| Masters project at the LDT Program at Stanford GSE |
ABSTRACT:
India ranks second in the world for teen suicide. Yet, the topic of mental health is scarcely recognized or discussed. Schools rarely employ counsellors. While teachers sometimes notice students struggling, they have insufficient knowledge and minimal access to relevant information to provide suitable and consistent support to make a difference. Parents are typically highly invested in their child’s development , but often struggle to have conversations about emotions with their teen-aged children. 'Baatein' ( ‘Conversations’ in English), is a system that guides teenagers, parents and teachers to address mental health issues in teens by making them aware, providing coping mechanisms and providing a platform to discuss issues at an equal footing. Baatein consists of : 1) An interactive magazine for guided parent-child conversations 2) A teacher dashboard to track progress and discuss it at parent-teacher meetings 3) Teacher resources to become non-specialized, community based caregivers.
Students can express what they’re going through with the help of the story and structure, parents will be able to open up a conversation in a comfortable, low stakes environment and teachers will have the resources to address students’ emotional issues in school.
CHALLENGE
Background: According to the National Mental Health Survey of India by the National Institute of Mental Health and Neurological Sciences (NIMHANS,2016) nearly 150 million Indians (11.5%) are in need of active interventions for mental health.
Of this number, the prevalence of mental morbidity (the incidence of both physical and psychological deterioration as a result of a mental or psychological condition) was higher in urban metros - 5.2% vs the national average of 2.7%. Prevalence of mental disorders was nearly twice (13.5%) as much in urban metros as compared to rural (6.9%) areas. This project thus focuses on the urban Indian population. The most common prevalent problems were ‘Depressive Episode & Recurrent Depressive Disorder’ (2.6%). The report also states that approximately 9.8 million young Indians, aged between 13-17 years, are in need of active intervention. Awareness about stress and depression is a priority among Indian youth. The resources for management and treatment, however, are sorely lacking. It is rare for students to have access to easy and free psychological counsel in school, or even outside of school.
Indians were likely unaware of mental illnesses and that they are treatable. However after a few sensational student suicide (Indian Express, Firstpost, DailyMail UK, April 2017) cases and a Bollywood celebrity opening up about her depression (NDTV, Hindustan times, March 2015) mental health issues in India have received unprecedented (NIMHANS, 2017) attention from the media and public since 2015.
It is seen that younger women in particular are particularly at risk when it comes to taking the extreme step of suicide. Alarmingly, suicide rates for young people in India are much higher as compared to young people in other countries like the US. The world over, the rates for youth suicide in India are second only to Sri Lanka. (NCRB, 2012)
The high rates of suicide are not matched by professional assistance however. The number of mental health professionals is distressingly low. According to a ‘Right to Information’ reply (Government Of India Ministry Of Health And Family Welfare, Department Of Health And Family Welfare, Rajya Sabha Starred Question No. 253, December, 2015) India has 3,800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1,500 psychiatric nurses. This averages to three psychiatrists per million (1000,000) people, that according WHO data(Geneva Discussion Paper 3, 2011), is 95% fewer than the Commonwealth norm of 5.6 psychiatrists per 100,000 (Preventing suicide, WHO, 2014) people. By this estimate, India was short of 66,200 psychiatrists in 2015. As per the National Crime Records Bureau report, 2015, the top three documented reasons for suicide among Indian youth are:
Family problems
Failure in examinations
Substance abuse
To give a personal account, my sister lived with depression for over 8 years from her teens into adulthood. As teenagers, we had very limited conversations about our emotions in our family. It was difficult for my family to talk about depression to each other and to the larger community that we are a part of, when she was being treated. Finding an appropriate, experienced mental health professional was also a challenge, even in a big city like Bangalore.
It is therefore imperative to facilitate and increase family and school communication about mental health. All these factors brought me to the design of ‘Baatein’, a system for families and teachers to understand mental health and provide a little space in family life to discuss this tough topic. ‘Baatein’ does not seek to replace any mental health care. Rather, it is a vehicle to prevent the stress that comes from lack of awareness and open communication in the community.
APPROACH
The Baatein program targets 8th and 9th grade students in urban middle class families, in schools situated in urban India. Research conducted by Patel et al. titled ‘The Role of Communities in Mental Health Care in Low and Middle-Income Countries’ shows that non-specialized caregivers in school and other community based settings can be effective. There is a growing movement of community and non-specialized care for mental health in low and middle-income countries where awareness and care are unable to reach people who need it. The first issue of the magazine addresses stress. Through this issue, students learn to:
Identify symptoms and effects of stress
Think critically about stressors and stress relievers in their lives
Connect better with their parents
Use coping strategies for stress
Parents learn to:
Identify symptoms and effects of stress
Speak to their teens about emotions with a neutral, low stakes context
Connect better with their teens
Use coping strategies for stress
Be open about their own struggles and past
Provide better support to their teens
Connect with teachers about their child’s mental well-being
Teachers learn to:
Understand the importance of their students’ mental well-being
Provide support to parents and students facing tough times
Reach out to mental health professionals and other teachers for support
Facilitate good conversations about emotional development between parent and child
Approach to learning This magazine and teacher resources are aimed to engage teenagers, parents and teachers on an equal footing. The way I see it, information about mental health is available on the internet and in the media, but engaging critically with this information is necessary to gain an understanding that changes perspective, and situates the information in the learner’s context. Without a critical discussion and debate about the information, people are more likely to forget, misunderstand or disregard information about mental health and strategies to support teens better. This hypothesis comes from understanding the theory of Paulo Freire and Vygotsky, that spoke about learning with a critical social consciousness. Learners learn best when they can examine and critique the information being given to them with the social context that they are embedded in (Freire, 1970). An approach where people are merely consuming content shown to them doesn’t provoke them to change the status quo. This had been Friere’s life’s work, to raise the critical consciousness of the oppressed. In India, among parents, teachers and children, there is a very definite status quo where the teachers and parents are above children. When it comes to mental health awareness or communication skills however, I don’t believe that age comes with an advantage. Conversations about mental health must be had on equal footing, because parents and teachers are also often new to the concept of mental health. Once they are on equal footing, a critical discussion is essential to break stigma and misconceptions around this topic. Passively consuming information can make the viewer feel they are knowledgeable about the topic, without really examining their own opinions about it, or how it relates to their real context.
Social Constructivism is another learning theory that informs my perspective on the design of this tool. Vygotsky's ideas on social constructivism have long informed classroom practice (Powell and Kalina, 2009). Rather than taking the approach of cognitive constructivism as proposed by Piaget, that center learning in the individual learner, social constructivism proposes that peers and teachers are a key part of an individual’s learning. An individual’s learning is affected by their background and worldviews, and their social context plays an important role in arriving at their own version of the truth. Baatein recognizes that teenagers learning in isolation about mental health is not an effective strategy to deeply embed learning in their daily lives.
DESIGN OF THE LEARNING EXPERIENCE
The ‘Baatein’ system aims to address many mental health topics over several months, with a focus on open family communication. The system consists of three interventions:
1) An interactive magazine for guided parent-child conversations 2) An online teacher dashboard to track progress and discuss at parent-teacher meetings, with resources to become non-specialized, community based caregivers 3) Including discussions about the magazine and mental health into Parent-Teacher meetings
THE MAGAZINE
The Baatein magazine contains a story and questions. The story is about Anju, a teenager in the 10th grade, and how she goes through a trying time because she isn’t able to express herself or share her stress with anyone around her.
Malone and Lepper make a strong case for using a story to motivate learners to learn, in Making Learning Fun, A Taxonomy (1987). They talk about Fantasy (a Storyline with characters) as a intrinsic motivation for learning. This happens because of the emotional investment occurring when a learner identifies with the character, leads to better application of information presented in a real world context, better memory of the material, and forming for vivid mental images of the material to be learned. Thus, the story format is not only engaging, relatable and fun, it is also a great learning mechanism.
After each chapter, there are “Talk” sections. In these sections, the child and parent take turns to ask and answer each others’ questions. For example, after reading a chapter on Anju’s sense of responsibility towards her family, her worries about the future and not being able to accept advice, the talk section prompts:
Child asks:
Do you think Anju was worrying too much about the future? What is her responsibility to her family after she grows up?
What’s the best advice you have got in your life?
Parent asks:
What might have been a good way to give advice to Anju when she was troubled?
Can you name a time when I have given you good advice?
For Both:
There is an optimum amount of stress required in a person’s life to be able to succeed at tasks and enjoy the process. Sometimes stress pushes us to do well, especially if it is linked to a group succeeding. Think of a time that stress helped you, and share!
This talk section is a novel feature, the pattern falling somewhere between homework questions in textbooks, talk show interviews and games like truth or dare.
This magazine is uploaded on an online platform and is accessible from any device (mobile, tablet, laptop or desktop), with an inbuilt audio recording feature. In the talk sections, families press the record button to record their conversations and then choose audio clips to upload to the teacher dashboard.
After going through the entire magazine, parents and students will fill out a survey of 3 simple questions to assess is the conversation went well, and if they need immediate additional support. The questions are: a) Did you feel hopeless or worse after talking through this magazine?
b) Do you feel like this was too emotional to handle, and/or quit the magazine in the middle?
c) Do you have strong objections to the content?
If any family raises a red flag, notifications are sent to counsellors and teachers.
The parent-child pairs were also given paper cards to use with the magazine. These were to playfully reward each other for interesting parts of the conversation. There were eight cards each for parent and child, three are shown below:
Say What You Mean
--------------------
You spoke honestly and to the point
Show How You Feel
--------------------
You were not afraid to show your emotions
Hahaha
--------------------
What a joke!
LOL
The cards were intended to encourage parents and children listen carefully to each other and have fun giving positive feedback to each other, when they were able to open up. This also was a technique to make them take the conversation happening fun, less personal and give feedback to each other with a different lens than before. This worked for some families, but most of the families did not use the cards. The magazine format is a way to slowly scaffold learning by discussing tougher topics related to mental health as the years progress. One expects magazines to arrive periodically, and so a variety of topics with increasing complexity can be addressed. The first issue started with stress, and upcoming issues may deal with topics like supporting mental illness in the family, autism spectrum disorders, gender and sexuality in relation to mental wellbeing, and so on.
TEACHER DASHBOARD AND WEBSITE
The dashboard and website is an aid for teachers to become a support system to students and parents. There are typically two academic terms in a year in India. Most schools assign a “class teacher” for every classroom. This teacher is responsible for all the students in the class, takes attendance, communicates with parents and maintains the room itself. Students typically stay in one classroom all day, other than for breaks or practical classes. The teachers move from class to class after a bell rings to signal a change in subject. The class teacher typically meets the children in the class everyday, and the other teachers meet them at various points in the week. The class teacher essentially has a ‘homeroom’ - for example, a teacher who taught Class 8 in my school would stay in Class 8, not move with the class as they graduated to Class 9.
Therefore, a class teacher is most familiar with the students’ growth through the year and typically has a lot of experience with one age group. This teacher would be the ideal person to be a contact point for Baatein. In some schools, teachers also make home visits to children in their class. This would be the best setting to discuss the magazine, but in most cases, parents visit the school bi-annually for Parent Teacher Meetings, which is another great place for discussion.
The teachers I spoke to expressed both frustration and interest in trying to support their students in non-academic ways, or have constructive conversations with them about the same. In one school, a teacher had a long debate with a group of students about the kind of stress they face in the school environment, and where it stems from, questioning their suggestions of greater access to technology in school. In another school, teachers enjoyed being a part of the brainstorming sessions instead of being in a position of authority where they had to be vigilant about how much the students were talking or controlling their behavior. In yet another school, the teachers left all the students under my and my friend's supervision, instead of being in the room with us, saying that her presence would make the students feel less 'free'. Thus, there is a variety: some teachers are curious and open about learning to support students, some feel disempowered, and yet others are eager to engage in discussions with students, but don’t have a platform. This program provides a space, a reason, for teachers to learn and express themselves to their students.
On the teacher dashboard, the teacher creates an account and accesses a set of videos, blogs and articles on supporting teen social-emotional learning, with a focus on mental health. The teacher must watch the starter videos, talk to a counsellor and complete a small test to be prepared to facilitate the use of the magazine and facilitating parent-child conversations at PTA meetings. Teachers can also make choices about the material that reaches their students. The design of the magazine accommodates for an adaptive storyline based on each family’s values. Teachers would potentially have some basic information about the family, such as number of parents, siblings and family values. They can make choices about the storyline that is delivered to each family. Because they made those choices, they would be more deeply involved and invested in the feedback that the parents have, and the conversations they can facilitate. Some of the forums and videos on the teacher dashboard will be designed to help teachers question their own biases as well. This dashboard is yet to be developed and tested further. In both these steps, the students are the key learners, but parents and teachers are learning too. Therefore, the design of this program appropriately has parent and teacher facing content and interfaces too. PARENT TEACHER MEETINGS A classroom in India could have 25- 60 students in each classroom. In urban areas like Mumbai, there are regulations to cap classroom size at 40. Even this is a large number, that is aimed at regulating quality in government schools, most private schools try to cap class size at 25. Teachers often only go over academic growth in their classroom, or bring up behaviour issues that put everyone in the discussion ill at ease. With Baatein, teachers will be able to discuss a student’s emotional growth with the context of the story in the magazine, and the teacher will have an idea about the current family dynamic through the audio files. Bringing up classroom behaviour will be a more supportive discussion in the context of overall emotional development and mental health.
The Parent Teacher Meeting helps solidify a sense of community for the teenager. It also helps parents and students reflect on the content, their relationship and their emotional states. Teachers will also feel a greater sense of connection with their students. All of this will ultimately aid in the learning environment created for their students and possible help deeper learning and more engagement in the classroom.
EVIDENCE OF SUCCESS
The Baatein Magazine was tested with 20 parent-child pairs (40 people) in Mumbai, India. I hired two facilitators/ researchers with counselling and/or teaching experience to find families and conduct the user research. The parents and children were thanked with a personal “Baatein” diary to record their thoughts. The facilitators interviewed 10 families each to participate in the study. I spoke extensively with the facilitators on what the idea of this research was. I was at Stanford throughout this time and was available to them over all our common waking hours for over a month. The first step was sending one survey each to the parents and students who were going to participate in the study (all 23 responded to the online survey). The survey asked demographic questions about the family. Twenty three families were contacted in total, 20 were interviewed. Two fathers and 18th mothers participated. The fathers were paired with daughters. Most children were girls, 4 sons participated with their mothers. They were aged 13 to 18. 2 families were from a high income group, the others were from middle income groups. The survey also administered a tested research instrument developed by the University of New South Wales, the DASS-2, to assess whether the participants had high levels of Depression, Anxiety or Stress. This instrument has been shown to be consistent across racial groups and is used by many researchers.
The students were asked about their emotions before an exam(that had happened 3 weeks prior to taking the survey). Out of the 24 responses, 12 reported high levels of stress, 6 reported moderate levels of stress, and 6 reported low levels. All the parents reported low and moderate levels of stress themselves in the 2 weeks before taking the survey.
This survey confirmed that I was testing the magazine content with a population of people that it was targeted to. India has extremes of socio-economic standards, and solutions that work for one population may not work for another, and so one has to be vigilant about the socio-cultural context while testing something out.
After the survey, the families watched an explainer video that I’d uploaded on YouTube about how to use the Magazine. This told them why I was conducting this research, when to record audio clips and gave an outline of the format of the magazine. They then went through the digital magazine that was uploaded on Issu ( link in references ) and made audio recordings of their conversations in the Talk sections. A few families forgot or chose not to make these recordings. A day later, they were interviewed by the facilitators. Some families chose not to be recorded on camera, and only allowed audio recordings. We collected 20 interviews in total, with 9 video recordings and 11 audio recordings. In order to let the interviewees be freer on camera, I encouraged the facilitators to shoot on a phone and not push for video recordings if the family was not comfortable.
The video recordings give a clear picture of body language, comfort level with the facilitator, engagement with the content and enthusiasm. Some families connected and identified with the story a lot, they said that it was close to the experiences that they had, but some families were not able to relate to it at all. In some of the recordings it was clear that the lifestyle and concerns of the interviewees was different from the ones portrayed in the story, even though their socio-economic status wasn’t specifically referred to in the interview. This may made the story hard to relate to for some people, and so the conversations that were had were not as enriching as they could have been. This ties back to Malone and Lepper’s (Making learning fun, 2005) theory of engaged learning, that the fantasy has to be relatable and the viewer emotionally invested in the character’s journey for learning to be more impactful.
The interviews focused on 6 major questions with the following purpose: a) To assess the content of the magazine for clarity, quality and learning value b) To assess the method (the questions, writing and story) c) Open ended feedback that may bring out important points to improve the experience and learning gained
The questions asked were:
What do you think about the content of the magazine? Was it clear? Did you find it valuable to go through it?
What was the experience of answering each others’ questions like? How was it different from the other conversations you have?
How did you relate or not relate to Anju’s story? Would you have liked it better without a story?
What can be described as good mental health to you, as a family ?
How did writing down what was asked in the magazine affect you?
Do you feel more confident about talking about tough topics with each other?
Some of the parent-child pairs (who consented to being captured on video) are pictured below: The response to the magazine was very positive. As per the learning goals mentioned before, here’s how this solution matched up to the intended goals.
Students were able to:
Identify symptoms and effects of stress | Yes for all |
Think critically about stressors and stress relievers in their lives | Yes for all |
Connect better with their parents | Three children reported finding out things about their parents that they never know before, most felt more comfortable or were already quite comfortable while talking to their parents |
Use coping strategies for stress | Two children asked for more exercises to practice coping mechanisms. This section needs improvement. |
Parents were able to:
Identify symptoms and effects of stress | Yes for all |
Speak to their teens about emotions with a neutral, low stakes context | Yes for all |
Connect better with their teens | 15 reported understanding their children’s emotions well already, all reported being glad to have a platform to discuss a topic not normally discussed at home |
Use coping strategies for stress | Needs to be better refined |
Be open about their own struggles and past | Yes for all |
Provide better support to their teens | Can be improved |
Connect with teachers about their child’s mental well-being | Needs to be worked upon with actual class teachers to test this phase |
The teachers I tested with were not their regular school teachers, but external researchers who had experience with teaching and counselling. Thus, the teacher learning goals can only be achieved with further testing. However, they were able to facilitate good conversations about emotional development between parent and child.
All the families found the magazine and the discussions to be interesting and engaging in some way. Four families criticized the story structure and writing, or wanted the story to be less generic. There were a two families that requested non-academic focused content, on relationships or gender and sexuality. All families reported feeling more comfortable or comfortable talking about mental health after having gone through the magazine. They were able to critically examine and place the content presented to them in their own familial context, and explain what mental health meant to each of them. To many people it meant having connections and support through tough times and giving and having space for oneself. The link to the google drive folder of videos is in Appendix B.
CONCLUSION
The next steps from here are:
To create a number of storylines catering to different family situations. After the family fills out an online survey, an appropriate storyline can be automatically sent to them.
To improve the visuals in the magazine, possibly including moving images (gifs)
Creating an online publication that accepts voice and other inputs, that can be uploaded onto the teacher dashboard
Refining the teacher dashboard, testing it out
Creating teacher resources around mental health
Connecting counsellors, psychiatrists to this service
Getting schools to buy into this program
The limitations are that this may not be adopted by teachers who feel it would increase their workload. It may also seem like more work to students and parents who have limited time together. The program will also be limited to families and schools that have computers and internet access. It also possible with a paper based magazine and in-person sessions for teachers, but that will add significantly to the cost of the entire operation.
There is also no business model attached to this program to make it self sustaining. School buy in may be tough to chase, but initial talk with schools indicate that all of them are open to mental health being discussed in school. Any forum that helps students do better at school is also welcome, and there are many medium-priced competitive private schools in urban India that may be interested in such a program to make their school stand out.
Reflections
One of the major confirmations for me was that families in India are ready to talk about mental health with their adolescent children, and there is a strong need for an open dialogue in schools and at home. A tool to facilitate parent-child conversations will be helpful in many scenarios. a) Content The content of the magazine could be improved upon a lot, both in the writing style and additional visuals which may be made more interactive. The story can be written keeping in mind the different kinds of families and family values encountered on this first round of testing, which would make the character and her context more relatable for all. The basic premise of the story and the topic of stress was appropriate and appreciated by all. b) Method The method - using a story and the interview style questions also worked well. The use of cards did not work as well as intended. This interaction may be improved by making the cards on screen too, or by changing what’s written on them. They can also be removed entirely, since the learning goals are being met without them. c) Overall experience All families were either positive about the experience or wanted more content. This is promising. None of them rejected the idea outright or felt that it was of no use. Many improvements were suggested, but the need for a comprehensive, informal mental health awareness and support system for teenagers, involving the adults in their lives, was felt by all. This projects starts to address this issue, and a few iterations down the line, this will be even more refined to be valuable to every stakeholder.
After presenting this project to reviewers at the LDT expo, two of the key pieces of feedback I would focus on are the timing of any SEL (Social Emotional Learning) intervention and the bigger picture of an intervention involving multiple stakeholders like schools, mental health professionals and legal considerations about minors and safety.
The magazine speaks about intense emotional situations happening to the character of the story, from a third person’s perspective. When the readers are going through an intense experience after having gone through the content, it is not guaranteed that they will recall and use strategies that they read and discussed about. This is the challenge of any socio-emotional learning curriculum. The intervention is not just-in-time. Unlike a hotline or a counsellor, you can’t reach out for that structured help exactly when you need it. This program is more about prevention and awareness than about providing help when needed, but its efficacy will be tested in the moments when teens are going through issues. Therefore, it will be necessary to design some resources that reach people who need them in the moment, and reach just in time.
This program involves schools, families and mental health professionals, all with their own agendas and outlooks on child development. When it comes to merging the three worlds together, there are institutional and legal aspects that will need to be well researched and considered. Challenges include making teachers effective and willing participants, through institutional change. Making parents relate on an equal footing as their children is also a larger social change, as the parent-child hierarchy is deeply ingrained in Indian culture. Parents have often only seen other parents having a relationship of command over their children, and it is difficult for them to imagine a different kind of relationship with their children. I have very limited knowledge about the ground reality of the profession of mental health in India. This will come with its own institutional problems.
Baatein seems to be a promising start in terms of content and learning goals, and with a few improvements to it, could impact a lot of lives and eventually raise the levels of mental health awareness, family support and school satisfaction in the country.
Appendix A: Competitive Exams, families and stress in India
Culturally, an examination at any level - school, graduate or national competitive entrance for professional education - is a very high stakes event in India. Hence, failure in examinations, is not as much a reflection of the pressure of competing in an exam, as is in the West, but a reflection of the social setup that makes students believe that their life is over, if they fail the examination. Therefore, schools are also very important sites for mental health awareness.
In India, students give school level (grade 12) examinations formulated and conducted by four separate entities:
Private boards like the CICSE,
Central government boards like the NCERT, NIOS,
State government boards like Karnataka State Board, Maharashtra State Board, etc
International boards like IB, A levels, IGCSE.
The choice for higher studies of choice is highly dependent on the outcome of the school level examinations.
Apart from these examinations, students take a separate set of national exams to enter government or private higher education institutions that focus on a particular professional field. These exams have a syllabus different from the regular school syllabus, that is often more advanced. An overwhelming number of students in India (around 1.4 million) appear for Engineering and Medical college entrance exams -. Only a miniscule percentage of the applicants get into prestigious government-run institutions like the Indian Institute of Technology (IIT) ( around 10,000 (IIT records, 2017). Especially in urban centers, children start preparing for these entrance exams as early as grade 7. They do so in the belief that they will get an advantage over their peers. Kota, a town in central India, is famous for being a “shadow education” center. Here students primarily prepare for the national competitive entrance exams, instead of learning at school.
Though such exam-prep methods are meant to make students feel more prepared and less stressed to perform at the actual exam, in reality, they often fuel more anxiety. More time in exam preparation also means less time spent together as a family in the crucial teen years, thus creating a drop in communication between parent and child.
Appendix B: Interviews
Can be accessed by stanford.edu addresses only https://drive.google.com/open?id=1ZDDnPnVLJA79PdK_9VfyCWEEbsLYHFqi
Thank You!
Advisor:
Paulo Blikstein
Guides:
Karin Forsell
Keith Bowen
Soren Rosier
My Family: Aai, Baba, Tai, Uppie, Nidhi, Parita Parekh Friends at the LDT 2018 batch
Schools:
The Ahmedabad International School, Ahmedabad
Lords Educational Trust, Bangalore
Innisfree House School, Bangalore
The Valley School, Bangalore
Teachers, parents and students who participated
Ms. Geetha, Counsellor, Innisfree House School
REFERENCES
National Crime Records Bureau SUICIDES IN INDIA. (2015) Retrieved from http://ncrb.gov.in/StatPublications/ADSI/ADSI2015/TABLES.htm
Kohrt, B., Asher, L., Bhardwaj, A., Fazel, M., Jordans, M., Mutamba, B., . . . Patel, V. (2018). The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies. International Journal of Environmental Research and Public Health, 15(6), 1279. doi:10.3390/ijerph15061279
Murthy, R. S. (2017). National Mental Health Survey of India 2015–2016. Indian Journal of Psychiatry, 59(1), 21–26. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_102_17
Vikram Patel, Chinthanie Ramasundarahettige, Lakshmi Vijayakumar, JS Thakur, Vendhan Gajalakshmi, Gopalkrishna Gururaj, Wilson Suraweera, Prabhat Jha.(2012) Suicide mortality in India: a nationally representative survey,The Lancet, Volume 379, Issue 9834,Pages 2343-2351,ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(12)60606-0
Malone, Thomas & Lepper, Mark. (2005). Making learning fun: A taxonomy of intrinsic motivations for learning. Making Learning Fun: A Taxonomy of Intrinsic Motivations for Learning. 3.
Powell, K. C., & Kalina, C. J. (2009). Cognitive and social constructivism: developing tools for an effective classroom. Education, 130(2), 241+. Retrieved from http://link.galegroup.com/apps/doc/A216181184/AONE?u=stan90222&sid=AONE&xid=5078f25b
Freire, P., Ramos, M. B., Macedo, D. P., & Shor, I. (2018). Pedagogy of the oppressed.New York: Bloomsbury Academic
Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, Mehta RY, Ram D, Shibukumar TM, Kokane A, Lenin Singh RK, Chavan BS, Sharma P, Ramasubramanian C, Dalal PK, Saha PK, Deuri SP, Giri AK, Kavishvar AB, Sinha VK, Thavody J, Chatterji R, Akoijam BS, Das S, Kashyap A, Ragavan VS, Singh SK, Misra R and NMHS collaborators group. National Mental Health Survey of India, 2015-16: Summary. Bengaluru, National Institute of Mental Health and Neuro Sciences, NIMHANS Publication No. 128, 2016 ISBN: 81-86477-00-X
Sengar, S. (2017, April 07). Mumbai Student Live Streams Suicide on Facebook As He Jumps To Death From Taj Lands End. Retrieved August 15, 2018, from https://www.indiatimes.com/news/india/mumbai-student-live-streams-suicide-on-facebook-as-he-jumps-to-death-from-taj-lands-end-274861.htm
FirstPost, S. (2017, April 04). Mumbai student live streams suicide on Facebook before jumping to death from Taj Lands End [Student suicide]. Retrieved August 15, 2018, from https://www.firstpost.com/india/mumbai-student-live-streams-suicide-on-facebook-before-jumping-to-death-from-taj-lands-end-3366366.html
Gareth, D. (2017, April 04). Indian student, 23, posts ‘suicide tutorials’ live on Facebook before jumping to his death from the 19th floor of a hotel [Student Suicide]. Retrieved August 15, 2018, from http://www.dailymail.co.uk/news/article-4379040/Indian-student-films-final-moments-jumping-death.html
Dutt, B. (2015, March 22). 'I Felt Empty And Directionless', Says Deepika Padukone on Her Battle With Depression: Full Transcript [Deepika Padukone Depression]. Retrieved August 15, 2018, from https://www.ndtv.com/india-news/full-transcript-lets-talk-depression-deepika-padukones-story-748527
Garg, C. C., & Evans, D. B. (2011). Discussion Paper No. 3 Geneva 2011. In What Is The Impact Of Noncommunicable Diseases On National Health Expenditures: A Synthesis Of Available Data. Geneva: Department of Health Systems Financing. doi:http://www.who.int/healthsystems/NCDdiscussionpaper3.pdf
Psychology Foundation of Australia. (n.d.). Depression Anxiety Stress Scales - DASS. Retrieved August 17, 2018, from http://www2.psy.unsw.edu.au/dass/
Shelar, S. (2018, July 1). Baatein Magazine. Retrieved from https://issuu.com/swatishelar/docs/baatein_magazine_d2c7379d02d6c3
Saxena, S., Krug, E. & Chestnov, O. (2014). Preventing suicide : a global imperative. Geneva: World Health Organization.