Play therapy session in schools in Bolivia. A facilitator is listening to children about rules and agreements for the session. Photo: © Christoffel Blindenmission CBM.
Why focus on child mental health?
Most health programs will prioritize maternal health and the first years of a child, which is very positive and must continue to be a strength. However, there is a gap of specific programs for children up to 5 years who will need access to mental health services. Because mental health is determined by a range of socioeconomic, biological and environmental factors, children need to develop a wide range of adaptation strategies to face new global pressing issues that will affect them as well as older issues such as violence and consequences of higher poverty indicators.
Knowing that depression is now among the leading causes of disability among young people there must be a deep reflection about the causes that lead to it and the consequences such as suicide. This year during the World Mental Health Day, the World Health Organization (WHO) decided to focus on suicide prevention, because statistics are higher than at any other time, every 40 seconds one person commits suicide, amounting to 800 000 lives every year. In addition, suicide is the second cause of mortality in people between 15 to 29 years meaning that we should intensify efforts for young people to have coping mechanisms against any adversity and also access to adequate support in the right moment.
Promoting and preventing mental health in communities in Bolivia. A facilitator explains to children the “treat us well” for prevention and early detection of child abuse. Photo: © Christoffel Blindenmission CBM
Is this an issue of low- and middle-income countries or high-income countries?
A sample of statistics in the United States shows that there is a high prevalence of depression, anxiety and behavioral disorders in children. According to the last report of prevalence among children between the ages of 3 to 17 by the Centers for Disease Control and Prevention (CDC) in the United States, the prevalence of depression and anxiety is higher in children from 12 to 17 years than in other age groups. Moreover, there is a higher prevalence of behavioral disorders among children between 6 to 11 years compared to other age groups.
According to recent research (CBM, 2019 Mental health study of children and adolescents) in peripheral areas in schools in Bolivia focusing on the gap age of 5 to 18 years, there is a prevalence of behavioral problems between peers. It seems that children at primary levels are developing more problems to relate with others of their own age. In addition, accessibility of mental health services is still a dominant challenge.
So, in words of Shekhar Saxena from WHO “When it comes to mental health, all countries are developing countries”. For that, mental health ought to be a priority in any agenda of all countries.
How to engage the community towards mental health?
WHO in their Mental Health Action Plan 2013-2020 aims to provide comprehensive, integrated and responsive mental health and social care services at community level, aiming also to focus on promotion and prevention of mental health. However, there is a lack of awareness of the importance of these aims and most of the time the power (voice?) of the community goes unnoticed. Using the community resources already in place will be a good starting point to not leaving any children behind anymore, detecting early any sign of abuse, mistreatment and violence to protect children against it and to have a procedure in all institutions to engage in those situations and to provide support and treatment. This entails working with families and key actors in the communities, such as schools, churches, health facilities, public leisure facilities, police, libraries, whatever exists in the community towards intersectoral strategies engaging all the actors in an approach called “treat us well”.
Early stimulation for children with devolopmental disorders and delays in Bolivia. This facilitator teaches parents how to engage, communicate and take care of their children, fomenting good attachment. Photo: © Christoffel Blindenmission CBM
Are schools key actors in mental health?
There is a presence of behavioral problems among children and it is not surprising that the school community relegates them in most of the cases. In addition, the prevalence of psychosocial problems is an issue that appears very often in schools and still is not addressed because there are gaps in service delivery, treatment and prevention. So, children without a correct diagnosis and who lack treatment remain in schools or in the worst cases they are forced to quit and are gradually isolated, developing more consolidated symptoms of mental disorders towards developing a psychosocial disability.
Most of the time, parents will not have the necessary information and teachers will be very busy dealing with overpopulated classrooms, not paying attention to children with different situations and needs. Lack of time is related to lack of knowledge. It seems that the education community with their authorities, teachers, families and children plays a key role in this. Moreover, governments are in a unique position to provide a national answer for prevention of mental health disorders before they cause psychosocial disability.
Do we have enough information to work on child mental health?
Since it was established in 2011, the Child Mental Health program “El Taypi” developed in Bolivia by local partners and CBM, is currently collecting some experience on this topic. The work takes place at the community level and starts by engaging with the community and getting to know their resources to have allies. This helps to identify pregnant women facing psychosocial risks such as depression, children with mental health disorders and children with developmental disorders and delays. The partner staff work closely through training and supervision processes with community health workers and many other key actors in the community such as the health sector, schools, universities and others.
In their interventions the partners use evidence- and practice-based tools and manuals such as Thinking Healthy, mhGAP guide (Mental Health Gap Action Program). Moreover, they adapted and elaborated for the context in the country other contents to work in prevention of violence, peer support groups, play therapy groups and others. They reach out to the whole family, not just the beneficiary of the program, to foment better communication skills and to strengthen their bond. In every school they work on the topic of “treat us well” for prevention and early detection of child abuse. They approach and sensitize parents, teachers, directors and children until the whole school is ready to practice and maintain good ways of communications without violence of any kind. In addition, children become leaders in this topic, and they are agents of change with their peers and also in the wider community outside the school.
“Treat us well” in Bolivia. This facilitator teaches a healthy understanding of children´s bodies and personal space through games. Photo: © Christoffel Blindenmission CBM
In schools the cases of child abuse detected during the trainings of “treat us well” are addressed immediately and according to protocol. Also, there is a component in the program for providing mental health services such as play therapy, individual psychotherapy, in some cases with the support of psychiatrists from the public health system who visit the community to attend to users of the project.
Are we ready to provide children a fulfilled childhood?
The Convention on the Rights of the Child (CRC) is a human rights treaty which sets out that children must be able to have family guidance during their development, be respected for their views, be allowed to share thoughts freely, be protected from violence, have access to education, health, food, environment and basic needs, including children with disabilities, have access to rest, play, culture and arts and more. This allows them to create the basis to establish mechanisms for adaptation for their future years and to experiment frustration or any other tough emotions, embracing them in order to cope with normal adversities in daily life and to be aware of their own skills, abilities, potential and talents.
Mental health promotion involves actions that improve psychological well-being. In child mental health the earlier we take action, the better the health outcome will be. Promoting and preventing mental health disorders are an important part of any strategy but they must be complemented by other strategies to service delivery, treatment with an intersectoral view. This way, the necessary efforts to provide children with a fulfilled childhood are gradually being put in place.
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