Youth Support Library

Adolescent Health in Urban India;   A Study of Mumbai  K. Anil Kumar

Paper prepared by K. Anil Kumar, Usha S. Nayar, and P. M. sandhya Rani of the Unit for Child and Youth research, Tata Institute of Social Sciences, Sion- Trombay Road, Deonar, Mumbai 400 088 India - The research on which this paper is based was funded by the Ford Foundation through its grant to the Centre for Health Studies at the Tata Institute of Social Sciences. Mumbai, India

Introduction Recognition of adolescents as a  population subgroup with unique needs came late in India. Popularisation of reproduction health concept, increasing number of AIDS cases among young people, and prevalence of early marriages were important factors for the recent attention on adolescent health from policy planners and researchers.

Research studies on specific facets of adolescent health exist in India in abundance. Such studies mainly focus on risk-taking behaviour especially among students the implications of social cultural differences for health  promotion, gynaecological problems related to early pregnancy and child birth  and adolescent sexual behaviour. Those attempts which dealt with adolescent health in a comprehensive way, examining its different facets in a single study were mainly based on secondary data and could not look into the less obvious problems of socio-economic inequalities. The present paper, based on a study among Mumbai adolescents aged 15 to 17 attempts to understand their health using both subjective and objective health indicators, and examines the relationship of health status with socio-economic situation and health related attitudes and behaviours.

Data and Method Conducted in 1994-95 in suburban Mumbai, the study covered 311adolescents from various socio-economic backgrounds respondents were selected from slum areas as well as from posh localities. Two other concerns in sample selection were gender and school going status. Strong son preference traditionally prevailing in India necessitates consideration of sex differences in heath situation of adolescents. A considerable proportion of Indian adolescents are out of formal education dropping out at various stages for various reasons. Exposure to health risks, and health status differ between these two groups.

Because the sample size is not large, results are to be treated as indicative rather than conclusive. That the study covers adolescents from different social and economic background and views health in a broader perspective makes it an exploratory attempt towards understanding the health of adolescents. Students of two schools which admit those from middle and upper class families, and adolescents from two slum areas were selected for the study. Adolescents from slum families were interviewed individually by trained researchers. Students of XI and XII classes of the selected schools filled in the interview schedule themselves with research staff explaining each question initially to the entire class and then attending to the individual clarifications. In addition to the interviews anthropometric measurements were also taken.

The study gathered information on household socio-economic status, eating habits of adolescents, perceived health, perceived adequacy of nutrition, nutritional deficiency diseases, illness during the 15 days prior to the interview, disability, risk taking behaviours, exposure to mass media, health services utilisation, their concept of health, and mental health status. For the purpose of this paper, perceived health, ailments during the 15 days prior to the interview, height, weight, and mental health score are used as health indicators. The variations in these indicators are viewed as functions of socio-economic status, eating habits, nutritional adequacy, prevalence of nutritional deficiency diseases, exposure to media, and attitude towards risk taking behaviour. For analysing the effect of independent variables on perceived health and reported morbidity,  logistic regression analysis is used. To examine the changes in height, weight, and mental health score, multiple classification analysis was employed. In the bivariate case, differences across population groups in health indicators is examined using x2 test and one way analysis of variance.

Results The number of boys (139) in the sample was lower than that of girls (172). Of the 311 respondents, 57.6 per cent were school going and the rest were dropouts. The distribution of respondents according to subjective health indicators by selected socio-economic and other health related characteristics was recorded. Keeping in mind the importance of sex and school going status, we consider these two also as dependent variables. Age-sex distribution shows significant age differences between males and female adolescents in the sample; the mean age of males being higher (16.2 years) compared to females (15.8 years).  Sex difference in school going status is also significant (I% level) with more females dropping out of the school system.  This observation is consistent with the situation prevailing in India at large.  Sex distribution by religion is not significant whereas that by caste is significant at 5% level. One indicator related to housing - whether the household has a separate kitchen served as a proxy to other housing related variables. The distribution according to this variable is not found different between males and females.

 A household socio-economic status index shows that the level of living of the selected male and female adolescents differ considerably (probability of I%) The rest of the variables are some of the intermediate variables which have a more direct bearing on health status and behaviour. Of these six variables, the sex differences in perceived nutritional adequacy, nutritional deficiency diseases, and per capita daily energy intake are significant. The distribution of adolescents by socio-economic and other characteristics according to whether they attend school or not show significant differences between these two groups. Further, the health related behaviours and attitudes as well as indicators related to nutritional adequacy show significant difference between these two groups.

Distribution of adolescents by background characteristics when two subjective indicators of health are considered. The first of these indicators is obtained as the response to an item to rate their own health status in a four point scale: excellent, good, fair, and bad. The second is reported acute illnesses during the 15 days prior to the interview. The term 'illness' is perceived differently by different people and can be thought of as subjective. The results show that, of the seven socio-economic and demographic indicators considered, three of them show significant influence on perceived health. Of the six health related indicators, only one shows significant effect. When ailments during the 15 days prior to the interview is considered, of these 13 indicators, only one - the number of meals per day - shows any significant impact.

Objective indicators of health considered by socio-economic characteristics and health related indicators are presented. For most of the independent variables, the mean height, weight and mental health score differ significantly across various categories. In the case of height, seven out of the thirteen indicators, in the case of body weight  ten out of thirteen, and in the case of mental health score eight out of the thirteen show significant differences across the categories. Anthropometric measurements show that, body weight rather than height exhibits a larger variation across the categories of different indicators. Mean height is significantly different across sex, age, school going or not, caste, having separate kitchen, perceived nutritional adequacy, and energy intake. Body weight differs significantly for these variables as well as for standard of living index, exposure to media and religion. Mean mental health score varies according to sex, school going status, religion, caste, whether the household has separate kitchen or not, standard of living index, nutritional deficiency diseases and exposure to media.

The first set of multivariate analysis used logistic regression analysis with perceived health status and acute illness as dependent variables. Many of the selected variables are not significant in explaining the differences in perceived health status.  Of the thirteen selected variables, age, separate kitchen or not, and nutritional deficiency diseases are the three factors that have a significant influence on the perceived health status.  At the same time, only two variables -separate kitchen and number of meals per day are significant predictors of ailments reported. When variables other than demographic and socio-economic are entered, the variable number of meals per day in the case of perceived health and nutritional deficiency diseases in the case of ailments become important predictors. When demographic and socio-economic variables are used as independent variables, only age and separate kitchen in the case of perceived health and separate kitchen in the case of ailments show statistical significance. When age, sex and school going status are the only independent variables, age and school going status become important in predicting perceived health whereas none of the three variables is significant for ailments.

Finally meals per day, perceived nutritional adequacy, nutritional deficiency diseases, exposure to media, attitude towards risk behaviour, and energy intake were analysed to see the influence of demographic and socio-economic variables. Surprisingly, in only two regressions - for media and energy did any of the independent variables show significance.  Religion and school going status are significant predictors of exposure to media and age is related to the energy intake per day.

Anthropometric measurements and mental health score were treated as dependent variables.  Multiple classification analysis (MCA) was utilised for analysis and since no more than ten factor variables can be entered in a single command, the variables energy, number of meals per day and standard of living index were not recorded and were introduced as covariates. The same analysis was repeated for each of the three objective indicators initially for the entire sample and later for each sex and for school going and non-school going adolescents. The grand mean of height, weight and mental health score were respectively 163.1cms, 42.9kg. and 9.2 The gross religious differences in height of adolescents is 6.44cms and the net difference is 2.81cms. Among Hindus, the height tends to be higher than the grand mean by 0.85 cms, among Buddhists it tends to be higher by 0.97 cms and among other religious groups (taken together), the average mean is lower by 4.63 cms. This pattern of variation changes considerably when the effect of other variables are controlled. When adjusted for such effects, the net religious differences in mean height increases from 2.81 to 3.91 indicating that the effect of other variables tend to hide the independent effect of religion on height. The deviation from grand mean for each religion also undergo considerable change. when control led for the effect of other variables, the effect of religion increases considerably; the variation explained increases to 4.84 per cent the greatest effect on height is of sex followed closely by caste. The effect of sex on height is considerable 9.61 per cent of variation in height can be explained by sex differences alone. Caste explains 9 per cent of the variation in the height of adolescents in Mumbai city.

It is possible to interpret the results in a similar way for the other two dependent variables also. The unadjusted and adjusted deviation from grand mean body weight is most affected by caste and sex, as observed in the case of height. The effect of independent variables and covariates on mental health score decreases once the intercorrelation of independent variables and covariates are controlled. The most important of the explanatory variables are nutritional deficiency disease and whether the household has separate kitchen.

The differences in the effect of independent variables on height, weight, and mental health score were analysed also for each sex and separately for school going and non-school going adolescents. For males and school going adolescents, the influence of these variables are considerably higher compared to females and non-school going adolescents

Discussion - Four-fifth of the selected adolescents reported their health as excellent or good underlining the feeling of general invulnerability prevalent among youth. Forty two respondents (13.5 per cent) reported to have suffered from acute ailments during the I5 days prior to the date of interview.  If we compute a rough estimate of the prevalence of acute illness, it would be higher among Mumbai adolescents compared to the national situation and that observed in some Indian states. In spite of the socio-economic differences, Mumbai adolescents both males and females - tend to think  that their health status is good.

An interesting related result of the study is the perception of health by adolescents. The respondents reported that they are in general healthy, but they could be healthier. In order to become healthier, most of the adolescents thought that they need to eat more food, eat food, with nutritional value, and exercise regularly. They were asked whether they knew anyone who can be regarded as healthy. Those who responded 'yes' to this were further asked why they regard this person as healthy. The responses centred around 'because he/she is physically fit', or 'he/she doesn't suffer from any disease' indicating that mental or social health are not thought by adolescents as facets of health.

We found that the variation in subjective health indicators across socio-economic categories is not marked, the bivariate analysis of objective indicators of anthropometric measurements and mental health score showed significant variations with social, economic and demographic factors. Similarly, while in the case of perceived health the intermediate variables rarely showed significance, objective health indicators showed statistically significant influence.

Whereas for subjective health indicators, sex-wise analysis and separate analysis of school going and non-school going adolescents did not provide any important deviation from the overall scenario, the objective indicators present a different situation. The influence of the independent variables vary considerably between sexes and between school going and non-school going categories. The differences in the influence of various factors between objective and subjective may be due to the lack of association between these types of indicators.

The relationship between objective and subjective indicators of quality of life is often weak. Of eight possible relationships only two between perceived health and ailments, and between ailments and mental health score are statistically significant.

Promoting Adolescent Health on   an Adolescent Ward

G.Anderson, S. Clarke, R. McClymont

Health promotion is an important aspect of primary health care for young people. This presentation will describe the Health Promotion Program currently offered at Westmead Hospital Adolescent Unit, Sydney

The aim of the program is to provide relevant health educational activities for hospitalised adolescents based upon needs assessments and involvement of young people in the planning, implementation and evaluation stages. The program is designed to extend young people's knowledge of and sense of responsibility towards, a range of issues affecting health and well being.

Adolescents are more eager to participate, learn and adopt positive changes when they play a role in determining their own health educational needs. In this program, adolescents positively contribute to the process of identifying and prioritising their own health educational needs. As a result of being involved in the planning, implementation and evaluation of the program, young people feel a sense of ownership and enthusiasm about the learning process. These learning experiences promote positive health related behaviours in physical, emotional, social and value orientated aspects of health and well being. A few examples of requested topics include: Feeling good about yourself Managing on a budget; Getting on with parents; What happens when you have an anaesthetic; The effects of drugs and alcohol; Healthy eating; Skin care and pimples; Sexuality and contraception; How to get the job you want.

The use of small group work and peer support stimulates thought, critical thinking and opinion. It also fosters a non-threatening milieu of interactive, yet relaxed sessions which maximise learning experiences. Evaluation by young people is a crucial part of this program. This presentation will describe planning and functional aspects of the Adolescent Health Promotion Program.


Reducing Teenage Pregnancy: An Interagency Discussion Document Helen King

Consultant in Family Planning and Reproductive Health Care.  Womens Health Directorate Sheffield NHS Trust

Sheffield has a Sexual Health Strategy, which was launched in January,1995. A multi-agency Implementation Group was formed in 1996 to monitor and review progress towards achieving the Strategy's objectives. The group determined priorities for action, one of which was the need to reduce unintended teenage pregnancies A small working group whose brief was to focus on inter-agency strategies for reducing unintended teenage pregnancies was established in January 1997.

This group, which consisted of representatives from Sheffield Health (Health Promotion and the Centre for HIV and Sexual Health), Community Health Sheffield NHS Trust and Sheffield City Council Youth Service, agreed that it would aim to produce a short working document by June,1997.

An initial extensive literature review drew attention to the over-riding importance of the cultural, social and economic context, including sex education, in occurrence rates of teenage pregnancy. It became clear early in the process, that the group could not presume to write a strategy that would seek to change areas of work over which it had no direct influence. However it would be able to produce a consultation document relevant to Sheffield presenting national and Sheffield perspective highlighting key areas for action.

This poster chronicles the process of developing the discussion document, which took 6 months longer than anticipated - the final version, appeared in January1998 - and subsequent multi-agency workshops were set up to pull together ideas and opinions from a large group of professionals in order to take work forward.



Mortality from Violent Causes in Adolescents and Young People: A Challenge for the Region of the Americas.  Tamara Zubarew1, Joao Yunes2

Director, Adolescent Health Programme, Catholic University. Santiago, Chile.

2 Professor of Epidemiology, University of Sac Paulo School of Public Health. Pan American Health Organisation

This paper summarises findings from analysis of mortality trends in homicides,suicide, traffic accidents, and all external causes in adolescents and young people from 16 countries in the Region of the Americas. Information compiled by the Pan American Health Organisation Data Bank between 19S0 and 1994 was utilised. A description of different subgroups of adolescents and young people, by age and sex, is provided Results indicate that in the majority of the countries (Canada, USA, Ecuador, Mexico Chile) Costa Rica, Trinidad & Tobago, and El Salvador) mortality trends due to external causes have been decreasing in adolescents and young people. Colombia and Brazil are the only countries analysed demonstrating increasing mortality rates in their populations. The countries with the highest mortality rates due to external causes in adolescents and young people, in decreasing order, are: Colombia, El Salvador, Venezuela, Brazil and Puerto Rico. The primary external cause of death in adolescents and young people are traffic accidents. However, in almost all the countries analysed, the death rates are decreasing. Ten of the countries analysed revealed a progressive increase in homicides in all of the age groups studied (Colombia, Puerto Rico, Trinidad & Tobago, Argentina, Uruguay, Panama, USA. Venezuela, Ecuador and Brazil). The countries with the highest homicide rates among adolescents ages 15 to 19 years, in decreasing order, are: Colombia, El Salvador, Puerto Rico. Venezuela, and Brazil. Young men, ages 20 to 24, were the sub group with the highest homicide rate. In the United States and Brazil there is an alarming increase in the homicide rate of boys between 15 and 19 years of age. Suicide is a growing problem in adolescents and' young people in Cuba, Canada, USA, Trinidad & Tobago, Argentina, and El Salvador. Increasing mortality rates due to homicide reflect the dire need for more epidemiological surveillance and violence prevention programs directed towards adolescents and young people in the Region of the Americas.


The Development of a Concept of Family therapy.

Sergei Sannikov   A short literary review

Family therapy as a branch of psychotherapy dealing with the issues of family relationships, means of affecting change aimed at both prevention and treatment as well as psychological and social adaptation was reflected in the parallel works of a number of psychotherapists from different schools and methodologies in the fifties and sixties.

Levi describes the observations of a number of experienced clinicians, who came to the conclusion that "functioning of the individual could be better understood and changed in the frames of his family":  The following factors are relevant here - patients staying in the hospital feel worse after the visits of their family members, - in cases where the patients' health improves the same clinical symptoms may be noticed in the other family members, who was previously considered to be healthy, - psychoanalysts who deal with children having behavioural deviations noticed that their parents often resisted positive change in their children, trying sometimes to prevent further treatment.  After these observations they began searching for causes of changes in the interpersonal relationship and the peculiarities of interfamily communications.

A. Zakharov described the influence of the family relationship on the development of illness in children (relations between the parents, between parents and grandparents between other family members).  S Minuchin proved that the conditions of the family boundaries and it's subsystems, may influence disease and social and psychological maladaptation. Quite the reverse occurs when adequate valid assistance of psychotherapist is provided the inner family relationships lead to it's healing. Menegetti notices that very often a family member which is considered to be healthy becomes the inductor of the interfamily psychological tension but not the real symptom carrier. One of the basic terms of Sallyvan's theory - is the image "of the nuclear family" taking place from very early childhood and based on present family relations and which has a strong influence on the forming of relations between the individual and environment.  

Rollo May states that the basis of the personality of an individual develops from early childhood and depends on his role in the family. Further the character develops depending on how the individual realises the primary model. The main goal of psychotherapy in his opinion is to help the patient, paying attention to the significance of childhood, to understand step by step how to use the influence of today's environment for successful correction of the individual's model. Virginia Satir who worked successfully in family therapy considers that creative potential and successful functioning of the individual may be only increased with the changing of the conditions of other family members and acquiring new aspects of their relationship. She considered that family therapy means the mandatory participation of all family members in the work. J. Bell as the first steps of therapy deals only with the parents and than added the "child's problem" to the work.  In Bowen's opinion it is possible to work even with the one family member for changing the whole family. Famous family therapist R. Stewart deals only with married couples. The Milan school uses the whole team of psychotherapists working with every family while others (including V. Satir) prefer that the family as a whole and each family member deals with the same psychotherapist. So there is no common idea of a family therapy.

The Kocharyans describe their view on the problem. According to their opinion the term "family therapy" is polysemantic and carries different meanings. That is because of the fact that the base for highlighting of the family therapy may be such opposite sides of the psychotherapeutic process as the OBJECT. In the first case we deal with the psychotherapy of a family as a system, and in the second- with the psychotherapy by the family (means using the united family effect for treatment of the patient).

They divide the three main models of the family therapy:

-        An Energetic model, which is based on the idea of energetic homeostasis. The therapy preferably is directed on decreasing of the emotional tension.

-        Symptomatic model. It is based on the correction of a psychological incompatibility. They use the method of informing the partners in their individual peculiarities and searching for the proper ways of their co-operation. First of all, the symptomatic model appeals to the role and behavioural structures for reaching the cross-matching of the role waiting and role behaviour.

-        The semantic model. In the frames of this model the individual structure and it's actual features are seen as the secondary defensive features when the individual's structure is modified with the "psychological defence". The conflict is explained not by the personal "defects" but quite the reverse the conflict itself provides the formation of some personal peculiarities. The idea of multidimensional individual structure, of the primary, secondary and tertiary individual peculiarities lies in the base of this model.

Own experience

I Practice - The years of experience of working with the patients having neurotic, psychotic  and  psychosomatic diseases show the insufficiency of the level of medical aid without using direct or indirect family therapy, especially in children and adolescents. In these cases we saw very often the inefficiency of treatment and early recidivism. In the case of repeated hospitalisations and visit to the physician the relationship between the interfamily co-operation and the deterioration of the patient's status was underlined. The addition of family therapy to the individual and collective therapy leads to quick healing, increasing the quality and the continuance of the remission, to the increasing of the other family members' health and psychological conditions. The higher was the grade of the participating of the family members in the treatment the better were the results.

We used different schemes of the work: sometimes it was possible to make the whole family take part in the process using individual psychotherapy and other kinds of medical aid for the family members. In other cases- it was a work with the family members who "were interested in" the changes. Not uncommonly it was possible to improve the child's condition by changing the accent of the work to the psychological assistant for his mother and harmonising of the "wife-and-husband" relations. We used both the work of one psychotherapist and the two of them.

2 Dealing with the problems of healthy people.

In recent years we have notes a changing emphais in our work from treatment of really ill people to the ones who were previously considered to be healthy. In some cases it was enough to use individual and collective therapy, in other cases an adequate aid was impossible without using family therapy. We mean in that cases not the "therapy by the family", but the "therapy of the family", in which case the family is seen as a multilevel system  with numerous self-depending and self-developing structures.

3 Dealing with groups of people and collectives.

The practice of family therapy used similar methods to the business consulting of groups of people for developing the optimal relationship, searching for the new resources and underlining the most fruitful development strategies.

4 Education of the specialists.

In recent years interest in family therapy among physicians, psychologists, teachers and social workers has significantly increased. More and more time and skills of the family psychotherapists is required to be allocated to the education of these specialists. Nowadays we have in Ekaterinburg very few psychotherapists having adequate skills and knowledge in family psychotherapy.

Ill Preliminary conclusions

The influence of a family on the process of establishing a human being in childhood, on the self-realising of adult, on the conditions of an old person is self evident. And it is also evident the influence of the family on the development of harmonic adaptation or maladaptation. The improvement in the quality of life (it may be healing after some disease or the person feeling better) which reflects the individual's relationship with the world and his formation as a more successful professional are impossible without changing the interfamily relations. Taking into account today's situation it is possible to confirm the need of further development of the theory and practice of family therapy.

IY Means of development of family therapy.

1 Foundation of the Family Therapy Development Fund.

2 Providing psychotherapeutic services for the family as a whole and dealing with other family members, with adequate usage of different types of complex multilevel therapeutic methods.

3 Providing the different types of medical aid for other family members including medicaments and also non-medicate ways of treatment.

4 Usage of different types of non-medicate ways, including cultural influence and healthy style of life.

5 Establishing the family clubs.

6 Dealing with groups of people and whole collectives:- usage of family therapy methods in work with whole collectives for their successful functioning,- work with individuals to increase their effectiveness in the family, in their professional and other kinds of activities.

7 Methodological assistance and co-ordination of the activities of other professionals who work both in federal and private enterprises and deal with the same activities. Development of the informational and analytical resources.

8 Active interchange of new scientific and practical achievements both of Russian colleagues and from other countries. Participation in international programs and projects. Exchange of specialists.

9 Training of specialists who deal with the medical, psychological and educational activities.

V According to all described above we think it is possible to ensure the necessity of wider use of family therapy as one of the basic integrative approaches for providing psychotherapeutic and other medical aid.


Medicinal Herbs in Psychotherapy

Use of phytotherapy in treatment of children and adolescents with psychiatric disorders

Galina Sannikova

Our experience of usage of phytotherapy (treatment with the medicinal herbs) in treatment of children and adolescents with psychological disorders based on the activity of the "Children and Adolescent's psychical health Centre".

Until recently the usage of phytotherapy in treatment of psychological disorders in children was considered only as an adjunct to treatment. Phytotherapy is used in psychiatry as a part of a complex treatment in combination with other methods of influence: psychopharmacotherapy, psychotherapy etc. Although our I0-years experience of using medicinal herbs in paediatric psychiatry shows that it is possible to solve a lot of problems connected with rehabilitation. Paying attention to the peculiarities of the herbs' action it is possible to influence the mechanism of adaptation disorders as well as on the constant postadaptational disorders, including biologically active influence of herbs on the thin metabolic, mediator and hormonal processes which can not be spread all over the other methods of treatment.

We dealt with 2038 children for a period of 1990 to 1997 years. Phytotherapy was used as an additional method in combination with traditional psychopharmacotherapy as well as separately and consisted of continuous step-by-step influence on the different parts of the pathological process (such as hypertension, seizures, excitability, phobic disorders sleeping disorders, cardiac and digestive disorders). It was the goal of indicating medicinal herbal drinks containing different plants with sedative, anticonvulsant, diuretic, spasmolytic and stimulating action. For correction of the side effects of traditional drug therapy we used also herbal drinks (so called "Herbal Tea") containing choleretic, metabolic, anti-inflammatory, immuno-stimulant and poly-vitaminic plants which have regulative action on the heart and circulation as well as on the digestive system.

The following schemes of phytotherapy were used according to the concrete indications:

I Basic phytotherapy- used as an isolated method of treatment in the cases when the usage of psychopharmacotherapy was contraindicated or hypersensitivity to it was registered

2 Additive phytotherapy- used as a method acting on one of the parts of the pathologic process which was not covered by official drugs.

3 Correcting phytotherapy- was used for decreasing the side effects while usage of drugs or continuous drug therapy.

4 Exchange phytotherapy- used in the cases of chronic somatic diseases such as obsession, diabetic mellitus etc.

5 Adaptation and preventive phytotherapy- used for increasing of non-specific immunity and in the cases of immune disorders connected with chronic diseases resistant to treatment.

Ten years observation of the group of 1796 children and adolescents shows that the usage of medicinal herbs in the cases of psychological diseases in children allows relief from symptoms of the disease, decrease in the severity of asthenic, cerebrosthenic, neurotic and vegetative disorders. It helped also to influence attendant pathology and to increase adaptive resources, to accelerate the healing process.

Of Note - at the acute stage of the disease necessary to use medicinal herbs for increasing the effects of the main official drugs, to decrease their side effects and to increase the immune resource, - at the stage of remission the usage of herbs may be preferable because of their mild and low toxic action, - at the stage of rehabilitation herbs may play the role of supplying therapy correcting all types of disorders with better adaptation.

So, our experience shows the practice of using medicinal herbs in the complex treatment of different psychical and psychosomatic disease on all the stages in clinical practice as well in the outpatients' practice and for prevention of decompensation of psychical and mental disorders.


Using ‘Project work’ with young drug abusers in a residential setting – Youth Support Experience

Authors - Diana Birch - Director;   Esther Mensah - Senior Care Worker;    Sonia Lucia – Student Psychologist.

Presented by – Lisa Bioletti.

Youth Support House is a residential unit which provides care in a therapeutic community setting for troubled young people suffering multiple problems. Many of our young women are also pregnant or are young mothers and their problems are added to when drug use or addictive behaviour complicate their presentation. Difficulties arise when the drug taking history is confused or unclear, the extent and nature of use prior to conception and during pregnancy can be underestimated or concealed with serious consequences for the baby - withdrawal symptoms and complications at birth, problems in feeding and developmental patterns in early life.

Baby Jed was jittery and difficult to feed while withdrawing from his mother’s methadone treatment, Carol took in an unknown cocktail of cannabis, alcohol and possibly amphetamine during her gestation and needed to be tightly wrapped to control her shaking, fed slowly and carefully monitored for several weeks after birth. Kate was using solvents - lighter fuel particularly during her pregnancy and died of a heart attack when her baby was only three months old. He also was jittery and slow to gain weight and showed slow early development. Janet was primarily an alcoholic and also used some cannabis her baby showed signs of foetal alcohol syndrome.  Fourteen year old Pat used and experimented with numerous substances, her baby was small, difficult to feed and had bilateral talipes.

Covert drug use after delivery will cause behavioural and emotional problems as well as interfering in parenting and may place the baby at risk. Jill would get drunk and abandon her children while she ‘self harmed’ - including throwing herself into the Thames. Liz would become too stoned to feed her baby. Sara showed psychotic episodes on Cannabis with violent outbursts and extreme paranoia which were witnessed by her confused children.

Placement at Youth Support House provides an opportunity for the young parent (and this may include young fathers also) to receive treatment for their addictive behaviour whilst at the same time being able to continue caring for their child under the supervision of staff. Observation and assessment of parenting can take place without the trauma and damage to attachment and developing bonds which would occur if the young person attended a drug rehabilitation unit whilst the child was fostered. Our treatment programme includes group and individual therapy plus attendance at self help groups such as AA -Alcoholics Anonymous or Narcotics Anonymous (NA). An important part of treatment is the ‘drug project’ work on which all residents spend several hours per week. We will describe the drug project work and outline the value of this approach.

Although substance abuse is common among youth, being equipped with basic facts and having accurate information about the drugs used is rare. Use of substances is often seen as a way into a peer group the benefits of which appear to outweigh the costs. Peer group myths and beliefs about the drug culture are assimilated in preference to the ‘health education’ message. Street wise does not necessarily equate with knowledge.

The first goal of the ‘project’ is thus the acquisition of accurate knowledge.  Here the learning process is self directed and patient centred. Our residents come from very different backgrounds - some have left school at age 12 years and may be semi literate or illiterate, some may have some school qualifications and one girl worked on an open University degree. Each works at their own rate and level using sources which use language they can understand and aiming to produce a piece of work which is useful and informative to herself. They are finding out the information they want and need and not what others may think they ought to know.

Most of the ‘project’ work results in the production of a booklet or drug guide which can be useful to others also. They are encouraged and helped to visit libraries, centres, health information resources, rehabilitation units and drug clinics to obtain information. They also share experiences and knowledge.

Project work begins with warm up exercises and brainstorming of ideas on various factual and emotional levels. Topics might include substances usually abused - knowing names and street names; feelings about and effects of substance abuse - which can be a very interesting part as they include their own experiences - ‘I never felt like that’ or ‘I’m lucky to be here’ or ‘It did this to me.’   The work then progresses to the information gathering stage and finally to production - looking at art work and choosing a style for the booklet.

It is acknowledged that effective prevention or drug treatment  education should be based on a) correct information and knowledge, b) exploration of attitudes and feelings c) acquisition and development of life skills. A young person with low self esteem and lacking in self confidence forms part of a vulnerable group who are unable to make informed choices about a range of health issues including drug use. An important element in our approach is the need to build the young adult’s confidence and help them develop their self esteem and a positive image. It is only when someone feels good about himself and confident as a person, that he can fully utilise knowledge and draw on personal inner strengths, attitudes and feelings in making decisions regarding his behaviour patterns. 

Youth Support House has been using the above approach as part of the therapeutic programme incorporating self esteem building into group and individual sessions. Project work aids in the acquisition of self worth since the finished product is an expression of personal creativity - it is a unique item, stamped with their individuality in which they can experience pride.  They are in fact so proud of their productions that they jealously guard them and it is difficult to get them to then share their work - the original idea was to produce a booklet which could be printed for more general use but each project participant wants to create their own special work and keep it after they leave.  The personalisation of the work lends itself to self discovery and self disclosure - ‘Oh yes, I did that’  which in turn leads to deeper insights regarding drug use and behaviour.

The project can thus be seen as an important therapeutic tool in the recovery process. Information gathering begins a creative process enhancing self worth and aiding self discovery which leads to insights which channel and focus the process of change which is begun in the more formalised therapy sessions