As per the National Mental Health Survey (NMHS) conducted in 2015-16, the prevalence of mental disorders among children between ages 13-17 was 7.3% in both genders. Further, 26.8% girls were getting married below the legal age, while 8% of girls between ages 15-19 were already mothers or pregnant. The survey also found that 37% of women between ages 15-24 have experienced physical, sexual, or emotional violence by their husbands— this includes children technically of school-going age.
The survey showed how young children, especially girls, are vulnerable to sexual coersion, unwanted pregnancies, unsafe abortions, physical injuries and digital challenges like cyber-bullying, internet addiction and pornography. These risks in turn affect their physical as well as mental well-being.
Six years have passed since the Mental Healthcare Act, 2017 was passed, codifying the country’s approach to mental health, mental healthcare and suicides. However, the Parliament is yet to develop a framework for a national-level school mental health programme.
While the government launched the Rashtriya Bal Swasthya Karyakram (RBSK) under the National Health mission in 2013, the scheme mainly focuses on the early detection and management of illnesses such as anaemia, malnutrition, developmental disorders, skin/heart/breathing diseases among children via screening at government schools and Anganwadis.
The scheme does screen children for mental disorders like autism, delays in learning, motor skills, cognitive skills, attention deficit and impairment in vision, hearing and neuro-motor impairment. However, mental issues like stress, anxiety, depression, or suicidal thoughts are not addressed in the this programme.
What is a School Mental Health Programme (SMHP)?
As per a report from United Nations International Children’s Emergency Fund (UNICEF), any mental health programme in schools must include five pillars of support — an enabling learning environment, access to early intervention and mental health services, teachers’ well-being, targetted mental health programmes using educational workforce in national, state and local levels, and meaningful collaboration between school, family and community.
Under existing educational policies, plans and budgets, UNICEF lays a basic framework for how to build a school mental health programmes:
- employ dedicated counsellors
- guarantee access to tele-health mental health services
- promote government-issued helpline numbers
- maintain sufficient workforce of teaching and non-teaching staff to ensure teacher well-being
- promote community-based activities
- spread awareness on mental health, its issues as part of school curriculum
- collaborate with families, communities to better tailor the programme, monitor children’s health - leading to increased confidence, trust in relationships
What SMHP does India currently have?
In 1982, India launched the National Mental Health Programme (NMHP) to ensure access to minimum mental healthcare for all, encourage inclusion of mental health knowledge in general medical services and to promote community participation in mental health service programmes.
Under the NMHP, the District Mental Health Program (DMHP) was launched in 1996, covering some basic elements — early detection and treatment, training general physicians to diagnose and treat mental illnesses, public awareness and monitoring.
As time progressed, the DMHP’s scope was widened to include improving medical infrastructure, dedicated mental hospitals, focused training, life-skill education and counselling in schools and colleges, address work-related stress and suicide prevention. The National Mental health policy, adopted in 2017, sought to destigmatise mental illnesses, take steps to prevent such illnesses and include those suffering from mental health issues in society.
In 2018, the Modi government launched the School Health programme under the aegis of the Ayushman Bharat scheme, launched the same year. This programme has a vast focus including screening of children’s health under the RBK scheme, weekly classroom activities on health and wellness, and thematic school assemblies.
Focusing on mental health of middle and high school children, the programme outlines health promotion activities like meditation and yoga, bullying prevention, internet safety and media literacy, prevention of substance abuse, violence and mental health awareness. Coordination committees at the block, district, State and national levels have been tasked with the implementation of the programme. These committees are to comprise of teachers, district magistrates, education and health officers, state secretaries and Union ministry representatives.
Activities listed by MoHFW for school children
In 2022, the Union Health Ministry also issued a handbook to schools for training teachers, counsellors and other staff, outlining the guidelines for early identification, detection and intervention in mental health illnesses.
Since 2020, the outbreak of COVID-19 forced school children to learn from home, cut off from peers, leading to psychosocial issues, loneliness and withdrawal behaviour. To address these, the government launched ‘Manodarpan’ — a website detailing guidelines, frequently asked questions (FAQs), posters, and videos for psychosocial support to students. The National Council of Educational Research and Training (NCERT) launched counselling services for children free of charge, employing 270 counsellors across regions to address mental issues among children via live interactive sessions.
What are the issues in India’s SMHP?
One of the major drawbacks of India’s mental healthcare sector is the inadequate manpower. As per the World Mental Health Atlas (2017), India had 0.29 psychiatrists per lakh population (plp) and zero child plp. Among other professionals, there were 0.8 mental health nurses plp and 0.07 psychologists plp. In total, there were only 25,312 mental health professionals in India, with only 49 child psychiatrists, as of 2017.
Despitea school health programme under the NMHP, India does not have a structure for implementation of a nationwide SMHP. A few sensitisation programs like training for teachers on mental health illnesses, promotion of yoga and meditation and a toll-free number for counselling is the extent to which India deals with children’s mental health. Moreover, most school health programmes deal with specific issues such as substance abuse, suicide prevention, domestic violence, and sexual abuse; there is no comprehensive, uniform SMHP to deal with mental health and well-being of all school children uniformly across the nation.
India’s healthcare staff scenario as per World Mental Health Atlas 2017
The lack of inclusion of stakeholders such as non-governmental organisations dealing with mental issues, private hospitals, mental health research facilities and pharmaceutical companies too has held back the government in implementing a nation-wide SMHP. As per the World Mental Health Atlas (2017), the Indian government spends only 1.3% of its health expenditure on mental health. With health expenditure barely amounting to 2% of the Union budget, funding for mental health is woefully insufficient.
What is the plan ahead?
Heeding the advice of many experts, the NITI Aayog is planning to set up a comprehensive school healthcare programme. As per an Economic Times report, the programme will cover students in both government and private schools via policy intervention to existing health promotion and disease prevention measures under the Ayushman Bharat scheme.
This move has been triggered by a rise in suicides among students. Since 2011, the number of suicides among students has steadily increased from 7696 students (2011) to 13,089 students (2021), according to statistics from the National Crime Records Bureau (NCRB). For those below 18, 1408 cases saw illness cited as the reason for suicide; 58% of these illnesses were related to mental health. Other than this, 1495 cases listed ‘love affairs’ as the cause and 864 listed ‘failure in exams.’
In order to tackle the rise in mental illnesses, NITI Aayog is in talks with various stakeholders, including the union ministries relating to Health, Education, and Women and Child to form a holistic and comprehensive plan for school children. But this still leaves open the question of whether the plan will expand beyond illness to also tackle the mental health of students.
