The Edition



Mental Health: We are all in this together

Dr Arvind Mathur, WHO Representative to Maldives
12 October 2018, MVT 10:13
Mental health is a global issue that affects all of us. PHOTO: WHO / THE EDITION
Dr Arvind Mathur, WHO Representative to Maldives
12 October 2018, MVT 10:13

Commemorating 'World Mental Health Day 2018' (October 10), The Edition brings readers an expert opinion from our guest writer Dr Arvind Mathur, the Maldives representative for the World Health Organization.

The world now has more young people than ever before – of the 7.2 billion people worldwide, over 3 billion are less than 25 years of age, making up 42 percent of the global population. Around 1.2 billion of these young people are adolescents aged between 10 to 19 years, meaning 1 in 6 people around the globe are aged between 10-19.

Adolescence is a critical time of life- a transitional period when people become independent individuals, form new relationships, develop social skills and learn behaviours that will last the rest of their lives. For many of us, this is the most exciting period of our lives but for some, it could be very stressful and, in some cases, where problems are not, and managed; it could result in mental illnesses too.

Adolescence is also a crucial period for developing and maintaining social and emotional habits important for ones' well-being. These include adopting healthy sleep patterns, exercising regularly, developing coping, problem-solving and interpersonal skills; and learning to manage emotions.

In this turbocharged transition from childhood to adulthood, multiple factors determine the mental health of young people. Factors which can contribute to stress during adolescence include a desire for greater autonomy, a pressure to conform with peers, exploration of sexual identity, and increased access to and use of technology.

Media influence and gender norms can exacerbate the disparity between an adolescent’s lived reality and their perceptions or aspirations for the future. Other important determinants for the mental health of adolescents are the quality of their home life and their relationships with their peers.

Adolescents are often exposed to harmful products such as tobacco, alcohol and drugs; they face greater risks of violence and road traffic injuries than in childhood and can experience devastating mental health issues such as depression, anxiety, self-harm, substance abuse and addiction to video games, as well as eating disorders and suicide. Young people can also face sexual health issues such as sexually transmitted diseases or unplanned pregnancies.

It is important to realize; that half of all mental illnesses begin by the tender age of 14, and most of these cases go undetected and untreated! Mental health issues are part of a growing problem in the Maldives as well, especially amongst the younger population.

The Global School Health Survey (2015) in the Maldives, which covered adolescents (between 13-17 years) constituting around 8.5 percent of the population. reported that 15 percent of had anxiety, 16 percent reported loneliness and 9 percent said that they did not have any close friends.

Alarmingly, 19 percent admitted to having suicidal ideation complete with a plan, while 13 percent had attempted suicide.

There are always faces behind such numbers, in this case it is that of young ones, as we let the precious gift of life become compromised.

Health and well-being (especially mental wellbeing) of young people takes a toll as he/she faces fierce competitiveness on a day-to-day basis, juggles and tries to manage expectations frequently with little to no coping mechanisms, as a cluttering of stress, anxiety and loneliness serves only to compound this further.

Slowly but surely, depression, anxiety and other mental health issues can creep up as she/he finds solace by spending long hours in virtual reality of social media or on the internet. Sadly, we often fail to recognize or refuse to acknowledge, these signs and allow young people to camouflage their emotions, feelings and anxiety.

Denial at the early stage not only by young people, but even by parents and family members, are common and the associated stigma makes access to help even more difficult and challenging.

To live happier lives, there is surely a growing need for raising awareness of mental health issues. The World Mental Health Day that falls on 10th of October every year offers this very opportunity- to raise awareness, advocate and educate people- “Young People and Mental Health in Changing World” as the theme for this year bring the focus to building mental resilience from the early stages of transition to cope with the challenges of today’s world. For tech-savvy Maldivians today; every young person has a smartphone bringing the world even if virtually to his/her palm.

The technology brought so many positive changes in our lives with the ‘world wide web’; bringing loads of information rapidly- at times more than we need to the ways we communicate and relate to one another, or the way we decide to spend our time; be it for entertainment on Netflix or Spotify or reading online newspapers or even playing video games online.

Using any of the digital communication tools like Viber, Twitter, Facebook and Instagram to share concerns, read affirmations, or express feelings and moods may many-a-time bring solace and happiness. Given the variety of health apps for smartphones, including the connection in real time to counsellors, young people may feel more secure and safe due to the perceived confidentiality and anonymity.

Suffice to state that we are continuously adapting to the ever-exploding potential of information technology and almost all segments of the population but especially young people, who are more exploratory even biologically, may also get carried away in bringing smartphone's stark difference over their lives and perceived reality.

Often the same social media platform may result in a young person feeling bullied, misunderstood or even excluded. Uncontrolled use of social media is known to pose adverse effects on a young person’s mental health and may trigger antisocial behaviour. The quality of their time spent at home and their relationships with siblings and peers are an important determinant of their mental health.

The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

Therefore, to strengthen protective factors and enhancing alternative to risk-taking behaviours; communities, institutions and relevant authorities have to prioritize interventions prompting adolescent mental health and well-being in building resilience so they can cope well in difficult situations.

Prevention begins with being aware of and understanding the early warning signs and symptoms of mental illness. Parents and teachers can help build life skills of children and adolescents to help them cope with everyday challenges at home and at school.

Creating a safe environment at home, school, workplace and within communities as well as a multi-sectoral approach of health, education, sports and other sectors through comprehensive, integrated and evidence-based programs, is essential for young people’s mental health.

The health sector has experimented with one such approach of “Adolescent and Youth Friendly Health Services” that aims to offer accessible, quality assured safe space with psychological and psychiatric services per their needs. The need for de-medicalising the mental health services and addressing stigma through increasing awareness is critical.

Psycho-social support, as part of a comprehensive mental health care system, is the need of the hour.

The inclusion of mental health in the Sustainable Development Goals has brought new hope and enhanced visibility to mental health a public health priority.

It is heartening to note that the Ministry of Health, with support from WHO has developed a Mental Health Policy, which is a strategic and operational plan that calls for multisectoral actions.

Let us make lives around us happier and healthier- in our homes, neighbourhood, schools and on our phones.

We are all in this together, as you and I need to learn to accept and understand young people; by being non-judgemental, listening to them and working with them to decide the ‘what and how’ of managing changes.

Let us continue the conversation and most importantly, let us make taboos around mental health, and discrimination towards people with mental health conditions a thing of the past.

Let us spread the message of living life to our full potential. In other words, a ‘state of complete physical, social and mental well-being' and not merely 'the absence of disease or infirmity’, and truly commit to the slogan ‘No Health without Mental Health’.

After all, mental health matters to everyone. We are all in this together.