'Mental Health Issues of children in Institutions" Dr.N. Janardhana Assistant Professor Department of Psychiatric Social Work, NIMHANS

ESTIMATES According to UN estimates, 8 million children across the world are living in institutions. The actual number is expected to be higher since there are gaps in these estimates and with the ever rising rates of HIV, conflict, disintegration of families due to various reasons, etc.

INDIA: An estimated 200,000 children in the country are in about 5,000 Observation and Children's Homes, and the numbers are growing.

Children Vulnerable Children Children with Diagnosable Mental Health Conditions Children seeking help

Institutional Care Institutional care Government institutions - Shelter homes - Children homes - Observation homes - Special homes Institutions run by NGOs

Impact Of Institutionalization On Children Care and Protection Basic needs Education Health care Recreation Vocational Training

Impact Of Institutionalization On Children Emotional deprivation Separation anxiety Anonymity and lack of personal attention Interpersonal relationship problems Difficulty in mainstreaming and adjusting in society Segregation and isolation Low self esteem Failure to trust, Excessive routinization and regimentation, Physical abuse and trauma, Deprivation of family care

Mental Health issues/ problems  Emotional problems  Behavioural problems  Scholastic performance related problems  Psychiatric problems  Adjustment related issues  Relationship issues with peers, teachers and others

Experience of working with the institutions providing care and protection for children

Continuum of Services Tertiary child care services Secondary and Specialist services Universal services Source: Vulnerable babies, children and young people at risk of harm: Best practice framework for acute health services, 2006

Developed curriculum for training on capacity building and counselling Understanding of child and child protection – Concept and theories of child development and – Needs of children : physical/ social/ emotional / psychological – Approaches to child protection – charity, welfare, need based and rights based – Juvenile Justice Act Children in difficult circumstances – Specific psychosocial problems and issues of children – Children in difficult circumstances/ children in need for care and protection

Developed curriculum for training for the capacity building and counselling Mental health needs of children Interventions with children – Institutional and Non institutional care programmes – Counselling Skills- Communication / problem solving/ motivation skills – Family Interventions with children – Group Intervention – Individual care plan – Preventive and promotive mental health activities with children (life skills education) – Behavioural Interventions

Children with special Circumstances requiring MH interventions Child Sexual Abuse Destitute and orphan Children Children sent for adoption Children using drugs Child running away from home Children victims of violence, trafficking and abuse Adolescent Girls marrying adults

Clinical and non clinical interventions for children referred from CWC All children do not require curative services but requires mental health care. Children with mental health problems been provided at In patient and Out Patient Department- for children in distress. Psychosocial interventions been provided to most children with non clinical symptoms. Group interventions for children in the institutions- anger management/ emotional regulation/ life skills and etc.

Assessment Bio psychosocial Interventions Training Curative Ensuring safety at Institutions, school and community Ensuring accessibility of services Preventive Public awareness Positive mental health Overall development Promotive

Levels of Interventions Individual LevelFamily LevelSchool/Institutional Level Community LevelNetworking & CollaborationResearch & DocumentationTrainingPolicy Formulation & Implementation

Interventions at the institutions Assessment of child’s psychosocial needs and abilities Children friendly environment Training Counsellors/institution staff to identify & mange children’s problems Managing children with special needs Tracing parents and Working with them Preventing child abuse and discrimination Developing group interventions for children Empowering children through creating awareness about their rights Ensuring Implementation of programmes & policies

Mental Health: A Development Issue?

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