Mental Health
Spending long working hours, verbal and physical abuse initiates higher risk of developing mental health problems among adolescents.

“The charming bangles of Hyderabad that are beloved all over the country are made at the expense of children’s lives,” says Varsha Bhargavi, a former child rights social worker and activist based in Hyderabad who has been working with rescued children for eight years.

As she speaks, she pulls out some drawings that the children had made after they were brought to the Mamidipudi Venkatarangaiya (MV) Foundation, which works against child labour within several districts of Telangana.

One of the drawing she places on the table is made by Abhi*, a teenage boy who aspires to become a teacher some day. “He was brought to Hyderabad by a local trafficker (Rashid bhai*) after his parents were paid off,” Varsha says. And once in Hyderabad, Abhi was forced to make bangles with 23-24 other children in a small room.

If you look at the drawing Abhi made using crayons and pencils, it actually portrays the plight of the confined lifestyle he had in that workshop, Varsha says.

“There is a broken bangle at the top among other bangles, there is an instrument on the left which they use to make them. Both the human-like figures he has drawn are holding bangles in their hands with their legs folded,” Varsha points out.

Abhi's drawing

Adolescent labour and mental health

The International Labour Organization (ILO) defines child labour as children engaged in work that deprives them of their childhood, potential and dignity, and that is harmful to physical and mental development. But defining a concept as broad as children’s rights has always been complicated for the lawmakers, and more so when it comes to adolescents.

Although being different in characteristics, children forced into labour, trafficking and those abandoned on the streets are interconnected in terms of oppression, and lie on a similar spectrum of mental health issues.

While mental healthcare holds a crucial position in national concerns over child and adolescent health, issues among those oppressed by the many facets of a broken system remain unattended.

But does mental health need to be considered a major factor when the bigger picture is about the existence and continuance of oppressive practices like child labour and trafficking? Activists and NGO workers claim ‘yes’, so does the research. And it all starts with the rescue.

Rehabilitating street children

Vanajaa Augustine is Tamil Nadu’s state program officer for Rainbow Homes in Chennai, which has been working for street children all over India. She says that the process of rescue itself is concerned with maintaining attentiveness to the child’s mental health.

“Living on the streets, children are highly alert of their communication with others,” Vanajaa says. Which is why Rainbow Homes has an established procedure for rescuing them.

“We work in areas near Koyambedu bus stand, beach station, flowers market etc and visit these places with all the required permissions. There are two ‘mobilisers’ in our team, who first establish a regular contact with the children, and meet them on a daily basis,” Vanajaa explains.

“This goes on for at least two weeks until some trust is established. We then approach their caretakers, who are often in denial about their misery, because they somehow want to have the child to themselves instead of letting them live in the shelter. Sometimes, we take the children already living in our homes, who try to convince them that life in the shelter is better,” Vanajaa says.

Challenges to rescuing adolescents from forced labour

Rescuing children off forced labour, on the other hand, is a different procedure altogether, that requires involvement of police forces accompanied by other government officials. A planned raid is executed after they are either tipped off or have been investigating a potential area.

Varsha, who now works with the Telangana state government as a coordinator for the Elimination Of Child Labour Project, points out to some significant flaws in this method.

“There is no doubt that what they’re doing is good, but there is a lack of social awareness in the planning. For example, in ‘operation muskaan’, during the raid the children were not allowed to take their belongings with them. While I was interviewing them, almost all the kids pointed out  one or two missing items that were valuable. This created further distress in them,” Varsha says.

“Similarly, we need to understand that rescuing causes a major shift in children’s psychological state, because they were deluded to have sought comfort in the places where they were working, and now they have been displaced from there. It’s then our duty to prove to them that life’s better on the other side,” she adds.

Mental health issues like fear, sleep deprivation, and adjustment issues are often attributed to factors that are situational and hence make a clear case against forced labour.

Infographic by Vaishnavi Sundar

Respecting adolescents' agency

“The initial period after the rescue is very critical,” Varsha says. “They do not trust us completely. Thing is, you’re not supposed to tell them what’s good for them, but help them find out,” she adds.

What Varsha explains is similar to the basis for client-centered counselling, where, unlike the regular patient-doctor relationship where doctor is an ‘authority’, the client takes an active role, and the therapist plays a supporting role.

While adapting the model for the rehabilitation of children who face various mental health issues is a progressive step, the problem is that it’s still very unclear as to exactly which issues are dominant in children and adolescents.

Sleeping problems, excessive fear

Perhaps one of the few organisations focusing on finding out exactly what issues rescued adolescents face is Salaam Baalak Trust (SBT), a non-profit establishment operating in Delhi and Mumbai which has a dedicated Mental Health Programme.

“Children after being rescued from labour and streets show a recurring problem of dysfunctioning in their neurotypical skills such as communication, cognitive and social skills. During clinical assessments we found that they usually have a bad perception towards themselves and their lifestyle which is alarming of suicide risks,” writes Dr Mazhar Khan, one of the consultant psychologists part of the Mental Health Programme, in an exclusive report that the team shared with TNM.

The programme has an eight member core team, composed of counselling, consultant and developmental psychologists, work with children and adolescents rescued off streets and labour.

The report lists disturbances in mental health like sleeping problems and excessive fear, accompanied by numerous psychiatric disorders like Bipolar disorder, clinical depression, psychosomatic disorders and even seizures.

“They were forbidden from discovering themselves and were forced into labour. What we found was a direct result of that. Spending long working hours, verbal and physical abuse initiates higher risk of developing mental health problems,” Dr Mazhar writes.

Psychological fallout of forced labour

“Psychological effects of child labour are as severe as its physical ones,” Dr Mazhar writes, and says that it is unfortunate that most of the time, our focus is only on children’s physical health.  

Dr Mazhar also talks about the high likelihood of substance abuse among the adolescents.

“The children sometimes are also very adamant on going back to work but we know it is not what they really want. Mental health problems that we found through clinical assessments were directly linked to the oppressive system of child labour. Due to environmental conditions, they developed these self-coping methods such as use of substance, denial of their conditions and projecting their aggression on others,” he writes.

Vanajaa adds that in the case of street children, even if they have a parent they hardly see them, and this increases their vulnerability. “Access to drugs and violent groups become more, and later it all comes out together as attachment disorders, withdrawal and types of trauma,” she says.

Group session with Girls Rights Protection Forum and delegates from Uganda and Kenya. Pic courtesy: Varsha Bhargavi

Child labour, caste, and mental health

While the effects of physical abuse, mental abuse and confinement have been studied among economically and socially privileged children, and linked to mental illnesses, people working in the field say that the problem gets worse for children from Dalit-Bahujan and other marginalised communities.

Bharthi Selva, a social worker based in chennai, says that adolescents are especially at a higher risk of succumbing to mental health issues when they or their parents are involved in manual scavenging, which is a prime example of casteism in India.

“Children accompany the parents who work in the septic tank. This suggests a clear likelihood of them taking up the same jobs, because casteism is generational. These children are afraid to talk about their parents at school, since they fear that they will be asked to clean toilets there too,” Bharati says.

The India Committee on Netherlands issued a report ‘Flawed fabrics’ which brought to light the hardship of adolescent Dalit girls working in Tamil Nadu’s massive textile industry.

The report highlighted the confined lifestyle of young teenage girls belonging to the Dalit-Bahujan and other marginalised communities, who were locked in the factories for long working hours and were denied freedom to even step out of the hostel.

“The long hours of work and the hostile, insecure and unhealthy environment, are all taking a severe toll on the workers, whose physical and mental health is negatively affected. One 14-year-old girl working at one of the mills in question reportedly committed suicide in March 2014, while another young woman aged 17 also reportedly threatened suicide in 2013 because of the hardships she had to endure at work,” the report says.

Sexual abuse is rampant

Sexual abuse is more active in areas of child labour than it is talked about. Due to impairment in cognitive skills from the beginning, it’s rare for children to report it when they grow into adolescence. It later shows up in the form of trauma and post-traumatic stress disorder, of which the signs are too blurry, but with a thorough understanding, they are not very hard to approach.

“There have been times when girls we rescued from the streets have showed signs of traumatic events. They are often expressed by a constant fear from someone who resembles in age and appearance the one who abused them,” Vanajaa explains. “At other times, there is a pattern in their lifestyle which comes to notice. For example, hiding into their rooms after a certain time in the evening,” she adds.

Post traumatic stress disorder is contributed by a series of anxieties and flashbacks that are results of a traumatic event, that usually involves violence (physical and/or sexual).

For children living on the streets, working in factories or being trafficked, PTSD is a recurring phenomena. The event does not necessarily have to involve them, but witnessing it can also be the cause; domestic violence, watching someone being abused are some of the considerable signs in these situations.

The warning signs of sexual abuse in adolescents do show a similar construct of behaviours, but are restricted by inability to communicate well and environmental factors which affect them. Although, as observed by both Varsha and Vanajaa, children tend to express their torment in other ways, and drawings are a proven way of doing that.

“We always ask them about their favourite colour, their favorite animal, and analysing the answers, we find out something about them that they can’t tell during the interviews. They are always trying to convey a lot of things that are not just telling of their pain, but also the comfort they yearn for,” Varsha adds.

Trafficking not isolated from forced labour

Trafficking is often wrongly looked upon as something separate from forced labour but they are interconnected. Across the country, children are disappearing off the streets at an alarming rate. Among the rescued children, trauma has been a majorly associated mental health issue.

Ronnie Nido is a social worker at the Tata Institute of Social Sciences and is presently a part of the team conducting studies on trafficking in major states of India.

“Trafficking is a process rather than an isolated event,” Ronnie says.

“Often people who have been through trauma recall particular incidences; imagine that for a trafficking survivor, who has had to go through a whole chain of trauma right from being taken away from home by trickery or force, transferred to a whole new space where they don't know anyone, and constantly subjected to all kinds of torture which prevents them from escaping, and lastly being placed in an even newer space for the sole purpose of exploiting their labour, be it sexual, physical or mental,” she explains.

While issues like depression and anxiety in trafficking survivors are not hidden from the world, self harm and a lost self-esteem in general have also been equally noted.

“Many of them, of course, suffer from severe trauma, PTSD, anxiety, trust issues etc. Some of them even begin to have self-harming tendencies like cutting one’s wrist, losing interest in life, addiction to various substances and even violent outbursts,” Ronnie adds.

“There were three consecutive cases of adolescent girls who had cut their wrist within a week’s time. All quoted different reasons but with the underlying tone that 'they saw no prospects in life for themselves' was very clear,” she recalls.

Group sessions at Salaam Baalak Trust. Courtesy: Salaam Baalak Trust

Interventions and treatment

Psychotherapy, also known as talk-therapy is an interactive therapeutic treatment that is used by counselling as well as clinical psychologists to treat mental illness. It’s entirely based on communications and the formation of relationship between the client/patient and a trained mental health professional. While it is proven to be an effective mode of mental health counselling, group therapy is extensively preferred when it comes to people are under rehabilitation.

Laura Gomez is a counsellor working with Rainbow Homes in Chennai and does group sessions on a regular basis. “Fear, extreme attention-seeking because of suffered trauma and the likes of such behaviours reveal themselves in the group sessions we do. I spent most of my day at the homes. There is always something or the other that needs to be looked after,” she says.

The Mental health professionals at Salaam Baalak trust use psychotherapy, group therapy combined with medication to treat the children suffering from various mental health issues, disorders and trauma.

“The therapeutic and medical treatment can be followed by a proper management plan which constitutes services such as career counseling and vocational training so that children can be mainstreamed in the society,” Dr Mazhar says.

Where does the law go wrong?

It is vital to consider the state of the law as well as the NGOs for interventions that are highly professional and scientific in nature and are equally important for the rescued children, but is the law ready for it?

The Child and Adolescent Labour (Prohibition & Prevention) Act 1986 was further in June 2016 with some changes which reinforce the prevention of child labour in general, but do not see it from the perspective of mental health.

The exclusion of adolescents just from hazardous jobs is one of these controversial inputs. While the Act incorporates all kinds of occupations as prohibited for children aged under 14 years, it only restricts hazardous jobs like working in mines and explosives for adolescents between 14 and 18 years.

Quoting an analysis report by The HAQ center of child rights, “If all occupations and processes are hazardous for children below the age of 14 years, they cannot be seen as beneficial for children aged 14-18 years. Additionally, since the new National Policy for Children, 2013 recognises all persons below the age of 18 years as children, the ban on employment of children below the age of 14 years in all occupations and processes carried out outside the home should extend to ‘adolescents’ too.”

Varsha agrees with this when she adds, “What exactly isn’t a hazardous job? Children employed for domestic help are mostly adolescents, and there are always gas cylinders in a house. Does that not make it hazardous?”

The law also does not including trafficking within the amendment, which activists say is a big mistake. While trafficking is covered in IPC, the use of the law depends highly upon what is counted as trafficking.

Not all NGOs can afford professional treatment

NGO workers like Vanajaa are also worried about the continued ignorance of the authorities over their requirements which are basic in nature.

“The practicing mental health professionals do not usually want to work with us because they have higher demands when it comes to salaries and I understand that. What we need is for the government to understand this requirement. Even providing basic education has become a challenge for us since the state government only allows schooling of children till Class 8,” Vanajaa says.

The lack of mental health counsellors for children rescued from trafficking is also a hurdle despite the Juvenile Justice Act making mental health rehabilitative services mandatory.

“The village Tumalapalli (AP) has a primary healthcare center, a proper whitewashed building with facilities, but no one works there because the doctor employed has to cover seven such villages. There is a clear lack of proper implementation of ‘Right to Healthcare’ that is one of the twelve rights mentioned in the Child Rights Manual prepared by the NCPCR.”

It is also because the society differentiates child rights from human rights, which is a discrimination in itself. Rehabilitation barely includes mental health which powers the vicious circle of this issue.

Vanajaa with the children of Rainbow Homes

There is hope

Dr Shantha Sinha, the former chairperson of National Commission For Protection Of Child Rights (NCPCR) and a Padma Shri awardee now directs the MV foundation and recognises such gaps based on her experience.

“Depression, lack of selfhood and deep insecurity are some of the issues that I have come across the most. Children who are rescued are looking for ways to reconstruct their lives and the need of professional intervention is very visible. Healing should be a primary concern when it comes to love and caring,” Dr Shantha says.

Rainbow homes, which has been facing a lot of trouble in terms of assistance from the government, have started using the help of Bridge Course systems in education and including awareness about physical and sexual abuse in reference to mental health of the children they work with.

“We make sure we employ social workers who have a studious experience of psychology and are aware about concepts relevant to mental health of children in the shelters,” Vanajaa explains.

For Varsha who now holds an advisory position in the state government, hopes can be held high with the forethought Telangana government wishes to imply.

“Mental health is one of the most screaming reasons why child labour and related practices need to be abolished by roots. State resource center has now been established in Telangana, in the 31 districts we are placing a district-task force with all the stakeholders who will look after all aspects of forced labour, same goes on the block (mandal) level. With this said, sensitivity training in regards to mental health interventions is what we are planning in our approach,” Varsha says.

*Names changed.