Perceptions of key stakeholders on peer led strength building program for suicide prevention among young adolescents: A qualitative study from Karnataka, India.

Context: Adolescent suicides are a significant public health concern in India and understanding the intersecting perspectives becomes imperative for the prevention of various mental health concerns. Aim: Assessing perceptions of various key stakeholders, that is, mental health experts, school and college teachers, and District Mental Health Program staff about peer-led strength building programs for suicide prevention. Settings and Design: A cross-sectional qualitative design using two Focus Group Discussions (FGDs) with mental health experts and teachers and one FGD with DMHP staff was conducted. The sample comprised 45 participants from Bengaluru urban district. Materials and Methods: The data were analyzed manually by the method of direct content analysis, and themes were determined using existing literature. Results: The teachers and the DMHP highlighted the need for an intensive training program/module that is necessary to be developed in order to train the peer leaders first. The mental health experts opined that creating a network will help in easy identification of the cases and appropriate treatment could be provided without delays. Conclusions: This study indicated that suicide is a preventable public health emergency and inaccessibility to existing as well as proper support systems was perceived as a major concern. Therefore, peer-led programs are beneficial in steering and improving help seeking behavior in suicidal adolescents.

Musical preferences of Indian children with autism spectrum disorder and acceptability of music therapy by their families: An exploratory study.

Background: Music therapy has been in use for children with autism spectrum disorder (ASD) since the 1940s. However, there is limited scientific evidence on its use in the Indian context. Aim: The present study aims to explore musical preferences of children with ASD and their caregivers' acceptability of music as a form of intervention. Materials and Methods: It is a cross-sectional study of 120 subjects diagnosed with ASD as per the Diagnostic and Statistical Manual of Mental Disorders-5 identified by convenience sampling. A semi-structured interview schedule consisting of 25 objective response questions with multiple choices and 11 open-ended questions (pertaining to music and the use of music) was used to explore caregivers'/parents' thoughts and beliefs. The responses to open-ended questions were collected in narrative mode. A descriptive approach of content analysis was adopted to analyse the data. The data are presented using descriptive statistics. Institutional Ethics Committee's approval was obtained for conducting the study. Results: Most of the children liked (89.2%, n = 107) music and responded (88.3%, n = 106) actively (listen intently/hum or sing or dance along) to music. Most subjects preferred rhythm (65%, n = 78) over melody (15%, n = 18). While 98.3% (n = 118) of the parents were willing to try music therapy for their child, 61% of them (n = 72) asked follow-up questions like - "Is there available data on it?" (n = 12; 10.2%) and "Will it be worth investing our time and efforts on it?" (n = 60; 50.8%). Conclusion: Most of the children including those with auditory sensitivity like music and prefer rhythm over melody. Caregivers possess a positive attitude toward the use of music therapy. However, most of them wish to clarify the scientific basis of the same.

Gaming among female adolescents: profiling and psychopathological characteristics in the Indian context.

Objectives: Gaming is a predominant leisure time activity among adolescents, and the literature suggests that unrestrained gaming behavior might lead to gaming disorder. ICD-11 and DSM-5 have recognized gaming disorder as a psychiatric condition and grouped it under the behavioral addiction category. Research on gaming behavior and addiction is largely based on data from the male population, and problematic gaming has largely been understood from the male perspective. In this study, we are attempting to bridge the existing lacuna in the literature by exploring gaming behavior, gaming disorder, and its related psychopathological characteristics among female adolescents in India. Methods: The study was conducted on a sample of 707 female adolescent participants who were contacted through schools and academic institutes in a city in Southern India. The study adopted a cross-sectional survey design, and data were administered using the mixed modality of online and offline data collection. The participants filled out the following set of questionnaires: socio-demographic sheet, Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), Strength and Difficulties Questionnaire (SDQ), Rosenberg self-esteem scale, and Brief sensation-seeking scale (BSSS-8). The data gathered from the participants were then statistically analyzed using SPSS software version 26. Results: The descriptive statistics revealed that 0.8% of the sample (i.e., five participants out of 707) obtained scores meeting gaming addiction criteria. Correlation analysis demonstrated a significant relationship between all the psychological variables with total IGD scale scores (p < 0.05). Total SDQ, total BSSS-8, and domain scores of SDQ, such as emotional symptoms, conduct, hyperactivity, and peer problems, were positively correlated, whereas total Rosenberg scores and domain scores of prosocial behaviors of SDQ were negatively correlated. The Mann-Whitney U-test was employed to compare "with gaming disorder" and "without gaming disorder" categories of female participants. Comparing these two groups revealed significant differences in emotional symptoms, conduct, hyperactivity/inattention, peer problem, and self-esteem scale scores. Furthermore, quantile regression was computed, showing that conduct, peer problem, and self-esteem displayed trend-level prediction for gaming disorder. Conclusion: Female adolescents prone to gaming addiction can be identified through psychopathological characteristics of conduct, peer problem, and low self-esteem. This understanding can be useful in developing a theoretical model focusing on early screening and preventive strategies for at-risk female adolescents.

Personal meaning of recovery among persons with schizophrenia.

BACKGROUND: Recovery in mental illness is not synonymous with cure. Personal recovery approach consider recovery as a process and not as an outcome. This approach takes into account the subjective meaning of recovery by assessing how a person has learned to accommodate and live with an illness. AIM: To study the personal meaning of recovery among persons with schizophrenia. METHOD: This article presents the findings of a qualitative study about what 'recovery' means to persons with schizophrenia. A semi structured interview schedule was prepared based on literature review and expert opinion. Twenty participants who met the inclusion criteria and personally consider themselves recovering/recovered from schizophrenia were selected for the in-depth qualitative interviews. Data was analyzed using Interpretative Phenomenological Analysis (IPA). Meaning of recovery from each participant's perspective was recorded. FINDINGS: The results indicate factors that patients deem important for their recovery are, absence of symptoms, regaining functioning, being able to work, having adequate emotional stability and not being on medicines. The findings are examined in the background of the previous studies and suggestions for clinical practice and research is also discussed. CONCLUSION: Recovery is far more than remission of symptoms. Persons with mental illness has their own criteria of recovery, which could be very distinct from the clinical definition. Current study findings can help in identifying meaning of recovery through the perspectives of persons with mental illness and in developing and implementing recovery-oriented services.

Development of a scale to assess the determinants of positive coping in parents of children with intellectual disability.

Identifying the determinants of positive coping is a critical step in empowering the parents of children with intellectual disability. In this context, this study aims to develop a scale to assess the determinants of positive coping. Accordingly, culturally relevant items were pooled, got validated by experts and refined. The scale was administered to 150 parents of children with intellectual disability. Factor analysis done through polychoric correlation helped reduce the items. Cronbach's alpha coefficients were established for reliability testing. The validity of the new scale was examined with the subjective wellbeing on a visual analogue scale and Family Interview for Stress and Coping in Mental Retardation. The new scale has a Cronbach's alpha of 0.71 and an intraclass correlation of 0.64. After factor analysis, 12 items were retained in the final version. This study also identified specific factors associated with positive coping. The new scale can be used with parents of children with intellectual disabilities to identify the determinants of positive coping.

Lived experiences of children and adolescents with obsessive-compulsive disorder: interpretative phenomenological analysis.

BACKGROUND: Childhood obsessive-compulsive disorder (OCD) is distinct from OCD in adults. It can be severely disabling and there is little qualitative research on OCD in children. The present study aims to explore the subjective experiences of diagnosis, treatment processes and meaning of recovery in children and adolescents suffering from OCD and provide a conceptual model of the illness. METHODS: It is a qualitative study of ten children and adolescents selected by purposive sampling. MINI KID 6.0, Children's Yale-Brown Obsessive-Compulsive Scale and Clinical Global Impression-Severity Scale were administered at the time of recruitment of subjects into the study. Interviews were conducted using an in-depth semi-structured interview guide and audio-recorded. The transcribed interviews were analyzed using Interpretative Phenomenological Analysis (IPA). The study sought to explore participants' sense-making of their world, their thoughts, feelings and perceptions through interpretative enquiry. The findings were confirmed by a process called investigator triangulation, member check and peer validation. RESULTS: IPA yielded five major themes-'illness perception changes over time', 'disclosure on a spectrum', 'cascading effects of OCD', 'treatment infuses hope and helps', and 'navigating through OCD'. A summary of these themes and their subthemes is presented as a conceptual model. The essence of this model is to show the inter-relationship between themes and provide a comprehensive understanding of the phenomenon of OCD. CONCLUSIONS: To the best of our knowledge, this is the first study to explore lived experiences of children and adolescents with OCD using interpretative phenomenological analysis (IPA). It was noted that perception of illness and treatment processes evolves over time, and recovery is viewed as a process. Future qualitative research can be carried out with a focus on 'therapist-related barriers' or 'student-teacher dyads' that can inform clinical practice and school policies respectively. Trial registration NIMH/DO/IEC (BEH. Sc. DIV)/2018, l1 April 2018.

Intervention-based mental health training for community level workers in India -A systematic review.

Community-level workers (CLWs) are frontline workers who function as mediators between the government and the community. They effectively and efficiently distribute government policies and welfare schemes directly to the public, especially health aspects. They play a vital role in primary care access and quality. Many recent studies demonstrate that physical health training of CLWs is indeed effective and increases access to services. However, there are no recent reviews that systematically understand the training of CLWs concerning mental health interventions, and reviews on CLW's understanding about mental health issues and implementation at the community level is inadequate. CLWs are underutilized in aspects of mental health interventions despite having more potential for the same. They are the ones who need to know much about mental health issues and treatment availabilities. To understand this gap, a systematic review on training on mental health interventions to the CLWs in India, the method and content of mental health training in such studies was done. Our systematic search following the PRISMA guidelines included eight studies that met the eligibility criteria. The review of the studies that satisfied inclusion criteria suggests that training on mental health interventions with CLWs sounds effective. The researcher also provides recommendations to strengthen the CLWs mental health knowledge and discusses implications of mental health interventions through trained CLWs for the community. Based on the review findings, the researcher recommends ideas about how CLWs can be utilized accordingly in mental health aspects during the current pandemic.

Clinical profile of children and adolescents diagnosed with anorexia nervosa in Indian context.

OBJECTIVE: This study was conducted to assess the trends observed in the prevalence pattern, clinical presentation, psychosocial profile and treatment profile of anorexia nervosa in children and adolescents who presented to a tertiary care child and adolescent psychiatry centre over a period of ten years. METHODS: Case records of children and adolescents diagnosed with anorexia nervosa at the department of child and adolescent psychiatry from 1st April 2009-31 st March 2019 were obtained from the medical records department of the National Institute of Mental Health and Neurosciences (NIMHANS). Standardized data abstraction forms were developed and used for the purpose of this study. Pseudo-anonymization was done to ensure confidentiality and clinical characteristics of the sample were studied using frequency analysis and central tendencies. RESULTS: Prevalence of anorexia nervosa in a clinic-based population is estimated to be 0.07% over the 10-year period. The mean age at presentation was 13.96 years (SD-2.3) and the male to female ratio was 1:12. The majority (80.8%) were admitted and only one patient (3.8%) received treatment on an outpatient basis. Two or more psychosocial stressors were associated with the onset of illness in 88.5% (n = 23) of the patients and dysfunctional family dynamics was noted to be a significant issue in the majority of cases. All the patients received pharmacotherapy and CBT-based individual therapy. The overall outcome was favourable based on the CGI-I scores. CONCLUSIONS: Prevalence of anorexia nervosa in the clinic-based setting is rising in the Indian context. Sample characteristics are similar to those seen in the west. There is a huge demand-supply gap that calls for creating a service provider network to ensure community-based care.

Family support and well-being programme (FSWP): A specialized family strengthening psychosocial services for parents of children in conflict with law.

Background: A multidimensional family support and well-being programme (FSWP) was initiated to support the families of children in conflict with law (CICL) and strengthen their participation in the integration process. This programme aims to successfully reintegrate children into the family and build parental capacity to manage them. This study presents the overview of the multidimensional FSWP initiated in an observation home, facility for CICLs, Bengaluru, a metropolitan city of India. Methods and Materials: The team of psychiatric social workers systematically delivered the family support programme to promote families' involvement at multiple levels (individual, relationships, community, and societal) for successful reintegration of children in communities. The preliminary data about the participants was collected using strengths and difficulties questionnaire and parent interview schedule. Results: The programme activities consisted of engaging parents and family members in the parenting management training programme, addressing their psychosocial issues, identifying resources for postrelease rehabilitation and promotive interventions with children and their parents. The FSWP activities are developed to increase positive outcomes like favorable behavioral changes in children and emotional regulation, frequent participation and support of parents in the trial and rehabilitation process, and encouraging parental involvement in for successful community reintegration and placements of children. Conclusion: The family characteristics are integrally related to delinquency and practioners need to integrate such factors to improve parenting behaviors and enhance positive relationships between families and children.

Abusive head trauma in India: imaging raises the curtain.

The purpose of the study was to identify children at our institute who possibly suffered abusive head trauma (AHT). A retrospective study of CT imaging of children between one month to three years of age between January 2013 and May 2021 was carried out at a dedicated neurocentre in Southern India. We identified 48 cases of possible AHT. The demographics, clinical features at presentation, imaging and fundus findings were analyzed. Imaging revealed subdural hemorrhage (SDH) in 42 and sub dural effusion (SDE) in 5 cases, one case had only hypoxia. The location of SDH was studied as was hypoxia underlying SDH, global hypoxia and ischemia. Cases of subarachnoid hemorrhage (SAH), parenchymal hematoma & intraventricular hemorrhage (IVH) were also noted. Skeletal survey, chest X-ray and CT spine were reviewed. AHT needs to be paid attention to in the Indian scenario. An extensive work up is required to substantiate the claim and to work on prevention & management of these cases subsequently.

Disruption of circadian rhythm and risk of autism spectrum disorder: role of immune-inflammatory, oxidative stress, metabolic and neurotransmitter pathways.

Circadian rhythms in most living organisms are regulated by light and synchronized to an endogenous biological clock. The circadian clock machinery is also critically involved in regulating and fine-tuning neurodevelopmental processes. Circadian disruption during embryonic development can impair crucial phases of neurodevelopment. This can contribute to neurodevelopmental disorders like autism spectrum disorder (ASD) in the offspring. Increasing evidence from studies showing abnormalities in sleep and melatonin as well as genetic and epigenetic changes in the core elements of the circadian pathway indicate a pivotal role of circadian disruption in ASD. However, the underlying mechanistic basis through which the circadian pathways influence the risk and progression of ASD are yet to be fully discerned. Well-recognized mechanistic pathways in ASD include altered immune-inflammatory, nitro oxidative stress, neurotransmission and synaptic plasticity, and metabolic pathways. Notably, all these pathways are under the control of the circadian clock. It is thus likely that a disrupted circadian clock will affect the functioning of these pathways. Herein, we highlight the possible mechanisms through which aberrations in the circadian clock might affect immune-inflammatory, nitro-oxidative, metabolic pathways, and neurotransmission, thereby driving the neurobiological sequelae leading to ASD.

Proactive detection of people in need of mental healthcare: accuracy of the community case detection tool among children, adolescents and families in Sri Lanka.

BACKGROUND: Most children and adolescents in need of mental healthcare remain untreated even when services are available. This study evaluates the accuracy of a new tool, the Community Case Detection Tool (CCDT). The CCDT uses illustrated vignettes, two questions and a simple decision algorithm to support proactive community-level detection of children, adolescents and families in need of mental healthcare to improve help-seeking. METHODS: Trusted and respected community members in the Eastern Province of Sri Lanka used the CCDT in their daily routine. Children and families detected as potentially in need of mental healthcare based on utilizing the CCDT (N = 157, aged 6-18 years) were invited for a clinical interview by a mental health counsellor using the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). The CCDT results were compared against the results of the clinical interview. The concurrent validity and performance of the CCDT were also evaluated by comparing the CCDT outcomes against the Strengths and Difficulties Questionnaire (SDQ). RESULTS: 7 out of 10 children and families detected by community members using the CCDT were confirmed to be in need for treatment (positive predictive value [PPV] = 0.69; 0.75 when compared to the SDQ). Detections based on the family problem vignette were most accurate (PPV = 0.76), followed by the internalising problem vignette (PPV = 0.71) and the externalising problem vignette (PPV = 0.62). CONCLUSIONS: The CCDT is a promising low-cost solution to overcome under-detection of children and families in need of mental healthcare. Future research should focus on evaluating the effectiveness, as well as additional strategies to improve help-seeking.

Adverse effects and short-term developmental outcomes of infants exposed to atypical antipsychotics during breastfeeding.

BACKGROUND: Postpartum period in women is vulnerable to the occurrence and exacerbation of psychiatric disorders. Mothers with postpartum psychosis or bipolar disorder need treatment with psychotropic medications, especially atypical antipsychotics. However, many mothers and families will have reservations about the use of psychotropics during the perinatal period, particularly during breastfeeding because of its presumed side effects and adverse developmental outcomes of the child. Since there are limited data in this area, the present study aimed to examine the adverse effects, if any, and the short-term developmental outcome of infants exposed to atypical antipsychotics during breastfeeding. METHODS: The study involved infants of postpartum women (n = 28) who were admitted in the mother and baby inpatient psychiatry unit of a tertiary care center in India. The medication side effects were checked every alternate day for 1-2 weeks using a checklist based on common side effects that infants may experience due to lactation exposure of atypical antipsychotics. Developmental assessments of the infants were done using the Developmental Assessment Scales for Indian Infants and through anthropometric measurements such as weight, length, head circumference, and chest circumference in follow-up when they came as an outpatient after 1-3 month interval. RESULTS: The occurrence of adverse side effects was quite low (17.85%). The main side effects directly attributable to atypical antipsychotics were constipation and sedation. Of the 17 infants who attended follow-up, 52.9% (n = 9) showed some form of developmental delay at the time of the first follow-up. However, low birth weight, higher maternal age (>35 years), and exposure to medications (quetiapine and phenytoin) during pregnancy may be confounding risk factors. CONCLUSIONS: The acute adverse effects of atypical antipsychotics such as sedation and constipation in the infant through breast milk were seen in less than a fourth of the sample. Developmental delay was noted in a proportion of infants; however, this may be due to other risk factors.

The use of first-generation long-acting injectable antipsychotics in children and adolescents-A retrospective audit from India.

OBJECTIVES: There is a dearth of knowledge regarding the usage of first-generation long-acting injectable (LAI) antipsychotics in children and adolescents, despite their off-label use, in low and middle-income countries (LAMIC). METHODS: Case records of subjects less than 18 years of age who received any first-generation LAI antipsychotics in the last 10 years(between 2010-19) were reviewed. Details documented for the study from the records included ICD-10 diagnoses, clinical profile, indication for use, medication details, severity of illness, improvement, and global functioning. RESULTS: Forty-five subjects (55.3 % male) received first-generation LAI antipsychotics during the study period. All subjects were diagnosed to have serious mental illnesses, with Schizophrenia (52.6 %) and Bipolar Affective Disorder (31.6 %) being the most common diagnoses. At baseline, according to Clinical Global Impressions-Severity (CGI-S) scale, a majority (94.7 %) were severely or markedly ill. Fluphenazine decanoate (60.5 %), flupenthixol decanoate (34.2 %), and zuclopenthixol decanoate (18.4 %) were the first- generation LAI antipsychotics used. Nearly half the subjects (47.4 %) experienced at least one acute adverse event. The most common acute adverse events noted included tremors, rigidity, sialorrhea, and bradykinesia. 31/34 subjects showed improvement at follow-up. CONCLUSIONS: The profile of patients for whom first-generation LAI antipsychotics were used included children and adolescents who had severe mental illnesses and were considerably ill. Acute adverse events were common. Short and- long-term follow-up studies are needed to evaluate the efficacy and safety of first-generation LAI antipsychotics in children and adolescents, especially in low and middle-income countries, given that they are reasonably priced and efficacious for severe mental illnesses.

Telepsychiatry for Mental Health Service Delivery to Children and Adolescents.

Children constitute 40% of India's population. Large number of children with psychiatric disorders and neurodevelopmental conditions are unable to access mental health services due to factors such as unavailability of these services in smaller urban and rural centres and lack of training for primary care providers. Given the relatively easy access to video conferencing technology, feasibility and acceptability of Telepsychiatry, there is an urgent need to invest resources and strengthen the use of Telepsychiatry for child and adolescent mental health training and serviced delivery . This viewpoint article discusses the need,scope,experiences and challenges related to use of Telepsychiatry in the area of child mental health.

Clinical Profile of Tic Disorders in Children and Adolescents from a Tertiary Care Center in India.

BACKGROUND: Tic disorders (TDs) are common neurodevelopmental disorders in children and adolescents. To date, there is very scant literature on TDs in children and adolescents in the Indian setting. AIM: The objectives of this study were to characterize the clinical profile, including comorbidities and pattern of medication use in the treatment of TDs, in children and adolescents. MATERIALS AND METHODS: The present study is a retrospective chart review of children and adolescents up to age 18 years diagnosed with TD in a tertiary care center in India. Data were derived from case records of patients with a diagnosis of TD, coded as F 95 according to ICD 10, from 1st January 2014 to 31st December 2017. RESULTS: We recruited 85 subjects. The majority (95.29%, n = 81) of them were male, and the mean age of onset was 8.4 years. Chronic tic disorder was the most common subtype, followed by Tourette syndrome and provisional or transient tic disorder. Eighty patients (94%) had a comorbid disorder, with attention deficit hyperactivity disorder being the most common, followed by obsessive compulsive disorder. Eighty-two percent of patients received pharmacotherapy. Risperidone was the most frequently used medication, followed by clonidine, haloperidol, and aripiprazole. Moderate to significant improvement with medications was seen in 88% of the patients. CONCLUSION: The present study of children and adolescents with TDs highlights very high rate of comorbidity and a favorable short-term course with medication use.

Child and adolescent psychiatry training in Nepal: early career psychiatrists' perspective.

BACKGROUND: Nepal is a developing low-income country in Southeast Asia. There is a huge burden of child and adolescent mental health (CAMH) in Nepal which has a population of around 29 million and 40-50% of the population comprises of children and adolescents. Child and Adolescent Psychiatry (CAP) has not been formally recognized as a subspecialty in Nepal and there is no standardized curriculum for CAP training. The objectives of the survey were to identify the current status of training, shortfalls and to explore the training experiences of early career psychiatrists (ECPs) in Nepal. METHODS: The participants were ECPs in Nepal. An online questionnaire was created consisting of 20 questions including 3 questions requiring an answer indicating a level of agreement scored on a ten-point scale. Questionnaire using google form was e-mailed with the uniform resource locator (URL). Respondents anonymously answered the questions. The survey was open from 01/01/2019 to 01/04/2019. RESULTS: Response rate was 83.69%. Around 42% (n = 32) were trainees in Doctor of Medicine (MD) Psychiatry and 58% (n = 45) of respondents had completed their MD Psychiatry. More than half of the ECPs had not received formal training specific to CAP. Seventy percent (n = 54) ECPs reported that their current workplace did not have a specific unit to address psychological problems in children and adolescents. However, 62% (n = 48) of ECPs came across 10 CAP cases per week. On a ten-point scale, mean score of ECPs confidence in diagnosing, management and overall confidence in CAP cases were 5.18 ± 1.56, 4.58 ± 1.59 and 4.67 ± 1.62 respectively. Fifty-four percent (n = 42) of respondents rated their training as limited and 74% (n = 57) of them wanted additional training in CAP. Psychological intervention, psychotherapy and a fellowship course were the additional training most of the ECPs wanted to receive. CONCLUSION: Despite significant exposure to CAP patients in daily practice, ECPs self-evaluated their training as inadequate and there is no standardized CAP training program in Nepal for ECPs. The desire of ECPs to receive additional training in CAP is highly encouraging and positive. We advocate for the development and incorporation of CAP training in current psychiatry training to fulfill these unmet training needs in Nepal.

Specialty training in child and adolescent psychiatry in India.

India has a considerable skilled manpower deficit in the area of child and adolescent mental health, given its population and their needs. To address this deficit, in the recent past, various centres in India have begun specialty training in the field of child and adolescent psychiatry with the lead being taken by the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. This is a welcome step in the right direction. However, specialty training of this nature cannot exist in a vacuum. There is a need for a comprehensive and cohesive child and adolescent mental health policy which must include adopting certain standards in training in the various sub-specialties of child and adolescent mental health. From this national policy, provisions must be made for a spectrum of care from specialized tertiary care to high-quality community-based care. Dedicated, skilled mental health professionals who will impart training at the highest level as well help train a cadre of specialists (psychiatrists, pediatricians) and non-specialists with various degrees of exposure and training in the field of child and adolescent mental health are the need of the hour to have a stepped model of care. This will go a long way in ensuring effective and equitable distribution of the sparse human resources. Similar issues may operate in other low- and middle-income countries and thus the discussion may be relevant to such populations as well.

Mental Healthcare Act 2017, India: Child and adolescent perspectives.

India has got a new mental health legislation, the Mental Healthcare Act in 2017 (MHCA). Compared to its predecessor the Mental Health Act of 1987, this act was purported to be more patient centric and rights based. Considering the significant burden of child and adolescent mental health problems in the community, it is essential to understand what this new act means for the mental healthcare of young people. This article presents sections of the act relevant to children and adolescents. We look at the provisions in the context of changes from the earlier act, concordance with other Indian legislations and with mental health legislations in other parts of the world.