The World Mental Health Day on October 10 has served as a valuable reminder about the mental health struggles of so many throughout the COVID-19 pandemic, including in India. There is very little doubt that the stresses associated with the pandemic have exacerbated the issues already experienced by so many in India, including students, frontline healthcare staff, farmers, and migrant workers.
Highlighting the extent of the mental health crisis in the country, last month, three Tamil Nadu students were found dead a day before sitting the National Eligibility Entrance Test (NEET), an entrance requirement for MBBS courses.
The three were between 19 and 21 years of age and all hung themselves in separate incidents. They had all attempted the test at least once before and were anxious about getting good grades this time around. Similar cases of student suicides during the pandemic also took place in Karela, Andhra Pradesh and other states.
Also during lockdown, which was imposed in the country in March to contain the spread of the coronavirus, a number of migrant workers took their own lives. These incidents are thought to have been triggered by sudden job losses. There have also been cases of people taking their own lives due to the fear of contracting the virus and the stigma associated with the disease. Suicides have even been linked to alcohol withdrawal following the closing of liquor stores during the lockdown.
According to independent researchers, Thejesh GN, Kanika Sharma, Krushna, and Aman, at least 133 people took their own lives due to issues associated with COVID-19 and the lockdown, including loneliness, anxiety about infection, and lack of freedom of movement.
This problem is not unique to India, however. People across the globe are under immense mental pressure due to the disruptions caused by COVID-19, as well as uncertainty about the future. And it certainly seems that not enough attention is being paid to the issue.
A recent study by the World Health Organization (WHO) found that COVID-19 has negatively affected mental health services in 93 percent of countries. According to a study published in the Lancet, cases of “clinically significant mental distress” in the UK increased from 18.9 percent in 2018 – 2019 to 27.3 percent in April 2020. In the USA, a study found that every third patient admitted to the hospital with the coronavirus developed some sort of mental issue. In India, AIIMS, Patna, has reported that almost 30 percent of coronavirus patients admitted to a hospital were “mentally disturbed.”
According to the WHO the increasing demand for mental health services caused by the pandemic worldwide is far from being addressed. “Bereavement, isolation, loss of income and fear are triggering mental health conditions or exacerbating existing ones. Many people may be facing increased levels of alcohol and drug use, insomnia, and anxiety. Meanwhile, Covid-19 itself can lead to neurological and mental complications, such as delirium, agitation, and stroke.”
India’s Mental Healthcare System
While a lot of the mental health issues caused by COVID-19 are immediate, the virus is also likely to cause long-term issues that will only become apparent at a later stage. As such, Ritika Aggarwal, consultant psychologist at the Jaslok Hospital & Research Centre, believes that India’s psychologists should be trained to manage the future post-traumatic fallout. The same goes for increasing awareness about mental health, infrastructure and access to mental health services.
Unfortunately, all these are currently lacking. In the 2017 – 2018, India only allocated 0.07 per cent of the health budget to the National Programme for Mental Health. As such, it is not surprising that at the moment, India only has 0.07 psychologists, 0.3 psychiatrists, 0.07 social workers and 0.12 psychiatric nurses for every 100,000 people. In addition, only around 10 percent of those suffering from mental health issues seek help—this is likely to be due to the lack of awareness and the stigma associated with mental health issues in India.
While mental health issues can have physical causes, such as low serotonin levels or having a magnesium deficiency, they also have an emotional aspect that requires addressing. As such, Aggarwal says that mental health should be integrated into the existing health system. “I remember when I initially started working as a psychologist I had to first raise awareness among the healthcare workers regarding the importance of integrating therapy and counselling into the traditional treatment process. Now, I have clients across all departments and we can see the difference it makes to the patient’s recovery.”
Since patients tend to trust their primary doctors, they are in a good position to identify mental health problems at an early stage. So how do we integrate mental health into an existing medical system in India? “We need to first identify the challenges and lacunae that exist in the mental healthcare system and in providing good mental health services and start working through those,” Aggarwal says. “This would include unifying the education systems, creating more seats in colleges, creating more opportunities for mental health providers, and investing more in mental healthcare.”
Primary care providers and frontline staff also need to be educated about the potential mental health issues caused by the pandemic and lockdown. They need to be equipped with psychological first aid strategies so that they can both treat patients and refer them to mental health practitioners if need be. This approach can be particularly important when it comes to COVID-19 patients in hospital wards and ICUs, as well as those undergoing quarantine, since they often only come in touch with frontline staff.
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