More children avail mental health services in Karnataka

Mental health in kids

State health officials first found out about the scale of the mental health crisis in Karnataka when they discovered that the newly strengthened mental health services were drawing large numbers of children and adolescents.

The overall numbers from the state, including adults, stood 32,330 in 2015-2016. This was when the state’s mental health programme covered just four districts – Shivamogga, Chamarajanagar, Uttara Kannada and Gulbarga – at a shoestring budget of Rs 52 lakh. By 2019, when the programme was expanded to all districts, the number of people seeking treatment had seen a more than 25-fold increase and stood at 8.9 lakh.

For Dr Rajani M H, who supervises the state’s Department of Mental Health, within the larger Department of Health and Family Welfare, the numbers were an eye-opener, but did not necessarily point to a mental health epidemic.

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“These figures show us that the crisis was always there, but with increased awareness and access to care, more people are coming forward to seek treatment,” she says.

A 2015-16 study by Nimhans, which was included in its National Mental Health Survey, detailed that one in 20 people in the country suffers from a mental disorder, while one in 40 had a mental disorder in the past. Nearly 1% of the population was reported as being at risk for suicide, while women in the 40 to 49 age group were the largest group at risk. The study also touched on the issue of disorders among children, specifically of teens between the ages 13 and 17.

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About 7.3% of the children in this age group (or nearly 98 lakh kids) were in need of active interventions. The prevalence of mental disorders was nearly twice as much in urban areas (13.5%) when compared to rural areas and the most common problems prevalent across the board were episodes or recurrent depression, agoraphobia (2.3%), intellectual disability (1.7%), autism spectrum disorder (1.6%), phobic anxiety disorder (1.3%) and psychotic disorder (1.3%). Karnataka, at 7%, was slightly below the national average according to Dr Gururaj G, Dean of Neurosciences, Nimhans.

Returning to the state’s mental health programme, as the scale of problem at hand became clearer, funding for it grew from Rs 3 crore to Rs 17 crore from 2016 onwards. The government expanded its operations to cover all 30 districts through a mobile service headquartered at each of the District Health Centres. “Today, our budget is Rs 20 crore and the goal of covering every district has been largely achieved, but not all children with problems are getting the help they need,” Dr Rajani says.

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Ignoring children’s problems
There is a tendency in society to ignore children’s voices, especially when they’re in trouble, she explains, leading to children developing emotional instability. She cited two such cases.

The first was that of a 11-year-old boy who one day refused to go to school, feigning a series of illnesses. His parents called him lazy and beat him up. In reality, he was being bullied at school and teachers had refused to intervene.

The second case had to do with two teenage girls living on the same street, who became unusually close, culminating in a romantic relationship between them. Strong protests by their parents led to one of the girls, 15-year-old Deepa (name changed), developing depression. Both cases were resolved after health officers were able to talk with the children and understand their problems.

Staff shortage cripples effort
In 2018, a total of 5,119 children were provided mental health support in government clinics or hospitals in Karnataka, according to the Department of Health. In the first three months of 2019, however, the numbers had shot up to 5,929 children.

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Dr Rajani attributed this rise to the expansion of the programme and to a series of awareness drives launched across Karnataka. But she cautions against drawing inferences from the figures provided above, as the data from private healthcare centres where many children seek help is unavailable.

As things stand, the number of qualified personnel in the health centres is far below requirement. According to a government official, there are only slightly more than 220 qualified staff, working in seven-member teams, in the state’s 30 districts. The limited number means large treatment gaps exist, be it for common mental disorders (85%), severe mental disorders (74%), schizophrenia (75%), bipolar disorders (70%) or substance abuse (91%).

“We are working to close this gap,” Dr Rajani says, explaining that the government is collaborating with Nimhans to train more staff.