Monday, Mar 20, 2023

Is Mental Health India’s Next Pandemic?

Is Mental Health India’s Next Pandemic?

The first wave was the physical health crisis, then came the financial crisis and this has led to the mental health crisis. But the question is whether India is ready for it.

Representational image. Tribhuvan Tiwari/Outlook

Amitabh Sinha (15), a school student from Mumbai complained about not being able to sustain attention in online classes as they are spending way too much time with screens. Radhika Dixit (10) was seen crying each evening as she was unable to go down in the building and play.

Rudranil Roy (52), an engineer from Bengaluru lost his job in an aviation company. He says, “Pre-Covid there were days when I used to complain about not having enough time to socialise, but now I have so much time and I don’t know what to do with it. At this age, it is difficult to get a job. It’s over six months that I am doing nothing and I have decent savings, but how long will I be able to survive on that? I have to pay for my son’s university fees. The uncertainty is killing me and I am losing all hope.”

Kajal Bose and her husband Kalyan Bose live in Kolkata all by themselves. Both of them are in their seventies. Say the elderly couple, “We have many health issues and our house helps are unable to come because of the frequent lockdowns. Still, both of us manage somehow, but the saddest part is every summer vacation we look forward to our children and grandchildren visiting us who live in different cities. That is the thing that keeps us alive, but the summers have gone by and we are still waiting for things to normalise.”

Children and adolescents are struggling to manage their urges to be outdoors and with their friends. For many, the continuing virtual classes are leading to virtual fatigue. There are cases of increased clashes with family members, particularly in the context of the presence and utilization of social media and related platforms. Parents worry about their children’s social skills and cognitive abilities, as well as the abilities to negotiate situations and their problem-solving skills. There is a lack of social connection that is creating disruption in the lives of young individuals who are experiencing immense boredom and keep turning towards parents for guidance and support.

Covid-19 has affected the mental health of kids ranging from three to four-year-olds to adolescents. According to the National Crime Records Bureau (NCRB) statistics, more than one student commits suicide in India every hour, with about 28 cases reported every day. A lot of behavioural issues are noted in children and they are getting aggressive and there is a lot of anxiety about the virus and performance in their studies. Governments around the world, including Canada, UK, US and Australia have recognized that their citizen’s mental health has been adversely impacted by the pandemic and have made suicide prevention and mental well-being a top priority. Australia has announced more than half a billion (AUD) dollars to deal with the mental health fallout unleashed by Covid, including an AUD$ 48.1 million National Mental Health and Wellbeing Pandemic Response Plan. The US has announced $425 million for Substance Abuse and Mental Health Services Administration (SAMHSA) programs. The funding will go towards crisis response, mental health support, suicide prevention, monitoring, research and community health centres.

Nelson Vinod Moses, Founder of SPIF (Suicide Prevention India Foundation), Bengaluru states, “The Indian government has stated that there has been no study conducted to evaluate the mental health effects of Covid. We pay mere lip service to mental health in a country where there are 150-million plus Indians who suffer from common and mental health illnesses pre-Covid. The post-Covid world has resulted in this increasing manifold.”

Says psychologist Seema Hingorrany, “The environment at every home is also very tense. I am doing therapy with two kids who lost their grandparents to the virus. They didn’t get to see the body and that has been very traumatic for them. Some parents have lost their jobs and the home environment is very gloomy.”

Experts have to say that there are kids coming to them for counselling whose grades have gone down drastically. Some kids are finding it difficult to grasp the lessons through online studies. There are kids who are missing their happy times spent in school with their friends, so they are feeling claustrophobic and bored in the four walls of the house. There are kids who have not yet come to terms with the reality that it will take some time for schools to open. Psychiatrist Dr Anjali Chhabria from Mumbai says, “A rise in frustration, unhealthy lifestyle and excessive use of gadgets is the prominent behavioural change seen in kids.”

In current times, everyone is running short of patience. A few things that can be done by parents, Chhabria feels is to help kids adapt to this situation by keeping aside our own negative impressions. She says, “Kids are perceptive and they will learn to be in despair if we as adults show how awful this situation is. Instead, help them transition into this process by making it less stressful for both your kid and yourself.”

According to the World Health Organisation reports, each year India contributes to around 2.2 lakh of suicides. India is dubbed the capital of suicides in Southeast Asia. Teen suicides are on a rise each year and it is a real problem in our society. Depression is one of the leading causes of deaths by suicide. On average, every 40 seconds one individual dies by suicide somewhere around the world.

Financial instability is a huge concern for a lot of people who are seeking therapy these days. The pandemic has resulted in mass unemployment. Seven months into the pandemic and the coronavirus rates increasing along with our economy in doldrums, most parents are struggling with new realities every day. Chhabria states, “The certainty that comes with monthly salary or going to a workplace is suddenly very shaky. Some people are looking for alternative job options, some of them are daring to change their field of work and a few others are restarting their journey. In case they are unable to handle the stress, I urge them to seek professional help from mental health professionals who are equipped with tools to help them.”

There are people who moved to big cities with a lot of hope, had to go back to their own towns and cities feeling miserable and depressed as they have lost their jobs. Now even if they are getting a job, they are getting it with very low pay. Says Hingorrany, “Every day I get to meet people who have lost their jobs. They are going through a terrible phase, they are unable to sleep, feeling anxious, they are crying all the time and feeling angry towards the creator, that is god. Many of them are sole earning members of their family, so they are selling off their gold and borrowing money from relatives. Basically, the uncertainty is killing them from within. These times are such that help is required not only from mental health professionals, but we need to unite and help each other. And if we notice somebody is suffering, we should immediately try and help them out.”

For the caregivers, the pandemic is extremely stressful. They are also living this pandemic and trying to combat like all of us. The added responsibility of a patient is a point of stress as the nature of this illness is so volatile. Taking care of someone while maintaining physical distance and being worried about their own health is taking a toll on their mental health.

The health workers are working relentlessly in fighting this pandemic. Their mental health like all of us is fragile in the given conditions as they are also equally affected by this pandemic. They are also striving to survive and help others heal. The agony of losing people to Covid-19 and the inability to physically get close to their patients, having to be away from family and constantly keeping a check on their own health are all the factors affecting them badly. Chhabria says, “We have had cases where caregivers share their emotions towards being shunned by people close to them due to fear of infection, seeing a patient’s health deteriorate due to Covid and not being able to help, having to witness people say their final goodbyes over a video call to their family members.”

The elderly population is mostly affected by the fact that the fatality rate amongst them is higher and they need to be extremely careful. With age-related illnesses and limitations in mobility, their activities were already restricted. Now with Covid, it has become almost impossible to move out of homes unless there is an emergency.

Dr Sameer Kalani, psychiatrist, Sukoon Hospital, Clinically Governed by Fortis Healthcare, Gurugram says, “Mental health among the geriatric section of society is a sensitive issue. The feeling of isolation during Covid can become especially crippling for older individuals as they are not as technology savvy as compared to younger generations. Conditions such as dementia, clinical depression (caused due to deterioration of cells and organs), and psychosis are common among older people.”

For the elderly, it is important that they keep focusing on maintaining their health during these times while also staying connected to those they love. It is also important to emphasize that they follow and continue to engage with activities that are pleasurable and that allow them to maintain routines which is helpful in combating the stress and anxiety of being in this pandemic. Narrating an incident, Chhabria says, “I am treating a 65-year-old woman who cried the other day in session as she is unable to do those few activities like attend painting class and meet her friends that would keep her happy.”

Emphasizing on the severity of the situation, Nelson Vinod Moses, Founder of Suicide Prevention India Foundation, Bengaluru says, “If left untreated, mental health ramifications of the current crisis will be longitudinal and trans-generational. We might have an entire generation of youths suffering from depression, substance abuse issues and a diminished will to live.”

Moses feels that the surge in mental health issues and suicides won’t dip after the severity of the virus wanes. Going by the history of pandemics, and the knock-on effects of an inevitable economic downturn, we can expect a second wave where the horror of an already on the boil mental health crisis will be fully expressed.

There is a stigma around mental health issues in our country. It’s time that mental health needs to be spoken about. We Indian s are still sitting on the symptoms of chronic depression and anxiety. When a young adult complains about low feeling or no appetite, low self-worth, a typical parent ignores it or sits on it for months rather than taking the child for a review or even addresses the symptoms with a qualified psychologist.

Hingoranny says, “When it comes to mental health programs or suicide awareness programmes, we are still lacking. We need to have a weekly awareness programme in all schools and colleges. Psychologists need to be invited to address mental health issues, especially during the coronavirus pandemic. And most psychologists need to do these programmes free of cost.”

There is a need for more resources as India is a large population and the ratio of a psychiatrist and psychologist to a patient is quite skewed. Chhabria states, “Mental health education is missing at the grassroots so if we begin from there, I believe a lot can be achieved and we can be better prepared to deal with mental health issues.”

According to Covid-19 Blues, an online survey conducted by SPIF ((Suicide Prevention India Foundation) across the country, suicide ideation, self-harm and relapses have all risen.

What the data reveals
• Self-harm, suicide ideation/death wish increases: Nearly 65% (28.9% said yes and 35.8% responded with maybe) of the therapists have observed an increase in people who have self-harmed. A whopping 71% (28.9% said yes and 42.1% maybe) of therapists said that more people have expressed suicidal ideation or a death wish to them post the outbreak.
• Increased rates of relapse: Nearly 6 out of 10 therapists (57.9%) who took the survey said that individuals who had previously recovered or were making a recovery, have now relapsed.
• More people seeking therapy: 68.6% of the therapists reported an increase in the number of people they see and in the hours, they spend taking therapy after the pandemic hit
• First-time therapy seekers rise: 54.7% of therapists said that the number of people they see who’s never sought therapy before have risen since the outbreak of the pandemic
• Common problems: Anxiety (88.7%), job loss or fear of job loss (76.1%) and stress 73.6%), isolation/loneliness and financial insecurity (73% each) top the list of common problems faced by people as reported by therapists.
• Caregiver fatigue heightens: 62.3% of therapists said that the current Covid-19 situation and doing only/mostly telepsychiatry has increased their caregiver fatigue.
• Impact on work: Worryingly, 75.8% (64.8% mildly impacted and 11% severely impacted) of the therapists reported that caregiver fatigue has impacted their ability to give their work a 100 per cent.