Help children before it's too late

JANELLE DE SOUZA interviews Dr Margaret Nakhid-Chatoor, president of the TT Association of Psychologists, on the treatment of mental health conditions in children following a court case on a boy who spent a year at St Ann’s Psychiatric Hospital.

Ten per cent of the world’s children between the ages of five and 16 have a clinically diagnosable mental health problem. Unfortunately, 70 per cent of those children have not had an appropriate intervention.

Dr Margaret Nakhid-Chatoor, president of the TT Association of Psychologists, made the statement in a recent interview with Sunday Newsday.

She said although some mental issues developed in the pre-teens, half of the cases became recognisable by age 14. She said that was because, around adolescence, people believed children should know better so inappropriate behaviour was more noticeable or would be deemed chronic.

Chatoor said years ten through 16 were crucial for a child as they began the formation of self; exploring relationships; coming into their own with their ethnic and sexual identity; and to be attracted to things and people that parents might not find suitable. She said parents seemed to think children automatically became more mature in secondary school and expected them to stand on their own.

However, moving from an environment where everyone knew you to having to find your way around new people and situations could be frightening for more reserved children. “I think this is the crux of children getting into all kinds of negative behaviours.”

Without intervention, Chatoor said children become adults with serious mental health issues, adults who are unable to cope with relationships or in the work environment. This, she said, could be detrimental to the country’s economy because if employees were unhappy or unstable, their output would be limited.

“An economy that has a population that is not mentally stable is not a good one. When you have employees who are coming to the job frustrated, who have problems with their children, who have financial issues, who have domestic issues... they are not going to produce in the way you want.

“They would be taking leave, attending to other issues, taking a lot of breaks. They would not be doing the best at their job.”

Chatoor said schools, especially primary schools, were in a unique position to help children because they spent the majority of their time in the classroom with a single teacher. She said at home, parents may not be as focussed on their children because of household responsibilities. Also, at home children may be interacting, mostly, with a computer, television, or other electronic device so that parents would not observe certain behaviours.

Stressing that behavioural issues were not isolated from mental health, Chatoor said teachers had become the first line of defence by default.

She said teachers might notice changes in a child’s behaviour but teachers often said they did not have time to deal with the children and so ignored the problem, or tried to palm off the responsibility on someone else.

Chatoor said, “If a child is reactive in the school, you could bet your bottom dollar something is happening in the home. The observant teacher, the effective teacher, would pull that child aside, find out the problem, refer and recommend. Misguided teachers who do not use the vocation to serve but just to collect a pay cheque, do not observe.”

She said by the time the children reached adolescence, many had already decided their lot in life. She gave the example of a 13-year-old client with learning disabilities. He did not attend school but had a job on weekends and because he was making money, he felt he did not need and did not want help. “To him the die is already cast. ‘I can’t learn, I didn’t like school.’ So you know what? Money is the thing.”

“The Government is looking to address all these interventions in secondary school but the problem started in the primary schools. That is where the majority of our resources need to go to help children who teachers have begun to recognise that something is happening there. It is too late at age 15 and 16.”

Chatoor said once mental illness developed, it could progress to become a disorder, making it more difficult to treat. “I do not believe that children can get better without an intervention, especially if it is a behaviour that is triggered by a chronic, domestic, family, or school issue.”

For example, she said a child with a simple learning disability could feel rejected or that they did not fit in, especially if they were told that they were different, lazy, were not trying hard enough, or compared with other children. This could trigger trauma.

She said there was a common misconception that childhood was carefree, trouble free, and that children did not experience stress or trauma. However, among other things, loss of any kind – a parent through death or divorce, a pet, a friend – could trigger significant trauma. “Because of that misconception, when children are ‘acting out,’ people say the child is just rude, mischievous or miserable.

“They don’t look beyond that. They don’t ask the right questions to see what is going on there.”

IN CHILDREN'S HOMES

Chatoor said the problem was even worse at some children’s homes.

She noted that some children’s homes had counsellors attached to them, people coming in to help the children with homework and other support services. However, she said some homes did not do that.

In addition, she said most of the staff at homes were not properly trained to deal with children, especially those with emotional trauma, and some institutions did not want to spend the money or could not afford to send their staff to training.

“The problem is, who are the people who are supervising these homes, those who are hired to help? What sort of training do they have? I do not think the majority of the caregivers are trained in child and adolescent development. You can’t just have training in nutrition or what not. You have to have training in the psychology of these children to understand their period of development and know why they are acting out.”

To make things worse, she said, some people choose to work at children’s homes because they provide their preferred target group to abuse. Therefore, close monitoring, assessment, and evaluation of all staff is necessary on a constant basis.

Chatoor believed the country had to get back to the time when the community was involved in the rehabilitation of children. She said everyone should move away from looking after ourselves or their own family only and become their brother’s keeper, especially, when it came to children.

“Acting in a timely matter is crucial. Children are powerless. Many times they do not even know why they are acting or reacting in this way. They do not have the coping mechanisms and judgements that maturity would bring. Therefore adult observation and adult recognition is necessary.”

She said stakeholders needed to become involved and realise that mental health was not a “quick fix,” that it would take patience, counselling, therapy, and treatment, and that “a good talking to” would probably not be effective.

She criticised health professionals who brushed off patients and just took a glance without examining them properly, hence, diagnosing patients incorrectly and playing with people’s health. She said they should know better and asked them to do better because parents and their children really needed help.

Chatoor explained that more guidance counsellors were needed in primary schools–at least one per school–so that individuals could be given the attention that was desperately needed.

Noting that schools’ student support services referred students to private professionals, she said the only public institution that was specifically designed to assist children with mental issues was a service at the Eric Williams Medical Science Complex. She described the service as underdeveloped because of the long waiting list and limited staff. Therefore, she called on anyone providing children’s services to use social media effectively, so as to alert parents who needed to know where they could go to help their children.

In the long term, however, Chatoor said a children’s trauma centre was needed, a one-stop-shop mental health space for children and adolescents. There, the children could be assessed, evaluated and treated for mental health issues; learning disabilities such as dyslexia and processing deficits; neurological disorders such as cerebral palsy and down syndrome; behavioural and developmental disorders; and mental illness such as anxiety disorder, bipolar disorder, eating disorders, ADHD, autism, and depression.

In response to numerous questions sent to her, via e-mail, on the state of care for children in the country with mental health issues, Minister of State in the Office of the Prime Minister Ayanna Webster-Roy replied, “The OPM is working with the Ministry of Health to have the relevant therapeutic centres established.”