Toddlers seeking psychiatric help: The kids are not alright

One out of five patients walking into NIMHANS in Bangalore for psychiatric and counseling help is a toddler. 10 October is World Mental Health day. And India’s mental health problems are legion which means there’s no lack of topics to focus on when it comes to newspaper coverage of the issue. But among all the other articles, Devina Sengupta’s piece in the Economic Times about the mental health of our toddlers jumps out. If one out of five patients going to NIMHANS for psychiatric help is a toddler, then goodness knows how many are not seeking help at all. It’s enough to stop us in our busy little tracks. The problem is partly because we are too busy. Both parents work. Sometimes one works in another city and only comes home on weekends. Their work is increasingly stressful. Even when the parents do come home, they often settle the child down with an iPad so they can continue to work. All this happens when the children are the most vulnerable, when they are just learning to recognise their parents as parents. It’s not clear from the report whether the problem is across social classes or whether it’s just masked by the daily grind of poverty when we go down the social ladder. [caption id=“attachment_1164215” align=“alignleft” width=“380”] Image used for representational purposes only. Reuters[/caption] “The child could not recognise any familiar faces, including those of his parents because they were hardly around,” P Satishchandra, director of NIMHANS tells the Economic Times. “Passed on from one set of caretaker parents to another, the child was throwing terrible tantrums, forcing the parents to seek our help.” Sameer Malhotra, head of the mental health department at Max Healthcare tells ET that when he asked a 5-year-old to draw pictures, the child drew empty nests and black barren trees. One can imagine this study just adding even more guilt to an overburdened parent, especially a working mother. In fact, an easy and dangerous takeaway from studies like these, is to put the blame/burden/responsibility on working mothers. But what Satischandra does not clarify in the piece is who these revolving sets of “caretaker parents” are. Are they maids and ayahs who last a few months and then are sacked? A grandmother who takes charge for a few days? The simple fact is we cannot return to the old days when a toddler could be assured of having a mother and grandmother at home at all times. While workplaces are getting more flexible, we are also not going to get that crèche at the office. A colleague says in India daycares are still looked at with suspicion. Though they have cutesy hopeful names like Blooming Buds they are regarded as a sort of the children’s equivalent of an old age home – a dumping ground for toddlers. Putting a child into day care is a de facto admission of some kind of parenting failure. She says when her daughter’s pre-school started offering daycare programmes, mostly the expat and Indian American parents were the ones who took it up. The other parents largely did not take advantage of it. Indians seem to still trust the maid at home to look after the child more than a trained professional at a daycare centre. Granted not all daycares are created equal and the daycare is not a silver bullet to all our toddler problems. Just because one has a name like Blooming Buds, it does not mean the children won’t be wilting in it. But it is worth ones while to spend the time and money in looking for a good daycare because it matters. A US National Institutes of Health study found that children in high quality day care actually scored a little higher on measures of academic and cognitive achievement in their teenaged years. They were also less likely to act out than peers. It’s a modest association (so it does not mean a straight shot to IIT/IIM/Ivy League) but it persists through childhood and teenaged years. But if the care providers at the centre were too controlling the children’s stress hormone levels shot up. Daycare does not just help the children. Meera Lee Sethi writes on the Greater Good Science Center that parents, especially low-income parents, also gain social capital. After studying 3,500 mothers spread over 20 US cities, psychologists John Bowlby and Jay Belsky found mothers with children in childcare were less likely to suffer from non-clinical depression, more able to handle material hardships and created a support group that went beyond just “hi and bye.” “If I were to ask if you would hand your child over to somebody whose name, address, and job you didn’t know, any rational person would answer no,” sociologist Mario Small tells Sethi. “In the context of childcare centers, many mothers were willing to do just that.” That leap of faith, taken together, through referrals from each other creates what Small calls “a psychic safety net” where a mother knows if she is late getting out of a meeting or stuck in a jam, there are other parents who can step in. For poor mothers the benefits were even more striking. Just taking their child to childcare opened them up to awareness of government programmes they did not have a clue about – whether it was help with finding housing or with taxes or museum discounts. Obviously not everything that works in an American context transposes to an Indian one. But the first hurdle we have to get over is our bias against day care. In India we love to talk about the luxury of having help around the house, something Americans do not have. But that does not mean that help is trained or equipped to supervise and raise a toddler. In our well-meaning desire to get the perfect ayah we can go through six ayahs in one year, inflicting even more damage on the child. Eventually a mother feels like she has no option but to give up her job because the child is acting out. The solution is not that there should be less working mothers, but that there should be more working crèches and daycare.