“There is no health without mental health”

For a number of years, Prof. Dr. Sc. Ranka Kalinić, a specialist in child and adolescent psychiatry and psychotherapy, has worked at the Mental Health Protection Centre in Banja Luka, where she formed the first complete team for children and young people providing services of prevention, diagnostics, and treatment of mental health disorders in children and youth. At the recently held Third International and Interdisciplinary Congress on Child and Adolescent Psychotherapy “THINK ABOUT YOUth” in Sarajevo, she spoke on the topic of “A silent call for help: Breaking the stigma of mental health problems in children and adolescents”; in the interview for UNICEF, ​​she talks about the importance of early treatment, prejudice against, and discrimination of children and young people with mental health difficulties, and ways in which we can and must fight the stigma.

You said in your lecture that 50 percent of mental health problems start before the age of 14. How important is it to detect problems and start treatment in time, and how much easier would it all be without the stigma?

In a hundred children, young people and adolescents suffering from mental health problems, 80 percent of those problems that can be kept under control, cured, restituted, resulting in not only a healthy, but also a functional person, a community member who is useful to oneself and others.

In children, stigma is the biggest problem for a timely diagnosis, seeking help and starting treatment. Because the longer the symptomatology, the longer the treatment, of course. 

You mentioned that children are often stigmatised in their immediate environment, even by the school that should provide the safest environment for them…

This is really terrible. I get an official letter asking me if it is safe for a child with a mental impairment to go on a field trip and if the child poses a threat to other children. And I entered every primary and secondary school in Banja Luka, gave over 450 educational lectures on the phenomenology of mental disorders in children and youth in a school environment, and why the school is important as a collaborator and ally in therapy. And such cases still randomly “pop up” and come as a shock to me again and again.

How come there is so much stigma from the immediate environment against children who experience mental health difficulties and need help?

Psychiatry as a branch of medicine, and especially child psychiatry, is a relatively young science compared to other branches. Although it is based on facts – biological, neurobiological, neurochemical and neurophysiological, although we know exactly why a problem arises and how it manifests itself, my estimate is that 70 percent of the population, as well as 50 percent of health workers in other professions still have an imaginary opinion about psychiatry. They believe that it is based on something elusive, immeasurable, imaginary, which essentially causes fear in people. When it comes to children, their psychological apparatus is not mature. They would not have that fear and sense of stigmatisation, if they were not told at a specific behavioural and verbal level “you are sick”, “you are crazy, you have a disorder, you are seeing a psychologist”, and unfortunately “you are not normal”, a sentence that even parents very often say to their child, when they “cannot cope” with certain behavioural problems. For this reason, parents first find it very hard to bear this violation of the opinion about themselves as perfect parents, with the perfect child, and they are prone to stigmatisation, and we know that stigmatisation leads to discrimination.

How much does prejudice contribute to stigmatisation?

The prejudices that we generally harbour as a people are those that we received in early age from our parents, both indirectly and directly, and they got them from their own parents, which is transgenerational transfer. Through some of the most trivial informal conversations between parents and their child, a parent unconsciously instils in the child animosity and intolerance against someone or something, and this is then incorporated into our thought process and cognitive capacities, and unfortunately it is very hard to fight this prejudice. On a personal level, it takes a lot of self-work to eliminate the prejudices we got in our childhood, but not everyone is willing to engage in such work. Nowadays, we can find a lot of information and educate ourselves however we want, but people in this region lack emotional intelligence, which I believe to be more important than the general one. While everyone will tell you how warm, welcoming and hospitable we are, that's all fine, but it's practically a picture of ourselves that we want to convey. Basically, when we need to put ourselves in someone else's shoes, especially of those who are marginalised or weaker than us, it is very difficult.

How to promote anti-stigma in such an environment?

My idea is that young people are the most apt for that, and I pointed it out in my lecture. It should be done through peer education, and we should include children and young people. For example, part of my presentation was done by two girls who are now in high school, my former patients. They faced the problem themselves in elementary school while they were in treatment. I asked them, as I wanted to involve them, and they accepted it wholeheartedly.  We do not fully grasp the potential we have in young people, that they are actually fresh brains, fresh energy, and that through them we can expand a network of people who will become sensitised to persons with problems. Also, developing volunteerism in young people, developing compassion and restoring the fading empathy in children, while using what is available to them. No more face-to-face lectures, one-on-one. We should use their means of information, the social networks. There are also influencers, we can find someone who will tell them things that they will understand easily. It must not be the same as before, lecturing them for an hour and a half, that doesn’t work with children anymore. It should be targeted, carefully designed and concrete. We already have some anti-stigma programmes that have proven successful in Canada where they have been running for several years.

What should we do individually, and what collectively, to change that image?

Promotion and awareness raising come first. To begin with, parents should know how to recognise if their child has a problem, and when to be “alarmed”, because the child is sometimes unable to verbalise their feelings. We should educate young generations about basics of dominant problems in the society, and they will be aware of them when they become parents themselves. We should teach people in our living and working environment who to turn to, and how the network of help services works. Many people still don't know who to turn for help. Finally, awareness should be raised of the fact that there is no health without mental health; that with a negative attitude towards someone who suffers, we destroy a human life, thereby harming both ourselves and the community. Because there are many productive people who receive treatment for diabetes but remain functional all their lives; likewise, they can be treated for depression, bipolar affective disorder and various other conditions.

When we get injured, we all reach for a plaster, but when we have a mental health problem, we don't ask for help…

Many parents come to me with children who developed temper tantrums - poor emotional regulation, when a child reacts violently if something is not given to them or allowed, they throw their bodies on the floor or scream. When I ask them how they react to the tantrum, they say “ouch, we are so ashamed, then we give him what he wants as soon as possible, just to calm him down so that people stop looking at us.” It’s completely wrong. We should start from the basics, and as much as education is a “washed-up” term, modern lifestyle is so fast and we must find a way to teach parents to recognise undesirable behaviours and functioning modes first, and then to respond to them immediately and wisely. Because a parent can do a lot on their own. Parents used to be the main therapists, but it is also very important for them to understand when a problem exceeds their parental competencies and when they need to seek professional help for their child.

You mentioned the shame that sometimes prevents people from seeking psychological help, especially for their child. At a time when everyone is “perfect” on social networks, how to encourage children and parents to seek solution to a problem that is like any other without shame?

This requires systemic empowerment of parents, but a mindset shift as well, because we have experienced a decline in moral values and an inversion of the value system in recent years. It is partly the fault of social networks, partly of the imposed imperative of quick success, enrichment and fast attainment of knowledge and career advancement. Everything is so fast, and suddenly the value system started collapsing to the extent that a child, an average student, became completely invisible in the system. And most of these children have some talent. On the other hand, there are the “inflated grades”. Ten years ago, I noted that something was wrong with our education system – there were never so many A-students, yet never as many ignorants. Not to mention functional knowledge, where we failed completely.  As parents, as mature personalities, we should be ashamed if we do not know how we can help our child with a mental health problem. If we are ashamed to talk about it, we should really ask ourselves how mature we are and where we are in the 21^st century, as a parent, teacher or any mature person. We should not be ashamed because a child has a problem, but because we missed the chance to seek help in the right place.

Can we still say that there has been some progress, compared to earlier times?

I have worked on mental health for 26 years, with direct contacts on a daily basis. I want and need to really get involved in the education of people around me – parents, teachers, psychological and pedagogical services within schools, social workers at the social work centres and others. When I started working, it was dreadful to the point that a child who had a problem was not allowed to attend classes, or even to access the school. Today, we have schools that are willing to modify the way of teaching children with mental health problems. And to apply individualised approach in examination, which is a big step forward.