Teenagers are in the middle of a mental health and fitness crisis – but there are issues mother and father can do to assist their youngsters.
Throughout an interview with CBS News’ Norah O’Donnell, scientific psychologist and creator of “The Psychological Lives of Teens” Lisa Damour shared two points all kids require for healthful progress: heat and framework.
“If you took all of the science we have performed about many years in psychology for what mothers and fathers can offer at house that is most supportive to young men and women – not just loving our young children but owning them have the feeling of we’d like them to is the heat,” Damour shared. “And the structure is that there are roles and predictability to household everyday living. That seriously has in excess of and about once more verified to be the magic blend.”
Damour admits it can be more durable often with young people, as “they are not always as receptive to our warmth.”
“They can really feel like they’re pushing absent from us, but I believe the crucial with young people is to don’t forget which is their position and to not get it personal.”
An additional component that is exclusive to youngsters, she explains, is they will from time to time have an upsetting emotion they want to share – and nothing at all a lot more.
“They’re going to get a lousy grade at college, and they will be carrying it about and they’re going to want to get rid of it. And so they attain out to their moms and dads occasionally by text or by phone or in human being. And they will convey to them something terrible like, ‘Oh, I got this awful test. I am heading to fail. I am never likely to you know be ready to perform in the outside environment.’ And the guardian will try to aid … and the teenager will reduce them off or not respond to their texts or just stroll away.”
Generally, the consequence is the teen feels much better, even if the father or mother feels they weren’t valuable. This is due to the fact the act of expressing a sensation helps lower distress.
“They have dumped the discomfort on the mother or father, and the mother or father feels really a bit worse than they did in advance of it took place, and what we have to recognize is that usually that is truly what enables adolescents to have on with their day,” she clarifies. “Just to get it out.”
When young children share their pain, a parent’s 1st reaction is generally to give suggestions, make ideas or ask queries.
But as an alternative, Demour advises remembering that teenagers are just on the lookout for empathy.
“I would say my selection a single phrase as a father or mother, when my very own daughters chat about their distress, I say, ‘Oh, man, that stinks.’ And these kinds of a large proportion of the time, that is all they are searching for,” she suggests.
“JamaiCAN,” reads a mural at one of the entrance gates to Bellevue, Jamaica’s only psychiatric hospital. The name of the old powder-pink building near Kingston’s upmarket waterfront is recognisable to any Jamaican and is shrouded in stigma.
A mural announces the mental health campaign ‘JamaiCan’ at Bellevue psychiatric hospital, Kingston. Photograph: Courtesy of Bellevue psychiatric hospital
Built as a colonial lunatic asylum in the 19th century, it had been a tool of political repression, serving as prison for Rastafarian luminaries, forefathers of pan-Africanism, and other Jamaicans who challenged British racial oppression. After independence, media coverage of Bellevue was dominated by stories of poor treatment of patients and threadbare facilities.
Staff and directors are today determined to transform the hospital into a modern treatment centre, building on decades of Jamaica’s pioneering mental health policies. But one barrier keeps emerging: resources.
“It’s really challenging to get focus on non-communicable diseases, and mental health is a fraction of the focus on non-communicable diseases,” says Ishtar Govia, a member of Bellevue’s board of directors and a researcher at the University of the West Indies.
Quick Guide
A common condition
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The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
‘A common condition’ is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
“Donors like to put their money towards things that get quantifiable results,” Gribble says. “With mental health that is more difficult to measure than with viruses, for example.”
However Jamaica, unlike many low and middle-income countries, has been at the forefront of mental health innovation over the past 50 years. After gaining independence in 1962, Jamaica became one of the first countries in the world to take decisive steps to deinstitutionalise its mental health system and integrate it into primary healthcare, despite limited resources.
Today, up to 80{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of Jamaicans with chronic mental illness are not hospitalised in Bellevue but receive treatment in local health centres or at home, thanks to mobile teams made up of psychiatrists and specially trained nurses.
This approach provides a useful task-sharing model for countries looking to restructure their mental health services, says André van Rensburg from the University of KwaZulu-Natal in South Africa, who has been researching deinstitionalisation in low and middle-income countries.
Prof Frederick Hickling, the senior medical officer at Bellevue in the 1970s and 1980s, led the shift away from the custodial approach to mental healthcare inherited from Britain. Photograph: Handout
The Jamaican model was introduced by the late Professor Frederick Hickling, who was the senior medical officer at Bellevue throughout the 1970s and 1980s – the highest psychiatric post in the country.
Hickling was determined to move the country away from the custodial treatment style inherited from Britain, whereby mentally ill patients were detained in hospitals against their will – as is still the case in many low and middle-income countries.
“Post independence we had limited financial resources and a population traumatised by colonialism and the legacy of slavery,” says Geoffrey Walcott from the Caribbean Institute of Mental Health and Substance Abuse, founded by Hickling. “We had to find novel ways to restructure our system.”
By allowing patients to receive healthcare without being committed to Bellevue, Hickling hoped to avoid the shame associated with mental illness while making treatment more accessible and cost-effective. Nearly half of Jamaicans live in rural areas, a costly journey away from Kingston’s Bellevue, while fewer than 10{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} own a car.
Hickling also sought to minimise involuntary treatment.
Dr Geoffrey Walcott says: ‘If patients are part of the decision-making process and accept treatment, they are more likely to recover and remain well.’ Photograph: Mary Fowles/The Guardian
“What we found is that if patients are part of the decision-making process and accept treatment, they are more likely to recover and remain well over a long-term period,” says Walcott, a former student of Hickling. “The biggest cause of relapse, especially for patients with schizophrenia, is non-compliance with treatment. When a patient is onboard with their medication, the relapse rate can be cut from 50{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} to 3{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}.”
Walcott recalls attending to a mentally ill man, armed with a knife and a machete, who had been apprehended by the police. “We opted not to take him involuntarily to a hospital and, while keeping his machete and his knife, he accepted treatment,” Walcott says.
After three weeks of treatment the man was lucid enough to cooperate with Bellevue’s social work team. “The team was able to find his brother and within six months the man was reintegrated into his family while taking long-acting injectables to manage his condition. Today, deinstutionalisation is baked into our healthcare model.”
But while Jamaica has found innovative ways to deliver mental healthcare to its citizens, this has not meant the end of challenges for the island as resources remain scarce.
“I am grateful that my son is not wasting away in some hospital,” says Yvonne McKenzie, whose son Andrew, 39, has bipolar disorder. “But I don’t feel supported by the system. I feel alone.”
For McKenzie, the mental healthcare model which centres on family and community cooperation means that, in the face of limited resources, the responsibility for managing illness can disproportionately fall on women.
Yvonne McKenzie at her home in St Thomas, Surrey, Jamaica. Her 39-year-old son has bipolar disorder and is being treated by Dr Walcott. Photograph: Mary Fowles/The Guardian
“I have seen my son’s psychiatrist more times than I can count, but I don’t think Andrew’s dad has spoken to him once,” McKenzie says. “Andrew was diagnosed in his late teens. Since then, I have been journeying with that diagnosis single-handedly.
“What I fear the most”, she says, “is what will happen to him after I am gone.”
Inge Petersen, a professor of public mental health at University of KwaZulu-Natal, says: “To help patients live in the community families need to be offered support. Often in low and middle-income countries the money does not follow the patient after they are discharged from hospital.”
Finding a way to reintegrate long-term residents into the community, some of whom have lived at the hospital for more than 30 years, is now Bellevue’s priority.
“It’s not possible to rehome every single resident,” Govia says. “We are working to create a transitional adult care facility.”
However, the hospital relies on NGO cooperation. “We may have the best of intentions”, Govia says, “but we really need to get the buy-in from third-sector organisations to be able to realise them.”
“Countries can have wonderful policies,” says Petersen. “But what is really required is technical support for governments in low and middle-income countries to implement successful deinstitionalisation.”
Posters at Bellevue hospital remember musician Bob Marley, who died in 1981, and Prof Hickling, who died in 2020. Photograph: Mary Fowles/The Guardian
Petersen would like to see a pool of global funding dedicated to implementing efficient mental health policies, similar to the resources available for treatment of HIV.
Govia’s long-term hopes for Bellevue include a world-class neurocognitive psychiatric facility. She also hopes that the hospital will become an example of successful transformation.
“I would love it if, in the next 50 years, Bellevue would provide insight into how to transform effective long-term care,” she says. “In Jamaica, the resource constraints have led us to find creative and cross-sectoral solutions. Even if the fruits are not fully visible yet, the insight and experience Jamaican psychiatrists can provide are important.”
Turkmenistan has two faces. The first is the one we see in state media: a pretty dancer, a caring mother, a sister or daughter in a beautiful traditional dress. She may be dancing, cooking or decorating an event with her presence.
The second is closer to reality: women and girls who have nowhere to go when they meet domestic violence, have no recourse to contraception and family planning services, and face sexual harassment – a few examples on a long list of unmet needs.
Access to information is severely curtailed. The state owns or controls all media and the internet is aggressively censored and restricted.
As founder and editor of Saglyk.org, the only website with credible public health information in the Turkmen language, my colleagues and I have been calling for nuanced and informed conversations by educating the public and advocating for science-based best practices in public health in Turkmenistan.
Saglyk’s comprehensive content on sexual and reproductive health is our most read. There is a great demand for this information, especially among women and girls. Turkmen schools don’t teach it. Families don’t discuss it. The media does not publish stories about it. The public space to discuss this basic aspect of being human is nonexistent.
Government agencies sustain this confusion by not providing science-based information to the public and failing to provide any public health data. This leads to women and girls in Turkmenistan having poor health outcomes. It also strips them of their agency. This needs to change.
According to Unicef, Turkmenistan has the highest mortality rate among under-fives in central Asia. According to the latest UN population fund figures only 50{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of Turkmen women who are married or in a relationship are using a modern form of contraception. And across all women aged 15-49, 8{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} have an unmet need for contraception.
A post from Saglyk’s social media, highlighting that 58.4{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of Turkmen women believe their husbands have the right to beat them in certain circumstances. Photograph: Instagram/saglykgram
The first national report on domestic violence against women, published by UNFPA in August 2022, found that 58{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of women aged 15-49 believe that violating the restrictions and obligations imposed by a spouse is sufficient reason for a husband to beat his wife. The most common form of spousal control is preventing women from leaving the house without permission. The second most common is banning women from working or studying outside the home. According to the study, 41{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of women have encountered at least one type of controlling behaviour from their husband or partner in their lives.
Patriarchal culture, harmful traditions, government inaction and absence of public education and communication drive awareness of reproductive and sexual health underground. The public in Turkmenistan see abortion as something deeply immoral so women prefer to keep silent. This also applies to the endemic domestic violence in the country. Women and girls are taught that it is a private matter that should not be discussed in public but heroically endured in silence.
Many government orders are communicated by word of mouth, without legal status. This creates room for corruption, misinterpretation and speculation, not only in public health but in all areas of economic and social life.
The restrictive law on abortion in Turkmenistan undermines the rights, dignity and health of half the population, denying them access to essential reproductive healthcare. In 2015, the government passed a law restricting abortion to only up to five weeks. Before 2015, women in Turkmenistan were allowed to access abortion care up to 12 weeks.
The abortion law further entrenches health inequality: women with resources can overcome the restriction and have an abortion but women with lower financial and social status cannot afford to bypass these restrictions and have no network to do so.
Research shows that restricting access to abortion drives it underground and makes it unsafe. The law was adopted without any public discussion on the medical, moral, legal and economic consequences, and was only made public in 2022. Our calls for constructive engagement with the Ministry of Health have been met with silence.
Saglyk has created a safe space to anonymously share stories of domestic violence, abuse and harassment. Our Bilim app helps women and girls track their periods and learn about their health and rights (Bilim means both period and knowledge).
But these efforts are not enough to bring structural changes to our society, so in the past two years we have been increasingly engaging with international organisations. We are asking organisations that grant or lend money to the country to hold the government accountable on its international commitments to gender equality and the way they are implemented in practice.
This way, we can ensure that tomorrow we do not wake up to a new law that will further restrict the basic rights of Turkmen women and girls to dignity and equality.
