Darjeeling Ladenla Road Prerna (DLR Prerna)
Expanding access to children’s mental health care is a crucial global health challenge. A staggering 20% of all children suffer from significant mental health concerns; most of whom remain unrecognized, unsupported and affected lifelong (WHO, 2010). A fundamental underlying cause of this support gap is insufficient human resources. Innovative models are urgently needed to address this challenge.
In India, approximately a third of the population is aged between 10-24 years. Children spend more time in school than in any other formal institutional structure, so schools play a primary role in cognitive, emotional and behavioural development of children. The school’s environment also has profound effects on the health and well-being of children and adolescents. Supportive and positive relationships among peers, with teachers and family members — have been found to protect against a range of adverse health and education outcomes for young people including depression, bullying, violence and academic performance. Mental health interventions that promote social skills, problem solving skills and involve the whole ecosystem can be critical especially in low- and middle-income countries.
Professionals in educational settings can play a critical role in children's mental health as they may be in the best position to note changes in behaviour, including emerging mental health issues. Similarly, knowledge about mental health and academic stress must also be promoted among parents and family members. Interventions should ideally include both teachers and families in cooperation to form a supportive ecosystem for students. Lay counsellors as well as teachers trained in mental health interventions have proven to be effective in low-resource settings.
TeaLeaf Teachers Leading the Frontlines: Improving access to children’s community mental health by meeting children in schools
The Broadleaf project in Darjeeling is training primary school teachers to deliver mental health care which increases access to care for children in low-resource settings. This MHI-funded model task-shifts mental health care to primary school teachers to allow them to deliver a therapeutic intervention to their selected students during school hours. Teachers engage in therapeutic interactions with students in their natural environment throughout the day, every day. This means that children receive mental health care throughout their day in their own environment rather than waiting for a weekly individual session with an expert which may never be possible in a low-resource setting. Notably, by task-shifting children’s mental health care to teachers, the child’s education becomes a therapeutic tool itself. The intervention also includes training for teachers on special education techniques they can use to level the academic instruction they deliver to the abilities of each child. The program thus aims to improve social, emotional, and academic outcomes for primary school students with mental health concerns.
The model leverages existing resources (teachers) by focusing on synergies between education and child psychiatry for children under age 10 with mental health struggles, for whom intervention is most effective. TeaLeaf repurposes education to be a therapeutic tool, incorporating therapeutic interactions by trusted adults into and throughout children’s everyday environment. This intervention strives to de-medicalize mental health; as opposed to “treatment”, this model provides seamless and practical “care”.