In India, the deepening of the mental health crisis

With physical distancing and anxiety about the future, Covid-19 has exacerbated mental health issues

Humanity has rarely experienced such a collective sense of vulnerability, a dual threat to the body and mind. While the effects of Covid-19 on physical health have been documented, its unprecedented psycho-social health effects have not got the required attention.

For centuries, we have prided ourselves on the ability to deal with mental health through various indigenous ways, particularly the strong social networks. Physical meetings, celebrations and gatherings are connections that strengthen us and replenish collective mental energies.

With physical, and, therefore, implied social distancing, being enforced globally as one of the most effective ways to deal with the physiological aspect of the pandemic, the social networking that aided mental well-being is suddenly missing. Instead, the majority of information consumed by people and communities has been tinged with fear and dread about an uncertain future. This has led to collective stress, anxiety and deteriorating mental health parameters. The gentle touch of a supportive friend, a friendly embrace or a pat on the back for a job well done, the wiping of tears from grieving eyes, these are not possible in a Covid-19stricken world.

Unlike in the case of physical health, there is a denial of and resistance to lessthan-perfect mental health in India. In most western societies, chemical/neural imbalances, genetics, endocrine system functioning and external stress factors are accepted as being at the root of major mental health disorders. Unfortunately, many Indians have a hard time accepting that those close to them may need professional clinical help.

A state-level report by the Indian Council of Medical Research (ICMR), published in 2017, noted that about one in seven persons in the country suffers from mental disorders of varying severity, with depression and anxiety disorders being the most common, affecting 45.7 million and 44.9 million people, respectively. The Global Burden of Disease (GBD 2017) report predicts that depression will be the second leading cause of disability worldwide by 2020. Further, the findings of a countrywide National Mental Health Survey 2015-16 by the National Institute of Mental Health and Neuro-Sciences (NIMHANS) revealed that nearly 150 million Indians need active mental health care interventions while fewer than 30 million are seeking this support.

Covid-19 has inadvertently fast-tracked attention to this mental health timebomb. Health care workers and Covid-19 suspects/ patients have borne the brunt of this. The stigma associated with Covid-19 patients is an unfortunate reflection of the uninformed judgments we are subjected to daily. Doctors and caregivers who work round-theclock away from their families, risking their lives for others, are being ostracised by their communities. This is enough to cause stress even to the most resilient.

Many are likely to suffer mental health issues as the fear of the future linked to the “new normal”, reluctant adaption to Covid19-appropriate social behaviour, and adjusting to the unlocking of economic activities may weigh people down and possibly weaken already-fragile minds.

Technology has helped. The extensive use of digital technologies in places of worship, gyms, and yoga studios; virtual workspaces and school classrooms have helped foster physical distancing without social isolation. Social media networks have ensured check-ins with millions of individuals across the globe. These include Covid-19 patients recovering alone in hospitals or those in forced quarantine.

We have successfully completed the mass training of health workers using digital tools. Training and capacity-building resources on Covid-19-appropriate behaviour, anti-stigma and psycho-social health is a mandatory module in the Integrated Government Online Training platform (iGOT). In this, special response groups such as the police, defence personnel, volunteers and students are learning via online training content, alongside health care workers.

The coordinates of psycho-social professionals and volunteers have been made accessible district-wise. NIMHANS launched a national helpline (080-46110007) on March 30 to provide counselling on mental health and psycho-social issues related to the pandemic and lockdown. This is available in several vernacular languages, with a dedicated helpline for Covid-19 health care warriors.

A separate online platform (psychcarenimhans.in) has also been set up for mental health support. Several webinars and videos including stress management, social stigma during the coronavirus pandemic, addressing psycho-social concerns of health care workers and dealing with issues of children and senior citizens, among others, are being uploaded regularly by NIMHANS and the All India Institute of Medical Sciences (AIIMS) on the ministry of health website.

This is a clarion call to open our hearts for our minds, and speak up without fear or shame about issues of the mind. It’s a call to stop viewing ourselves and others through a prejudiced lens and stand together as a nation and humanity to help us heal and move forward.