Introduction

Mental Health is usually assumed as the antonym of mental illness or in other words it is absence of any psychopathology. This explanation ignores the concept of positive health and therefore attempts have been made to provide a definition from a broader perspective. Mental Health is a state of well being in which the individual realizes his or her own abilities, can cope with normal stresses of life, can work productively and is able to make contributions to his or her community (Atlas of Child and Adolescent Mental Health Resources, 2005). Achieving mental health and maintaining it consists of two functions. One is preventing and treating various psychological disorders and other is about promoting mental health & well being.

However, concepts of mental health in adults are difficult to generalize and assess in child population due to following reasons:

1. The child is continually changing and growing. Sound knowledge and thorough assessment with culture specific tools is therefore required for understanding normal developments and its limits. Behaviors change as a child develops hence it is not clear whether the same diagnosis can be applied across the age range for example: temper tantrums are normal in 4-5 years but it becomes a point of concern at 8-9 years.

2. Child’s difficulties may arise in context of relationship within the family. The problem may be in structure and functioning of the family rather than in the individual child.

3. Co-morbidity can be associated childhood problems. A child having any type of physical or mental disability may show features suggestive of poor mental health which gets manifested through various emotional and behavioral problems.

Epidemiology:

The classic Isle of Wight Study by Rutter et al (1989) was a landmark survey that found prevalence of various psychiatric conditions in 2193 school going children to be 7% and male female ratio to be 2:1. In a recent review of 52 separate community based studies, mean prevalence was noted to be 15.8% (Roberts et al, 1998). In the studies, higher rates of psychological problems were correlated with:

• Age (Roberts, 1998),

• Chronic health problems and disability (Cadman et al, 1987),

• Organic brain disorder like epilepsy (Rutter, 1977),

• Low IQ and Learning Disorder (Hinshaw, 1992)

Factors influencing Mental Health of Children

Factors affecting mental health in children can be categorized under (Carr, 1999):

Risk Factors: Factors that may lead a person to various psychological problems can be grouped under following:

Predisposing Factors: The factors that increase vulnerability to develop psychological problems.

Precipitating Factors: The factors that trigger the onset or exacerbation of the psychological problems.

Perpetuating Factors: The factors that maintain the psychological problems and prevents its resolution.

Protective Factors: The factors that prevent any deterioration in the condition.

 Risk Factors

1. Genetic Factors: Genetic influence has been found in many disorders like Autism, Tourette’s Syndrome, Down’s Syndrome etc.

2. Prenatal Complications: Intrauterine conditions may also lead to unhealthy development of the fetus and in turn various disability conditions. The factors associated with it are advanced maternal age, Rh incompatibility, maternal malnutrition, smoking and alcohol use, infections, physical or emotional trauma etc.

3. Perinatal Complications: Difficult delivery, prolonged labor etc are few conditions that may be commonly associated to developmental delays, hyperactivity etc.

4. Physical injuries, disabilities and diseases: Organic brain disorders (like epilepsy) are one of the strong predictors for behavioral problems. Other conditions which increase risks for psychological problems are physical injuries and congenital conditions leading to disabilities and chronic medical illness.

5. Intelligence: Low IQ is associated with increased risk for various psychiatric conditions and this dual diagnosis leads to major disability and impaired functioning.

6. Parental separation and loss: Various behavioral and emotional problems are found to be associated with parental separation and loss. Depression and anxiety are most commonly found conditions. Secure parental attachment is one of the protective factors which prevent from various psychological problems.

7. Parental illness: Parental illness leads to insecure attachment, chaos in family environment, economic difficulties which become a precipitating factor in various emotional and behavioral problems.

8. Parenting style: Different parenting styles have been associated with different developmental outcomes. Authoritative parenting style is a protective factor that prevents child from emotional problems. Authoritarian style results in shy, anxious and nonconfident child where as permissive style results in poor impulse control.

9. Disorganized family environment: Families having discord among members, lack of supervision & intellectual stimulation, harsh discipline negatively influences mental health of children.

10. Child abuse and maltreatment: Physical, emotional or sexual abuse and child neglect lead to aggressive behavior, fear, academic failure, oppositional behavior.

11. School related factors: Frequent change in school, rejection from peers, bullying, often leads to emotional, behavioral and academic problems (Rutter, 1985)

12. Influence of media: Exposure to aggression & violence in movies, television channels and video games are also contributing factors in decreased frustration tolerance, bullying, withdrawal from playmates

Protective factors

1. Good physical health & No history of illness, injury or disability.

2. Uneventful prenatal or perinatal history

3. High intellectual ability

4. Secure parental attachment & Authoritative parenting style

5. Preschool early intervention programs & Healthy school environment

6. Involvement with peer group

Ways to improve mental health

• Children with any risk should be assessed by experts on a regular basis.

• Environment free from inconsistency and unrealistic expectation should be provided.

• Children should be given an accepting and non-critical environment.

• Communication between children and adults should be facilitated.

• Early intervention program particularly for children with disability is required so that young children can get maximum benefit and facilitate inclusion to regular schools.

• Emphasis on communication and social skills training should be made.

• Children having emotional and behavioral problems should be taken for psychological intervention and medical intervention, if required.

• Parent and family counseling should become an integral part of various child set up. It is specially required for children having any type of disability or illness so that parents and family develop a healthy attitude towards their child.

UN Convention on the Rights of the child (1990) states that

1. Mentally & physically disabled child should enjoy his/her full life in conditions which ensure dignity, promote self reliance and facilitate active participation in the community.

2. Education of the child should be directed to development of child’s personality, talents, mental and physical abilities to their fullest potential.

For fullest development of all children it is required to work on the deficit areas and foster his mental health because -

“Many things can wait, the child cannot. Now is the time….
His blood is being formed,
His bones are being made,
His mind is being developed.
To him we cannot say tomorrow, his name is today”

(Atlas of Child and Adolescent Mental Health Resources, WHO, 2005)

References

Atlas of Child and Adolescent Mental Health Resources, WHO, 2005.

Cadman, D., Boyle, M., Szatmari, P. (1987). Chronic illness, disability and mental well being: Findings of the Ontario Child Health Study. Pediatrics, 79, 805-813.

Carr, A.(1999). The Handbook of Child and Adolescent Clinical Psychology : A Contextual Approach, London, Brunner Routledge.

Hinshaw, S.P. (1992). Externalizing behavior problems and academic underachievement and adolescence: causal relationships and underlying mechanisms. Psychological Bulletin, 111, 127-155.

Roberts, R.E., Atkinson, C.C., Rosenblatt, A. (1998). Prevalence of psychopathology in child and adolescents. American Journal of Psychiatry, 54.

Rutter, M.(1977). Brain damage syndrome in childhood: concepts and findings. Journal of Child Psychology and Psychiatry, 26.

Rutter, M. (1985). Family and school influences on behavioral development. Journal of Child Psychology and Psychiatry.

Rutter, M.(1989). Isle of Wight revisited: twenty five years of child psychiatric epidemiology, Journal of the Academy of Child and Adolescent Psychiatry, 28.