1. - Wellbeing and Mental Health of Caregiver Dr. Jitendra Nagpal Program Director - Expressions India New Understanding New Hope

2. ……. Many of the things we need, can wait. The children cannot……. Right now is the time his bones are being formed, his blood is being made and his senses are being developed to him we cannot answer “Tomorrow”. His name is “Today”. Gabriela Mistral, 1948

3. We Borrow this world from children…. We owe it back to them …. - M.K Gandhi

4. Childhood is a journey… not a race We need individuals who have an infinite capacity for not knowing what can’t be done - Henry Ford

5.  From health to wellbeing  From learning to experiencing  From answering to questioning  From observing to participation  From welfare to human rights model Child Seeking and Child Centred

6. The Caregiver Distress… Carers face distress as a direct consequence of their caring role and experience higher rates of mental ill health than the general population. This leads to negative effects on the quality of life of the carer and the standard of care delivered to the Efforts to identify and treat caregiver psychosocial distress will need to be multidisciplinary Require consideration of the cultural context of the caregiver

7.  India - Children & adolescents constitute 40% - 44% of over 1000 million population  10-12 % of < 18 yrs suffer from disorders in behavior, learning and development.  ICMR (2001) - Mental & Behavioural Disorders in children & adolescence – 12.8%  WHO (2001) – Serious Emotional Disturbances in children & adolescents – 15% The Indian Scenario?

8. Prevalence of Mental Health Disorders in Indian Children (Mental Health Research in India)

9. Well Being Well being is generally used in Philosophy to describe the ultimate good of a person.

10. Health & Wellness – Seeking a Balance Physical PsychologicalSocial

12. Critical periods for brain development

13. The Early Years Neural Circuits Begin Developing Early in Life (700 synapses formed per second in the early years) Source: C.A. Nelson (2000) FIRST FIVE YEARS 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Months Years Sensory Pathways (Vision, Hearing) Language Higher Cognitive Function Use it or loose it Neurons that fire together wire together

14. Caregiving: A Balancing Act Other chronic strains and life events Internal coping resources External coping resources Secondary stressors Primary caregiving stressors Perkins et al., 2007

15. Conceptual model of the care giving process among caregivers of a pediatric population

16. Pearlin’s Stress-Process model of stress in carers (adapted from pearlin et at, 1990)

17. SUMMARY MODEL FOR PSYCHO SOCIAL WELL BEING OF CAREGIVERS LEVEL OF INTERVENTION WHO IS INVOLVED Entire Community All Family Member Counselors / teachers peer mentors Counselors / Peer Mentors other experts Integrated in to the Community Part of ADL in the family Careres needing additional help Professional management Mental well being I Mental health knowledge, attitudes and behaviours II Psychosocialproblems III Severe problems / disorders IV

18. Common types of interventions Psychoeducational—teach caregivers information and skills in managing dementia – Distinction, active participation vs. information only Support—Unstructured, emphasize support from members Cognitive behavior therapy—focus on caregiver emotional reactions, teach ways to manage caregiver reactions Respite/adult day care

19. Coping styles and interventions to reduce psychological distress in carers An important role for health-care professionals is in helping caregivers enhance their coping skills, supporting existing skills and facilitating the development of new ones.  Training and education programs  Information-technology based support  Formal approaches to planning care  Combination of education and emotional support  Spiritual support  Religious coping  Positive strategies for managing disturbed behaviour  High quality of informal relationships and presence of informal support  Psychotherapy  Cognitive-behavioural family intervention

20. Conclusion High strain caregivers at increased risk for depression and health problems Intervention for caregivers has the potential to produce long lasting, life changing, benefits for caregivers Potential to save costs and to minimize the long term damage to caregivers’ lives Important to build CG resources and do more to increase caregivers’ access to effective intervention

21. The most beautiful experience is the mysterious. It is this fundamental emotion which stands at the cradle of true art and true science. Albert Einstein Thank You