Background: Romantic relationship is one among the defining feature and developmental tasks of adolescence, often considered to have significant influence on the course of other developmental tasks, overall health and wellbeing.

Objective: The present paper made an attempt to review different mental health promotion manuals developed for adolescents in India with the aim to understand whether those manuals address the emerging issues of adolescence in romantic relationship.

Method: Seven manuals were selected for this purpose and reviewed based on its content, methodology, target population and how issues pertaining to romantic relationship has been addressed.

Results: It was observed that all the manuals covered different aspects related to developmental needs and concerns of adolescents in general; especially the developmental significance of romantic relationship with its socio cultural background has received little attention.

Conclusion: This article implied for developing comprehensive manuals on emerging issues of adolescents in romantic relationship as a great need of the time.

Keywords: Infatuation, Love, Adolescence, Mental health manuals, Romantic relationship

INTRODUCTION

Adolescence is a crucial period for every individuals with ample of rapid physical, psychological and social changes [1]. Romantic relationship is one among the defining feature [2] and developmental task of adolescence [3]. It is also considered to have significant influence on the course of other developmental tasks [4]. Existing literature in this area is overwhelmingly emphasized on the importance of romantic relationship in the lives of young people as they move from early to late adolescence [5].

On one hand healthy romantic relationship have potential benefits for adolescence, on the other hand unhealthy relationships pose end number of risks and long-lasting impact on them [3]. Apart from this, quality of romantic relationship can also have enduring effects on self-esteem of adolescence and shape their personal values regarding romance, intimate relationships, and sexuality [6]. Many of these issues are being addressed through various government programmes, policies, school mental health programme and adolescent education programmes [7]. However it is estimated that only 1% adolescents receive quality counseling, health and medical services in India [8].

Pertaining to mental health of adolescents’ school mental health programme plays a vital role, even in addressing the concerns related to romantic relationship. In India as a part of school mental health programme primary attention is given to developmental needs, prevention of high risk behaviors such as substance abuse, sexuality, HIV/AIDS and promotion of mental health through life skills education, mental health orientation to teachers, student enrichment programmes, etc. [9]. Various governmental and nongovernmental institutions have developed manuals in line with such programmes. Even so very minimal focus is vested upon romantic relationship among adolescents despite of its magnitude which may results in abiding impact on their life. In this context the present paper made an attempt to review the available manuals in India developed to address mental health promotion of Adolescents in Romantic Relationship.

METHODS

The present article is a narrative review of manuals and training modules on adolescent mental health in India with special focus on adolescent romantic relationship. Aim of the article is to understand whether the existing manuals address the emerging issues of adolescence in romantic relationship.

The literature search for the present study was both manual and electronic and carried out by using appropriate key words such as Adolescent Mental Health, School Mental Health in India, Manuals and Modules on Adolescents. Researcher could gather total 7 manuals which are published and available freely with full text from different sources including website of Government of India, organizations working/publishing resource materials for Children and Adolescents like National Institute of Public cooperation and Child Development (NIPCCD), National council on Education, Research and Training (NCERT).

RESULTS

A brief description on the manuals reviewed with its methodology and key areas covered is given in the Table 1. The results show that most of the manuals are training manuals with activities and reading materials designed for teachers, counselors, parents and students as its target population. While majority have adopted life skills approach and few used general adolescent mental health programmes. Participatory methodology was followed in all the manuals using different techniques such as group activities, case study method, role play, games, etc. Utmost importance was given to developmental needs and issues, sexuality and reproductive health, substance abuse, enhancing academic competence, stress management and psychosocial competence (skills) in general as its focal areas. Most of the manuals are field tested and found to be effective in enhancing psychosocial competence and mental health among adolescents. Interestingly the concept of romantic relationship has been discussed under the domain of interpersonal relationship with peer and opposite sex in almost all the manuals. Case vignettes, case study and group activities were used to enable adolescents to identify the difference between romance, love, infatuation etc., emphasizing upon accepting and maintaining healthy relationships, dealing with pressure to have sex, consequences of healthy/unhealthy relationship and different ways of handling the crisis situation in romantic relationship. Through this attempt was made to enable adolescents to identify their feelings and generate thoughts on healthy ways of dealing with stressors in interpersonal relationship and skill enhancement in this regard. Among the 7 selected manuals only one manual deals with handling break-up and managing stress in the context of romantic relationship. Surprisingly, the developmental significance of and issues related to romantic relationship, skill enhancement in maintaining healthy relationship, dealing effectively with the consequences of unhealthy romantic relationship, risk behaviors and prevention of it, have received little attention in all the manuals. Role of school counselors becomes very important while delivering school mental health programmes and providing counseling services to address the needs of adolescents.

DISCUSSION

As a whole all the manuals reviewed have focused upon overall developmental needs, psychosocial issues and skill enhancement in handling them effectively during adolescence. Existing literature in the area of adolescent romantic relationship emphasized on its developmental significance [10]. In connection to it the manuals also recognized this finding but failed in addressing it holistically by considering it as one part of adolescent concerns. It was also highlighted by the researches that romantic relationship may pose a great risk on adolescence in different areas of life including decreased academic performance, unsteadiness of mental health characterized by depression, antisocial behaviors, and dating violence [6,11-13]. The manuals have attempted to address these issues in a general context through skill enhancement to deal with such problems, undermining the influence of romantic relationship them. Studies have also focused upon sexuality and reproductive health in the context of romantic relationship and reported that dating relationships put teens at peril of sexually transmitted infections and teenage pregnancy. Inducing pressure for sexual activity [3] especially on girls who have had prior experience of sexual engagement and tolerance towards sexual coercion is considered to be acceptable among young teens as reported by the researches [14]. Probably because of these findings manuals have thrown light on premarital sexual relationships, i.e., both consensual and non-consensual under the heading of sexuality and reproductive health and emphasized upon safe sex practices, prevention of teenage pregnancy and their rights. Predominately case vignettes and group discussion methodology was adopted in addressing the consequences of unprotected sex, importance of saying ‘NO’ (assertive skills), negotiation skills to responding to their partners and to enable adolescents to be in a healthy relationship.

In west studies proved that the risks associated with adolescent romantic relationships can be minimized by helping young people to develop skills that support healthy relationships [15] through school and community-based programs [16]. For instance, expert convening on Healthy Teen Relationships, held at Atlanta in 2011 recommended the need for identifying quality of relationship and fundamental skills relevant for managing a healthy adolescent romantic relationship, designing a continuum of healthy and unhealthy teen dating behaviors; including diverse youth perspectives to facilitate the development of a definition of healthy teen relationships and empowering youth to lead decisions about the language and tools used to promote healthy relationships. They have also suggested that healthy teen relationship education can take place in variety of settings, such as communities, schools, and health clinics [17]. In accordance with these recommendations the manuals reviewed from Indian context also stressed on different areas related to meaning and characteristics of healthy and unhealthy teen relationship along with introducing the difference between infatuation, love and friendship under the heading of interpersonal relationship. Although based on the review it was observed that developmental significance of adolescence romantic relationship is not addressed adequately and also issues pertaining to romantic relationship and dealing with the consequences of it is not given much importance. India by virtue of having collectivistic culture the concept of romantic relationship is shaped by end number of socio-cultural factors. Often being in romantic relationship especially during adolescence is considered as something obnoxious, it further worsens if it is a girl. Hence during recent years, various issues coming into light especially among adolescent girls in romantic relationship such as running away from home, child marriage, unsafe sexual relationships and teenage pregnancy [18-20].

Thus there is an immense need for addressing these issues at family, schools and community level considering the socio-cultural determinants of romantic relationship among adolescence in India. Manuals could be one of the key tools for planning and implementing such programmes. Therefore focus of the manuals should be shifted from general mental health needs of the adolescents to, addressing their concerns related to romantic relationship, designing preventive measures against risk taking behaviors and promoting mental health and overall wellbeing. Apart from this more attention also need to be given to research, training and therapeutic services in the area of adolescent romantic relationship. School social workers have crucial role in addressing their issues, preventing risk taking behaviors and promoting their mental health. School social work being a helping profession having the expertise of diverse socio-cultural understanding of the people has a great implication at preventive, promotive and curative level in this area [21-23]. School social workers could play a key role in addressing various concerns highlighted by the studies in this area such as support needs and skill development in maintaining healthy relationships without violence, maintaining emotional stability, enhancing parent teen relationship, balancing other developmental tasks like academic and career growth, healthy sexual behavior, launching out as responsibilities, marital preparedness, improving family and peer relationships, promoting mental health and wellbeing. All these can be achieved through developing comprehensive manuals on emerging issues among adolescence. Alongside research studies also need to be conducted in feasibility testing of such programmes and evaluating its efficacy.

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