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Anxiety Test

August 26, 2021 admin Life
/7

Anxiety Test

Over the past two weeks, how often have you been bothered by the following problems? Please answer all the questions.

1 / 7

1. Do familiar surroundings sometimes seem strange, confusing, threatening or unreal to you?

2 / 7

2. Not being able to stop or control worrying

3 / 7

3. Worrying too much about different things

4 / 7

4. Trouble relaxing

5 / 7

5. Being so restless that it is hard to sit still

6 / 7

6. Becoming easily annoyed or irritable

7 / 7

7. Feeling afraid, as if something awful might happen

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The effects of Sexual Abuse on Mental Health of Children

August 20, 2019 admin Uncategorized

Have you ever wondered why teenage pregnancies are on the rise in primary school children especially in western and the coastal regions of Kenya as reported by the media? I’m sure many of us have asked ourselves questions like “What would make such young children engage in sex instead of concentrating in school work?” Some of us would blame and judge these children for lack of morality and focus on their school life!

Well, whereas some of us were privileged to go to school with full support of our parents or guardians, it is common to find some children who lack basic needs including food, clothing, school fee, and shelter for smooth schooling. Amidst these challenges, some children still defy all odds to perform well in schools and become successful; a true reflection of their perseverance, hard work, and resilience. However, the consequences of such hardships in a child’s mental health and development are immense.

For our August blog, I interviewed a guidance and counselling teacher and gained insights into issues affecting primary school children in Kilifi and further discuss how these issues affect the mental health of children and the possible solutions to the problems.

Interviewer: Thank you for joining me in this interview. What is your experience with working with pupils in this school? Which methods do you use to understand the issues pupils face?

Teacher: Primary school pupils present with different issues all the time. Sometimes teachers who are observant quickly realise the change in behaviour in a child and may get concerned to know more about the child’s life. In other instances, children would write down their concerns and place them on the “speaker box” where teachers can pick and read them. Since the children are advised to keep their queries anonymous, the speaker box is the best way to identify the issues the children are struggling with. Therefore, the speaker box got the deepest secrets and struggles that the children face in their daily lives.

Interviewer: What are the common challenges that your pupils face?

Teacher: Firstly, some of the girls in upper primary trade sex for money and that is how they end up getting pregnant and eventually drop out of school. When teachers realize that a child suddenly starts to behave in a different way, first, they try to understand the root cause of the change in behaviour before providing counselling. Later when the issue at hand is clear, teachers always involve the parent about the problem their children presented with so as to find a holistic solution. However, the parents would become defensive and wonder why a teacher would stop their child from having sex for money as that is their main source of income. “What kind of teacher are you? Don’t you realize that this is the only source of food as a family? How else do you want us to survive?” a parent would lament. Efforts to report such cases to the police would most probably be futile because, in the long run, the parent and the perpetrator would negotiate their way and resolve the case out of court.

Interviewer: Mmmmhh… that’s sad. What other problems do the pupils face?

Have you ever wondered why teenage pregnancies are on the rise in primary school children especially in western and the coastal regions of Kenya as reported by the media? I’m sure many of us have asked ourselves questions like “What would make such young children engage in sex instead of concentrating in school work?” Some of us would blame and judge these children for lack of morality and focus on their school life!

Well, whereas some of us were privileged to go to school with full support of our parents or guardians, it is common to find some children who lack basic needs including food, clothing, school fee, and shelter for smooth schooling. Amidst these challenges, some children still defy all odds to perform well in schools and become successful; a true reflection of their perseverance, hard work, and resilience. However, the consequences of such hardships in a child’s mental health and development are immense.

For our August blog, I interviewed a guidance and counselling teacher and gained insights into issues affecting primary school children in Kilifi and further discuss how these issues affect the mental health of children and the possible solutions to the problems.

Interviewer: Thank you for joining me in this interview. What is your experience with working with pupils in this school? Which methods do you use to understand the issues pupils face?

Teacher: Primary school pupils present with different issues all the time. Sometimes teachers who are observant quickly realise the change in behaviour in a child and may get concerned to know more about the child’s life. In other instances, children would write down their concerns and place them on the “speaker box” where teachers can pick and read them. Since the children are advised to keep their queries anonymous, the speaker box is the best way to identify the issues the children are struggling with. Therefore, the speaker box got the deepest secrets and struggles that the children face in their daily lives.

Interviewer: What are the common challenges that your pupils face?

Teacher: Firstly, some of the girls in upper primary trade sex for money and that is how they end up getting pregnant and eventually drop out of school. When teachers realize that a child suddenly starts to behave in a different way, first, they try to understand the root cause of the change in behaviour before providing counselling. Later when the issue at hand is clear, teachers always involve the parent about the problem their children presented with so as to find a holistic solution. However, the parents would become defensive and wonder why a teacher would stop their child from having sex for money as that is their main source of income. “What kind of teacher are you? Don’t you realize that this is the only source of food as a family? How else do you want us to survive?” a parent would lament. Efforts to report such cases to the police would most probably be futile because, in the long run, the parent and the perpetrator would negotiate their way and resolve the case out of court.

Interviewer: Mmmmhh… that’s sad. What other problems do the pupils face?

Teacher: Secondly, some of the children in lower primary, especially boys are sexually molested by guardians. Similarly, girls in lower primary are sexually abused by their close relatives and family friends. Sadly, the people that should protect the children are the ones that turn against them and become the perpetrators. Due to poverty, some parents and even the girls themselves have turned sex to an entertainment industry that they use to earn a living and to obtain basic needs.

 

Sexual abuse and mental health in children

 

Sexual abuse refers to multiple forms of sexual violence such as incest, molestation, rape, and other forms of non-consensual sexual abuse. Children who are victims of sexual abuse experience both short-term and long-term consequences that can be devastating and affect them when they become adults. In the short-term, the children who are victims of sexual abuse may show regressive behaviour such as bedwetting or thumb sucking past the appropriate age; behaviour problems and poor academic performance at schools; social withdrawal and refusal to participate in school activities; sleeping and eating problems; and frequent yeast or urinary tract infections.

The victims of child sexual abuse may also suffer long-term effects such as anger at the perpetrator and the adults who did not protect them against the perpetrator; feelings of anxiety in response to people who share the characteristics of the abuser; and difficulties in forming adult relationships due to mistrust and difficulties in sexual functioning in adulthood. Moreover, children who were sexually abused are likely to develop instability in relationships, negativity towards their partners, and having more sexual partners. Other problems include teenage pregnancies, poor parenting styles, and adjustment problems in their own children. Lastly, children who are victims of sexual abuse are likely to experience revictimization later in life.

Mental problems are common in victims of sexual abuse. Children who are sexually abused may develop depression due to feelings of loss of body autonomy which may result to hopelessness and helplessness. Children may also suffer from low self-esteem and low self-worth. Anxiety is common among children who are victims of sexual abuse as they may be overwhelmed by the feelings of revictimization which could lead to panic attacks whenever they face someone with the characteristics of the abuser. Posttraumatic stress disorders may occur as a result of intense memories of the abuse. Sexual abuse can also lead to a disruption of the personality such as borderline personality disorder due to fear of being abandoned.

 

Although to many of us, the only visible outcome is a pregnancy and we are quick to come up with policies such as the “school re-entry” policy for teen mothers; “return to school” policy; “child care services and boarding facilities” policy, the trauma that sexual abuse leaves the child with lasts for a long time. If the victims do not get the needed psychological help and treatment, children will be in a vicious complicated cycle of issues that will definitely reduce their potential and deem their light.

 

What should be done?

Child sexual abuse and facilitation of child sexual abuse is a worldwide issue that are both against children’s rights. Therefore, the penalties for child sexual abuse should be strictly adhered to so that abusers are convicted if caught. Moreover, stronger efforts by stakeholders are needed to protect children against sexual abusers and give children a safe environment for learning and development. Given the long-term negative impact of sexual abuse, it is indeed sad to learn that parents or guardians who are custodians of children and are responsible to protect them turn into abusers or use the children to trade sex for money! This is a well-known problem that indicate moral erosion caused by poverty, ignorance, and neglect. There is a need for economic empowerment for parents and guardians to enable them to earn a livelihood, restore their morale and self-respect and for them to take care of their children’s basic needs. Most importantly, there is need for victims of sexual abuse to get the much-needed comprehensive psychological interventions to help them to heal and break the vicious cycle of poverty, sexual abuse, and mental health problems.

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Mental Illness in Adolescents: Nacho’s Story

May 19, 2019 admin Uncategorized

The adolescent stage is one of the most challenging developmental stages. During this stage, it is normal for teenagers to feel upset, confused, or angry. However, when these emotions cause concerns and mental problems such as psychosis (a phenomenon where one has impaired thoughts and emotions, delusions and hallucinations, and thus loses contact with the reality), it is important to seek professional assistance. Psychotic phenomena can occur to seemingly very healthy youngsters. However, some can be vulnerable due to potential underlying issues in their development and a psychosis can be triggered by prolonged stress. This story pictures a girl who experienced psychotic phenomena and was referred for mental health care.

 Nacho’s story

Nacho’s mother was shocked when she received a call from her daughter’s headteacher informing her that her daughter was unwell and seemed to be having a mental health problem “mwenda wazimu”. She panicked and swore that could not be her daughter. She explained to the principal that Nacho had never had such a problem and she did not understand what the headteacher was talking about. Nacho’s parents went to pick her from school and sought mental health care from one of the hospitals. In the course of her treatment, her psychiatrist nurse referred her to me for further psychological assessments and diagnosis as she was not responding well to the medications. Her mother had accompanied her to the appointment.

 

Nacho (not her real name) is a 15-year-old girl who is a third born girl in a family of five. She has four sisters and a brother. She is a brilliant form two student (second class in secondary school) in a national boarding school. Since childhood she has been a bright, talented, all-round girl whose talent attracted the director of her primary school who offered to sponsor her primary education since she was 10 years old.

 

When I meet her on our first interview, she looks calm and collected. She is, however, very soft spoken but confident. During the interview she tells her life story that is replete with events and conditions that made her vulnerable despite her apparent talents.

When Nacho was 5 years her second last born sister was sponsored by a well-wisher to go for an open-heart surgery in Israel where her mother accompanied her. Fortunately, the surgery was successful and after some time they came back home. Unfortunately, while her mother was away, her last-born sister suffered severe malnutrition and developed rickets. Her mother had to focus on treating her last-born sister immediately she arrived from Israel. These were difficult moments for Nacho as her sibling’s ill-health caused a lot of financial constraints, stress, and worry to the family.

When Nacho was about 10 years old, her father had problems securing a job in the hotelier industry. He could only manage to get short contracts which never lasted for more than 3 months and became jobless again. From this moment, Nacho never understood why her family had to go through a lot of problems. She kept thinking and wondering why her family had to suffer this much.

However, this became her motivating factor to work even harder in school so she could one day have a brighter future. With the sponsorship from the director of her primary school, she was assured of school fees at least for her primary school education. True to her vision, she scored very high marks in her final primary school exam and got an admission in one of the best secondary national schools in the country.

The family was happy to have their daughter in the national school, little did they know that this could have been the beginning of Nacho’s problems.

Nacho reported to her new school which is approximately 850km from her home and settled down to start working hard as she had done in her primary school. Within no time, she became her classmates’ and teachers’ favourite student who quickly gave her a leadership role – a class prefect.

However, after a while, with extreme weather change and strict school rules and more responsibility and expectations as a student and a leader she started becoming overwhelmed. As a student she is expected to wake up at 4:30am to go for her morning preps until 7:20 am, as a prefect she is to supervise the other students while doing daily school cleaning and prepare herself for school by 8:00am. During lunch hour they take lunch while having group discussions. They then proceed for afternoon classes and are all expected to go for games from 4pm to 5pm. After this, dinner is served, and they go back for evening preps until 10pm. By 10:20pm all students are expected to be deep asleep. Obviously, 6 hours of sleep are way too little for a teenager, and chronic lack of sleep is known to be related to a number of mental health problems.

When school closed for second term she talked to her father about her new school. Being a very supportive father, he carefully listened to her and advised her to focus on the bigger picture as sometimes as humans, conditions and situations might not be favourable as we might wish but we have to adjust accordingly. She promised her father that she would try to adjust accordingly and continue with her studies. Fortunately, since the teachers realized that most students always sleep during class time, the school schedule was changed to allow students more time to sleep. However, this was only favourable to the rest of the students but not to prefects. While the rest of the students were busy finishing their homework during the evening preps, all prefects were expected to attend school meetings to discuss the new schedule. The meetings could last until 10pm when students are expected to sleep, and none is supposed to be awake. Since the prefects should be leading by example, they too are expected to adhere to these rules. However, Nacho was not able to do her homework since during the time scheduled for the homework, she was supposed to be attending the prefect meetings. When she went to class without the homework, the teacher questioned her and wondered why she was not performing as expected and moreover as a prefect she should be an example to the rest of the students.

Nacho then decides to speak to her class teacher to step down as a class prefect so she can have ample time to complete her assignments and attend to her school. However, her classmates and her class teacher say she is best suited for her position so she cannot step down. Supervising the other students and doing her duties as a prefect becomes a challenge and a huge burden to Nacho. She quickly gets irritated when a student does not follow her instructions. The students start becoming rude to her and she feels pressured to the wall. Nacho started feeling no one understands her.

Fortunately, the schools close and Nacho is happy to be back at home. She pours her heart out to her father who promises to get her to another school at the beginning of her second year in school. Despite how difficult it is to get a transfer to another school; Nacho passes her exam and qualifies for her transfer. Unfortunately, Nacho’s father is not able to pay the required new school fee and the transfer charges, and he convinces Nacho to try and go back to her old school while he continues to secure another job and save enough money for the transfer.

Thus, Nacho’s dreams of changing her school are shattered. Since she understands the situation at home, she agrees to go back to her old school in January. When Nacho goes back to school, she feels too much pressure and helpless. She has too many responsibilities and expectations that she cannot meet. The school environment is not favourable, yet her family cannot afford to change her school. She has problems both at home and school. She becomes inactive in class; teachers get concerned about her situation but cannot understand her point of view. Instead they keep telling her that she cannot drop being a class prefect duty and as a leader she needs to lead by example. She loses her class concentration; her mind starts wondering and she starts overthinking.

Just when the students are about to start the exams, Nacho and other students get admitted to the hospital due to food poisoning. It is during this time that the doctors realized Nacho is not only suffering from the food poising but might be having a mental problem as she is talking alone and seeing things that other people are not seeing.

Just when we are about to end this interview, Nacho mentions that when her parents came to pick her up and took her home, her mother listened to her and recalled that while she was about 4 years, she had a similar situation and could talk and hear things others were not hearing.

Her parents then took her to a mental health facility where she was given drugs and for 3 weeks was on treatment. Since she was not responding well to the medication the psychiatric nurse had to refer her for further psychological assessments and diagnosis. Nacho’s greatest fears at the moment is feeling that her neighbours are always talking about her condition. Whenever she sees a group of people, she thinks they are talking about her condition.

 

I later brought her mother on board so we could talk about Nacho’s childhood and the mother confirmed that when Nacho was about 4 years she was admitted to hospital with severe malaria and she could talk to herself and see things that the rest of them could not see. Luckily, she was treated and discharged from the hospital and since then Nacho has never been sick until when the mother received the call from the principal.

Her mother confirms that since Nacho came back from school, she had an obsession with cleanliness and neatness. She gets frustrated when the other siblings cannot perform their duties on time e.g., she wants them to take a bath on time despite that sometimes they have to finish doing their homework etc. She, however, thinks that Nacho learned this behaviour from her father as whenever the mother and children see him, they get busy and have to ensure everything is at its place and clean. Failure to which the father will get angry and start an argument with the mother while the children are listening. Nacho’s mother always advises her telling Nacho’s father that it is not a good idea for them to argue while the children are listening. However, since he does not get her point, she finds herself shouting back at him. She then says, “actually now that we are talking about this, I feel the home environment might have contributed to Nacho’s condition”.

I finalize the interview and the mental health assessments and give them my feedback. Both Nacho and her mother feel better and hopeful for better days.

Fortunately, Nacho’s parents found a neighbouring boarding school for Nacho and now she can go to school while on treatment. With the permission of the new headteacher, she will be able to come back for treatment and assessments as needed.

Each year about 100,000 young people experience a first episode of psychosis globally. This means that 3 in every 100 people experiences psychosis. Psychosis is a phenomenon where a person has sensory experiences that is, they hear or see things that do not exist or believe in things that are not real.

 

Early stages of psychosis may include difficulty in concentrating, poor school performance, poor personal hygiene, irritability, feelings of anxiety, displaying strong emotions or not showing emotions, and social withdrawal as indicated in Nacho’s case. The behaviour of children with psychosis may change over time as psychosis can develop gradually or suddenly. Children or adolescents may begin talking about strange things or ideas that do not make sense for instance, they might talk about their ancestors who they claim has sent them with a special message to the family. Others may become withdrawn and seem to be in their own world. This is also apparent in Nacho’s case.

 

 

It is important to identify these signs and symptoms as early as possible and get treatment which improves the chances of full recovery. Treatment includes antipsychotic medication along with individual, family therapy, and specialized programs. Changes in lifestyles such as reducing stress, additional support e.g. from school and family can be helpful in reducing the symptoms. If a parent or guardian is concerned about their child’s mental health they should talk to a doctor and get a referral to child and adolescent mental health specialist who is trained at evaluating, diagnosing, and treating children with psychotic disorders. The parent/guardian should describe the behaviour of the child that concerns them and talk to other people close to the child e.g. teachers or close relatives to see if they have also noticed any changes in behaviour of that child.

 

There are several causes of psychosis in adolescents such as family history of psychotic disorder, pregnancy complications, chronic inflammation, medical illness, exposure to traumatic life events and stress, low-socioeconomic status, social isolation, use of cannabis. In Nacho’s case, there were several risk factors for her condition. First her medical condition-severe malaria- at age 4 triggered her first episode. Secondly, her family’s low-socioeconomic status, stressful home environment, and stressful school environment all contributed to her psychotic episode at 15 years.

 

 

How can a parent/guardian help their child to cope with mental illness?

 

During this moment your child will need your support the most. It may be difficult for the parent or guardian to cope with the feelings of hopelessness, anxiety or anger before your child gets a diagnosis. However, after a diagnosis, you can work together with the mental health provider to help you change how you interact with your child and how to handle their challenging behaviours. For instance, it may be important to praise your child often to encourage their strengths. It is also important to interact with your child often and have fun and play together. You may need to learn how to manage stress so as to respond calmly in stressful situations. Seeking family therapy and support groups and further understanding of your child’s condition may help you to cope better.

To help your child cope better in school, it is important to inform the teachers and school counsellor about her condition so that they can be supportive and offer a conducive school environment.

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The Plight of Parents of Children with Mental Illness

February 12, 2019 admin Uncategorized

In the African society, a baby is seen as a blessing. A baby is a beautiful creature that should be celebrated. Therefore, the birth of a baby symbolizes a new beginning. A newborn is welcomed with songs, dances, and praises, celebrations and ululations as the parents and the baby are gifted with various things.

Parenting is a moment full of joy and at the same time, one of the most challenging moments in life. The moment a baby is born the life of a parent changes forever. It’s no longer all about the parent but the baby. This is the time parents learn the strength they did not know they had, the love they never knew existed, and a life full of dreams and hope for the baby. However, this is also accompanied by worry, tension, and sometimes tears as parenting a newborn can be overwhelming.

It is a beautiful Saturday, a bright morning in the coastal region of Kenya. In my quest to reach out to children with mental illness, I start a long journey to a village in the interior areas of this part of the country to meet some of the children that need mental health services. After a long drive, we arrive in the village to meet the children who are playing in a school. Immediately we arrive, we are greeted by a group of parents whose smiles and joy cannot be hidden – the smiles of hope and a sigh of relief! All the children come running to
welcome us. I immediately notice how the parents struggle to keep them off the “visitors”. After realizing that I’m comfortable with the children around me, the parents give up pushing them away from us. I take the first hour to play with the children: some are moulding toys, some staking toys together, some playing with balls, others drawing, while
others are sited quietly in a corner.

I feel a tap on my shoulder, and I get distracted from the toys we were stalking together. It’s the project coordinator drawing my attention. Introducing me to the parent, “this is Dorcas, “…she helps children with mental illness”, he says. Immediately, the woman’s face lights up and calls her son to join in the conversation. She tells me a history of her son, how he dropped out of lower primary school because the teachers thought he was too aggressive towards other children and could not be handled anymore. She is left with no option but to take her child home. That was the last time he attended school. The son is now a teenager, but he stays at home and helps with a few household chores. Sometimes he is aggressive while other times he sits quietly and does not seem bothered by anyone. He has a short memory span and doesn’t remember things quite often. The parents have tried all sorts of medical attention but have not found anyone who understands the child’s condition.

The mother shares all her frustrations and becomes too emotional to speak. I give her a long hug and later she says, “thank you for listening”. Her face lights up again.

My encounter with this experience gave me a lot to think about. I imagine the day this particular child was born and the parents’ journey through this period, especially in an African context. When parents realize that their child has a problem, life becomes unbearable. The burden of caring for a child with mental illness together with the stigma in the community and lack of social support make parents isolate not only their children but also themselves from social activities.

To make it worse parents feel pained to realize that their child has a disease that they cannot understand. Sometimes parents fail to understand their child either. They begin to think that the child is just a difficult child, disobedient, and aggressive. The frustration can make the parents to not only hate their own child but also physically abuse them or in worse cases abandon their children.
Mental illness encompasses psychological and emotional disorders that impact how individuals behave and feel. Just like adults, children can develop mental health conditions such as anxiety, attention, communication, emotional, behavioural, and eating problems.
Children with mental illness are often victims of stigma as the communities they live in view them as an outcast and a punishment to the family. This is mainly due to the misconceptions about the causes of mental illness. Most African communities believe that mental illness is caused by the actions of parents, ancestors, supernatural powers, or witchcraft.
The lack of proper diagnosis and care/treatment makes the situation even worse. When parents fail to get a diagnosis about a child’s condition, they resort to other forms of seeking help such as witch doctors or spiritual leaders who are believed to cast out the evil possessions in the child or isolate their child from the community.
Despite the high burden of mental illness in children, it remains a subject that continues to be neglected. Parents of children with mental health are not only faced with stigma due to their children’s mental state but are also faced with limited access to mental health services in addition to the lack of financial resources. The lack of proper mental health care for treatment and prevention of mental illness in children is a double tragedy as these problems escalate in adulthood and may lead to worse outcomes.
The purpose of this first blog is to outline the need for help of children with mental illness, highlighting the effects of children’s mental health on their families and the society and form a platform to provide educational blogs on parenting children with mental illness. In the next blogs we will aim to create awareness on children with mental illness and provide needed information to caregivers of children with mental health problems.

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