marriage and childbearing should never take place in adolescence.

Q: Recently, the Health Ministry in partnership with PFI and UNFPA launched the Saathiya Resource Kit to equip peer educators to work with adolescents under the Rashtriya Kishor Swasthya Karyakram (RKSK) programme. What is your professional opinion on the Saathiya Kit?

A: One of the characteristics of the adolescent phase of life is the shift in dependence from one’s parents, typical of young children, to one’s peers. It is for this reason that information coming from peers is expected to have a greater impact on teenagers as opposed to advice from parents or other adult figures. The Saathiya Resource Kit builds on this fundamental shift in adolescent behavior. It remains to be seen what the impact of the Saathiya programme will be. This is what we at the Public Health Foundation of India are doing in partnership with two state governments and the London School of Hygiene and Tropical Medicine.