ENSURE MENTAL HEALTH CARE IS A TOP PRIORITY
It is no easy task to prioritise the systems which need to be put in place as Covid-19 blazes its way across the country. But often the issue of mental health, especially for women, slips through the cracks. The virus has created financial distress; loss of jobs for the main breadwinner, most often the man; friction within families and domestic violence.
The pandemic will also exacerbate the insecurities women face on the economic front. There is already a significant wage gap between men and women in India, indeed in most of the world. There was already a trend towards a decline in women entering the workforce. Now, as they assume the roles of caregivers to children out of school and the elderly most vulnerable to Covid-19, their position becomes even more marginalised. This will add to anxiety.
Of particular concern are adolescent girls. They are out of the school system; they are not sure whether they will ever get back to it; not everyone has access to online classes; and they are vulnerable to early marriages.
The focus on mental health is patchy in general. The last Union budget cut down the allocation for mental health from ~50 crore to ~40 crore. Additional resources could now be garnered from the PM CARES fund, corporate social responsibility funds and other private initiatives.
The helplines are stretched due to a lack of trained counsellors at the best of times. Now the situation has worsened. Earlier, there were counselling centres and clinics people could visit; now, most are shut down. For those who require medication for psychological problems and mental illness, there are fewer, if any, stocks in pharmacies. Most of these are prescription drugs and not available online.
The situation is particularly fraught in rural areas where infrathe structure is inadequate. Migrant workers who have gone back home face severe mental stress, from anxieties about livelihoods to social stigma. Mental health needs are not seen as a priority nor is help readily available. In a few areas, there are NGOS working to provide counselling, but these are few and far between. There appears to have been an increase in reported suicides in some states. Some of these involve people who have lost close relatives to the virus or have tested positive for it.
There are certain groups which are more vulnerable than others, including those who have just lost their jobs, migrant workers who have no means of income or food security, and women facing domestic abuse. They must be targeted by health workers.
In 2015-16, the National Mental Health Survey found that one in 20 Indians suffers from some sort of depression. It would be reasonable to assume that this figure would have gone up now. There are just 0.3 psychiatrists, 0.17 nurses and 0.05 psychologists per 100,000 patients who need help for mental disorders in India. According to the same survey, between 85-90% of those who need help don’t get it either because the condition is not recognised as threatening, the stigma associated with mental problems or simply lack of qualified health providers. The National Crime Records Bureau registered 134,000 deaths by suicide in 2018, many of them young people. The Mental Healthcare Act passed in 2017 provides the right to mental health care, but many of the systems required to make it effective are still missing.
The virus has occasioned a rethink in our health care systems and infrastructure in general. It is now time to put mental health into the mix and prepare for the future which will bring many more challenges on this front.