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.

CHILD MENTAL PROBLEMS

Emotional problems in children vary in complexity and severity. A Comprehensive service needs to operate at several levels. These include:

1. Problems which require additional professional help at the level of the family doctor or the school counsellor.

2. More serious problems which require the help of a specialist child health professional with a training in understanding emotional disorders.

3. Serious and complex disorders which require the specialist help of a multi-professional core team working together in a clinic.

4. Extremely severe and complex problems that fail to respond to help at other levels and need admission to hospital

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.

Finally, one sometimes comes across serious and/or life threatening situations with some children. These include emotional breakdowns, suicidal risks, severe anorexia and drug addictions. These children may need to be admitted to hospital.

THE PSYCHOANALYTIC THERAPY AND RESEARCH CENTRE.

History of the Centre

The Indian Psychoanalytical Society was founded in Calcutta in 1922 just 3 years after the British Psychoanalytical Society was formed. It was Girindrasekhar Bose who formed the Indian Psychoanalytical Society at his home. The Indian Psychoanalytical Society is affiliated to the International Psychoanalytical Association. Mr. Bhupendra Desai (who studied with Bose) and Mr. Amrith contributed largely to the development of psychoanalysis and psychoanalytical training in Bombay. Another Pioneer in this field in Mumbai was Mrs. Freny Mehta who was the Head of the Indian Council of Mental Hygiene, an organisation which employed Psychiatric Social Workers to lecture and counsel in numerous schools and colleges in Mumbai. In 1974 a group of psychoanalysts founded a public charity trust called the Psychoanalytic Therapy and Research Centre in Bombay. The aim of the Centre was to promote the growth and development of psychoanalytical work with children and adults. The Centre was originally based in Taredeo but in 1977 it moved to its present site in the Fort area. By the mid-80s the Psychoanalytical group achieved semi-autonomous status when it became the Bombay Sub-Committee Board of Training still linked with Indian Psychoanalytical Society and affiliated to the International Psychoanalytical Association. In recent years the Psychoanalytical Centre and Training was sustained by the work of Mrs. Minnie Dastur, Mr. Sarosh Forbes (who was also a Founder Member of the Centre ) and Mr. Shailesh Kapadia. In 1995 Dr. Manek Bharucha and Mrs. Aiveen Bharucha, both Tavistock trained Child Psychotherapists joined the staff. Dr. Manek Bharucha was a Seminar Leader and a Personal Tutor on the Observational Studies Course at the Tavistock Clinic. In the same year the Centre not only developed a monthly forum for all professionals working in the field of Child Mental Health but began the Tavistock Model Bombay Course in Observational Studies which has now been running from 1996. In 1999 the Centre began the first Child and Adolescent Psychotherapy Training in India.

AIMS OF THE CENTRE

The Development of the Educational and Training work of the Psychoanalytic Therapy and Research Centre is shaped by the widespread recognition that effective practice in the field of child and adult mental health depends on the skills of the professionals. There is an increasing demand for high quality and innovative training programmes for mental health workers and for professional groups within the Mental Health, Education and Social Work sphere, whose contribution is vital at the community level. It is our aim to make an increasing contribution particularly by the psychotherapy training and the integration of psychotherapeutic approaches into the overall approach to care and prevention.

To ensure the relevance and appropriateness of our training activities we maintain active links with Training Institutes and Community Groups.

- Indian Psychiatric Association (Western Zone) Continuing Education in Psychiatry.
- Local Schools and Colleges including special schools
- Local N.G.Os involved in the care of the mentally ill and needy children.
- The Spastic Society of India.

INTERNATIONAL LINKS

The Professional Development of the staff of the Centre has been considerably enhanced by substantial contributions from Senior members of the British Psychoanalytical Society and the Tavistock Clinic (London). These early links were fostered by Dr. Donald Meltzer, a training analyst and Mrs. Martha Harris training analyst and child psychotherapist. Over the years, numerous leading mental health professionals from America, Britian, Australia and Israel have visited the center and have been involved in offering teaching programmes. There is a Bi-annual Asian - Australian Psychoanalytic Conference organized by the Indian, Israeli and Australian Psychoanalytical Societies which is held in Bombay.

TRAINING PROGRAMMES

Adult Psychoanalytical Training

Training Committee Secretary: - Mr. Sarosh Forbes.

Training Analysts: -

Mrs. Minnie Dastur
Mr. Sarosh Forbes
Mr. Shailesh Kapadia
Dr. Manek Bharucha

Analyst Lecturer: - Mrs. Aiveen Bharucha

CHILD PSYCHOTHERAPY TRAINING

Course Organiser - Dr. Manek Bharucha

Consultant to the Bombay Course:

Mrs. Gianna Williams (London)

Seminar Leaders and tutors:

Mrs. Aiveen Bharucha
Dr. Manek Bharucha
Mrs. Minnie Dastur
Mr. Sarosh Forbes
Mr. Shailesh Kapadia

TAVISTOCK MODEL BOMBAY COURSE IN PSYCHOANALYTICAL OBSERVATIONAL STUDIES:

Course Organiser - Dr. Manek Bharucha

Seminar Leaders and tutors:

Mrs. Aiveen Bharucha
Dr. Manek Bharucha
Mrs. Minnie Dastur
Mr. Sarosh Forbes
Mr. Shailesh Kapadia
Ms Banu Ismail
Mrs Zarine D'monte
Mrs.Micky Bhatia

INTRODUCTORY SERIES OF LECTURES ON PSYCHOANALYTICAL THINKING

Course Organiser - Dr. Manek Bharucha

Lecturers:

Mrs. Micky Bhatia
Mrs. Aiveen Bharucha
Mrs. Minnie Dastur
Mrs. Zarine D'Monte
Mr. Sarosh Forbes
Mrs. Simonil Forbes - Madan
Ms. Banu Ismail
Mr. Shailesh Kapadia

CONFERENCES AND MEETINGS

1. MONTHLY FORUM FOR ALL PROFESSIONALS WORKING WITH CHILDREN.

2. BIENNIAL INDO-AUSTRALIAN ISRAELI CONFERENCE

3. CONSULTATION - CONSULTATION TO INDIVIDUALS GROUPS AND INSTITUTIONS ON REQUEST.

4. SUPERVISION

1. INDIVIDUAL SUPERVISION ON CHILD, ADULT OR GROUP WORK ON REQUEST.

2. THE REFERENCE LIBRARY OF PSYCHOANALYTICAL LITERATURE IS LOCATED IN THE CENTRE BUILDING IN FORT AND IS AVAILABLE TO STUDENTS.

3. PSYCHOTHERAPY FOUNDATION FOR CHILDREN AND ADULTS.

What is believed to be essential for mental health is that the infant and young child should experience a warm, intimate and continuous relationship with his mother (or permanent mother substitute). In which both find satisfaction and enjoyment. (Bowlby - Maternal care and Mental Health 1952 W.H.O. Monograph, Geneva). He found that children with a history of disturbed early maternal relationships subsequently were found to develop superficial relationships with others, had no capacity to care for people or make true friends, had difficulty in concentration at school and had anti-social tendencies. The capacity of a mother or parents to offer this care can be impaired if the following are present (1) mental illness (2) extremes of poverty and unemployment leading to neglect (3) alcohol or drug abuse and or Aids (4) sexual abuse are present. Research shows that this leads to a cycle or deprivation as these children when they reach adulthood fail to provide emotionally for their offspring.

Some of these children and families are offered help by specialist teachers, social workers or psychiatrists but a significant number of children are found to be unreachable as their complex problems make them inaccessible to these professionals.

The Centre aims to train and develop a core group of dedicated professionals who can offer specialist psychotherapeutic work and a consultative service to other institutions who are helping these children, families and adults.

In many countries, psychotherapy funds have been created to help to develop and provide therapy for children and adults. The Psychoanalytic Therapy and Research Centre has a Psychotherapy Foundation which aims to offer therapy to severely disturbed children and adults and to offer scholarships to assist students in financial need so that specialist psychotherapeutic skills can be offered widely in the community.

PSYCHOANALYTIC THERAPY AND RESEARCH CENTRE

Registration:- The Psychoanalytic Therapy and Research Centre is a registered Public Charity Trust (under Section 50 A (1)) with exemption under section 80G of the Income Tax Act (No. E-4971). The Indian Psychoanalytical Society is registered under Act XXI of 1860.

Trustees:

Ms. Falguni Desai - Solicitor, Kanga & Co.
Mr. Anurag Kanoria - Industrialist
Mr. Navroz Seervai - Advocate, Bombay High Court
Mr. Hormazd Madan - Management & Financial Consultant, Accenture
Mr. Perviz Mandroina - Community Worker.

 

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