Adolescence Crisis
- A Children’s Day Mental Health Series -

Dr. Mona Nongmeikapam / Dr. Meesha Haorongbam *

Mental health of adolescents: Key facts

o Globally, one in seven 10-19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group.
o Depression, anxiety and behavioural disorders are among the leading causes of illness and disability among adolescents.
o Suicide is the fourth leading cause of death among 15-29 year-olds.
o If adolescent mental health conditions are not properly addressed, they may extend into adulthood.

One in six people are aged 10–19 years. Adolescence is a unique and formative time. The word is derived from the Latin original ‘Adolescere’ meaning to grow or ripen. There are several changes happening in these young individuals, physically, hormonally, biologically, cognitively, socially. These erupting changes make them especially vulnerable to all sorts of adversities and turmoil.

As evident in the recent on-going conflict in the state, these young persons are gullible, emotional and are an easy prey to all sorts of social and environmental calamities. But in them also lies the future of any state, any place and hence protecting them from adversity, promoting socio-emotional learning and psychological well-being, and ensuring access to mental health care are critical for their health and well-being both during adolescence and later on in adulthood.

Globally, it is estimated that 1 in 7 (14%) 10–19 year-olds experience mental health conditions yet these remain largely unrecognized and untreated. They could be at the risk of social exclusion, discrimination, stigma (affecting readiness to seek help), educational difficulties, risk-taking behaviours, physical ill-health and human rights violations.

Adolescence is a crucial period for developing social and emotional habits important for mental well-being. Adopting healthy sleep patterns; exercising regularly; developing coping, problem-solving, and interpersonal skills; and learning to manage emotions are a must.

Protective and supportive environments in the family, at school and in the wider community are important. Risk taking and thrill seeking, validation seeking from peer groups, need to “belong and be accepted”, exploration of identity and a burning curiosity which comes with this age group all add to their vulnerability.

Negative media influence, gender norms, violence (especially sexual violence and bullying), harsh parenting and severe and socioeconomic problems are recognized risks to mental health.

Some adolescents are at greater risk of mental health conditions due to their living conditions, stigma, discrimination or exclusion, or lack of access to quality support and services. Comorbid physical or psychiatric illnesses, social conditions, ethnicity or background can add to these factors.

Emotional disorders

Emotional disorders are common among adolescents. Anxiety disorders (which may involve panic or excessive worry) are the most prevalent in this age group and are more common among older than among younger adolescents. It is estimated that 3.6% of 10–14-year-olds and 4.6% of 15–19-year-olds experience an anxiety disorder.

Depression is estimated to occur among 1.1% of adolescents aged 10–14 years, and 2.8% of 15–19-year-olds. Mood swings, suicidality, substance abuse and school absenteeism or failure could be outcomes due to the above.

Behavioural disorders

Behavioural disorders are more common among younger adolescents than older adolescents. Attention deficit hyperactivity disorder (ADHD), characterized by difficulty paying attention, excessive activity and acting without regard to consequences, occurs among 3.1% of 10–14-year-olds and 2.4% of 15–19-year-olds.

Conduct disorder (involving symptoms of destructive or challenging behaviour) occurs among 3.6% of 10–14-year-olds and 2.4% of 15–19-year-olds.

Eating disorders

Eating disorders, such as anorexia nervosa and bulimia nervosa, commonly emerge during adolescence and young adulthood. Eating disorders involve abnormal eating behaviour and preoccupation with food, accompanied in most instances by concerns about body weight and shape. Anorexia nervosa has higher mortality than any other mental disorder.

Psychosis

Many psychotic conditions emerge in late adolescence or early adulthood. Symptoms can include hallucinations or delusions and could impair their education and day to day functioning.

Suicide and self-harm

Suicide is the fourth leading cause of death in older adolescents (15–19 years). Risk factors are harmful use of alcohol, abuse in childhood, stigma against help-seeking, barriers to accessing care and access to means of suicide.

Risk-taking behaviours

Many risk-taking behaviours for health, such as substance use or sexual risk-taking, start during adolescence. Risk-taking behaviours can severely impact an adolescent’s mental and physical well-being. Substance abuse in the form of alcohol, cannabis or smoking are a high risk in this age group. Interpersonal violence was ranked among the leading causes of death of older adolescent boys in 2019.

Early detection and treatment

1. It is crucial to address the needs of adolescents with mental health conditions.
2. Avoiding institutionalization and over-medicalization, prioritizing non-pharmacological approaches, and respecting the rights of children are key for adolescents’ mental health.
3. In-house counsellors/ psychologists are already on board in several schools across the town to combat the rising adolescence crisis.
4. An exclusive adolescent mental health clinic is in the pipeline.
5. Emergency helplines like the state run Tele Manas ( Toll free numbers 14416 or 18008914416) could be life-saving in a crisis situation.
6. Frequent outreach programmes especially targeting this age-group, creating awareness and clarifying doubts and misconceptions on various topics ranging from substance use, promiscuity, safe sex practices, career counselling and stress management would be a boon.

It can be tough to tell if troubling behavior in a child is just part of growing up or a problem that should be discussed with a health professional. But if there are behavioral signs and symptoms that last weeks or months, and if these issues interfere with the child’s daily life at home and at school, or with friends, you should contact a health professional.

RED FLAGS:

o Have lost interest in things that they used to enjoy
o Have low energy
o Sleep too much or too little, or seem sleepy throughout the day
o Spend more and more time alone, and avoid social activities with friends or family
o Diet or exercise excessively, or fear gaining weight
o Engage in self-harm behaviours (such as cutting or burning their skin)
o Smoke, drink alcohol, or use drugs
o Engage in risky or destructive behaviour alone or with friends
o Have thoughts of suicide
o Have periods of highly elevated energy and activity, and require much less sleep than usual
o Say that they think someone is trying to control their mind or that they hear things that other people cannot hear

These young vulnerable individuals are just a step away from being the pillars of our society. Let us invest their well-being: physical, mental and social so that we can rest assured that our future rests on able and trustworthy hands that will raise us to greater heights.

Dr. Mona Nongmeikapam (pukningpothasang(AT)gmail.com)-
Assistant Professor,
Department of Psychiatry,
Regional Institute of Medical Sciences

Dr. Meesha Haorongbam (meeshahao(AT)gmail.com)-
Senior Resident,
Department of Psychiatry,
Shija Academy of Health Sciences