Psychoanalysis-MumBai.org
Title
"Complete Information on Psychoanalysis training & counselling on Child Mental Health"
Description
There are several fallacies and misunderstandings that commonly arise when considering the needs of children, adolescents, parents and families. These have contributed to a considerable under-resourcing of Child Mental Services, not only in India but also in developed countries such as the U.K. In the U.K., children constitute 20% of the total population, yet receive much less than 5% of the total mental health budget in most districts. Surprising though it may seem, a concerted effort is often required on the part of service providers in the area of Child Mental Health to establish the nature and consequences of mental disturbances in childhood and the links between making provision for children and families in these areas and educational gain, employment gain, law and order gain and welfare gain. In other words, these misimpressions interfere with the recognition that would otherwise be obvious that mental health gain investment during childhood is particularly effective in financial terms and also in terms of quality of life and life expectancy. Several studies in India and in the West have clearly established that mental health problems occur just as frequently in children as they do in adults. Yet, though Adult Psychiatric Services and Training are well developed in India, there are a few training and services in the field of Child Mental Health. Sometimes, working with children is seen as being an extension of working with adults rather than a field in it's own right. One of the difficulties in recognising the nature of the emotional problems of children is that children and especially young children do not have the means of communicating their difficulties in an explicit way. Disturbed children can be thought of as being naughty, lazy, bad, evil, immature, disobedient or uncooperative. In addition, their difficulties can be too readily explained away by their circumstances and parents and caretakers do not think of the need for specialist help as there is a belief that the child will grow out of the problems. In other words, purely by the passage of time, the difficulties are expected to disappear. Or else, there is a belief that all children pass through such a phase and therefore the particular child's problems need not be attended to. Another set of difficulties arise from the notion of there being a hierarchy of needs in thinking about children. It is only natural when we are confronted by the tremendous problems of deprivation and neediness that we would respond by scotomisation - looking at only a part of the problems and according to that part of the problem a more urgent priority. For example, the street children or slum children are attended to in terms of their need for shelter, their need for caring adults to look after them and their needs for education. Unfortunately, there are few planned outcome studies of the psychological development of children offered such amenities. Yet, there is an abundance of anecdotal evidence of the serious difficulties that are encounter with such approaches in terms of teenage pregnancies, delinquency and violence in the children and breakdown of the arrangements for care. Clearly also, the staff that work with such children include volunteers from schools and colleges that have little awareness of the specialist emotional needs of children. Literally, there is a belief that working with children is child's play - not a serious task that requires extensive training and also staff selection and close supervision in order to exclude the possibility of child neglect and abuse. Turning a blind eye to such situations is often justified by the belief that something is better than nothing. We are concerned that such projects often grow bigger and bigger and are thought of as model institutions when indeed they are based on problematical premises. Such a scotomisation is often supported by pictures of the children as smiling and participating enthusiastically greeting and welcoming visitors to the project and in the daily activities. Superficial friendliness is often equated with emotional intactness and yet this is understandable, because looking at these problems could be perceived as opening the proverbial Pandora's box.
Children usually come to the attention of a professional at level 1 and will only be referred on to other levels if their problems are severe. Children spend a large proportion of their lives at school and it is therefore not surprising that difficulties first come to the notice of teachers. These include the child's behaviour in the classroom or the child's ability to cope with the demands of learning. Some children when they first join school do not conform to the requirements of the school. There may be an apparently paradoxical situation that the parents have not come across any difficulties at home when problems are found by the class teacher. Parents may be quick to blame the school such problems and to sort out the various elements in the difficulties. Working at this level has an important preventive function in the early recognition of problems before they multiply into much more serious difficulties. Some problems cannot be attended to at level 1 and then pass on to level 2, which involves the care of paediatricians or clinical psychologists. Parents may be concerned about a child's poor attention span or difficulties in relationship with one or both parents or severe jealousy of a brother or sister. In addition there may be difficulties such as nightmares, bedwetting, stealing or telling lies. Some children have temper tantrums and may be aggressive at home. Other children may constantly do the opposite of what the parents tell them to and there may be numerous battles with the parents. Parents may also be worried that they are out of touch with what is going on in the child's mind or in the child's life outside the home. Sometimes a child may have been adopted and the parents may not be able to talk to the child about the situation. Sometimes families go through difficult circumstances such as the separation of the parents, or a bereavement, or frequent moves of home. A child may have severe bouts of asthma or abdominal pain where there are also emotional difficulties in the family. The Paediatrician is often called upon to manage such situations and if the Paediatrician has had some training in understanding such difficulties (e.g. the Observation Course), they would be in a better position to help these children.
However, some problems need a more in depth approach involving a referral to a specialist child mental health service (level 3). These include cases in the earlier levels that cannot be handled at those level by the Professionals involved. They need to be adequately assessed by a multiprofessional team including a child psychiatrist, child psychologist, child psychotherapist and social worker. These are complex and serious problems. The family may have already been to see several different caretakers and had conflicting opinions from them and yet not been able to understand the nature of the difficulties. Sometimes parents cannot understand that different children have different internal resources for coping with difficulties. Some children are more vulnerable than others and are less able to tackle external difficulties. Evaluating and assessing such situations requires skilled professionals.
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