The pandemic forced light upon the already struggling healthcare system and broader conversations about health. The pandemic also brought with it uncertainty, fear, and anxiety – a lot of which were difficult to cope with in these trying times. The need for conversations in and around mental health is of great importance, says PARVATHI SAJIV.
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THE pandemic unravelled the flaws of the present healthcare system and the need to improve the same. But healthcare isn't limited to tending to the physical demands of a patient alone. It includes taking care of the well-being of the mental state of mind as well.
Given the taboo and stigma of mental health in Indian culture, it is essential to acknowledge the emotional troubles one undergoes as actual issues. The fear of being labelled, "Emotionally Weak" contributes to the stigma that silences and suffocates the people suffering from such problems. The fear of speaking up also prevents them from identifying their issues in fear of social exclusion.
The lack of vocabulary around mental health prevents people from engaging in discussions and seeking help. Therapy as a practice wasn't even acknowledged in China until 15 years ago. Countries like the U.S, Canada, and Europe provide services, accessibility, and networks to help people, but the situation looks grim in India.
“The coronavirus pandemic poses the greatest threat to mental health since the second world war.
According to the World Health Organization, 7.5% of Indians have mental health issues, with 56 million suffering from depression and 38 million experiencing anxiety disorders. Yet, the amount spent by the Indian Government on mental health would be up to 33 paise per mental health patient.
A study by ASSOCHAM revealed that 42.5% of employees in the private sector showed symptoms of anxiety or depression, while only 1,000 of the country's 1.1 million active registered companies have employee assistance programs explicitly focused on mental health. Further, India has 0.75 doctors for every 100,000 people, whereas the desirable ratio is three for 100,000 people.
Many Indians were already suffering from mental health issues which further aggravated the sudden pandemic.
Dr Adrian James, the president of the Royal College of Psychiatrists, a leading psychiatrist in the UK said that the coronavirus pandemic poses the greatest threat to mental health since the second world war.
Another study by the Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, revealed that the pandemic could lead to "mental morbidity symptoms" among those already living with mental health conditions.
“Factors such as remote working, financial stress, job loss concerns, anxiety about the pandemic, and other reasons are accelerating anxiety levels.
With misinformation and fear looming in the people's minds, uncertainty hinged, and social networking became a thing of the past.
A study in the medical journal, The Lancelet revealed that a range of mental health concerns from anxiety and anger to sleep disturbances, depression, and post-traumatic stress disorder (PTSD) is likely due to the psychological impact of quarantine. It also revealed that up to 29 percent of SARS quarantine patients, a previous coronavirus outbreak in 2003, suffered PTSD.
Factors such as remote working, financial stress, job loss concerns, anxiety about the pandemic, and other reasons are accelerating anxiety levels. The flip side reveals that those reported to be working from home showed an improved mental health condition, with better sleeping hours and bonding time with family members.
The major triggers for anxiety included sudden lockdown being implemented, and lack of transparency. This created a sense of confusion, poor communication panic, stigma and distress. Even as the pandemic unravelled, there was a lack of community engagement that the government could have consciously taken cognizance of and partnered with civil society organizations to help those in need.
“Better governance of the healthcare system is critical.
As Oommen Kurian, Senior Fellow at the Observer Research Foundation said, "this is a rare point in history when economists and health experts agree on the need for additional resources for the health system." Better governance of the health care system, therefore, is critical.
While it is true that India has succeeded in developing indigenous COVID-19 vaccines, at heart lie issues of trust, transparency and quality concerns. The government has to take up the opportunity and responsibility to ensure that we adhere to the process's scientific integrity and transparency.
The situation aggravates for those who live with psychosocial disabilities, as a study in The Lancet revealed that the disruption in essential services like free medication during the lockdown compounded the impact of the COVID-19 pandemic.
As part of the Mental Health Fellowship in partnership with The Health Collective, IndiaSpend interviewed dozens of people with psychosocial disabilities, caregivers, and activists, to find out that the healthcare expenditure outweighed their livelihood means. These put people with psychosocial disabilities at risk of long-term institutionalisation, or homelessness.
Given the importance of mental health, legislation is of vital importance. The Mental Health Care Act 2017 was passed and approved by the Parliament and got the President's assent in April 2017. It eventually came into force on May 29, 2018.
The enactment of the Mental Healthcare Act, 2017 by the current government is an attempt to protect the mentally ill's rights and enable citizens to decide on the method of treatment in case of mental illness, lest they are mistreated or neglected. The legislation will be effective only when the gaps are resolved, and the implementation is done well.
Mental Health is different from general health as in certain cases, mentally ill people may not be able to make decisions independently. The new Act revoked the existing Mental Healthcare Act, 1987, which was widely criticised for not recognising a mentally ill person's rights. The Act also overturned the 309 Indian Penal Code which criminalises attempted suicide by a mentally ill person. The Act protects a person's right to mental illness, thereby facilitating their access to treatment by an advance directive.
“The Act's main objective is to reduce distress, disability, and premature mortality related to mental illness and enhance recovery from mental illness by ensuring access to mental health care.
Advance Directives empower a mentally ill person to have the right to decide the way they want to be treated for the illness and who their nominated representative will be. This directive has to be vetted by a medical practitioner.
This Act further seeks to protect people from inhuman treatment, gain access to free legal services and their medical records, and the right to complain in the event of deficiencies in the Mental Health Establishments provisions.
All mental health practitioners and every health institute will have to be registered with the Central Mental Health Authority at the national and State Mental Health Authority levels in every state.
The Act decriminalises suicide attempt by a mentally ill person and imposes a duty on the government to rehabilitate such people to ensure that there is no recurrence of a suicide attempt.
To empower the accessibility of mental health services to all, the police officer in charge of the station will report to the Magistrate, if they have a reason to believe that a mentally ill person is being ill-treated or neglected.
“Most developed countries allocated above 4% of their budgets on mental health research, infrastructure, frameworks, and workforce.
It also mandates that mental health services be established and available in every district of the country. The financial burden on state governments will be massive with the current inadequacy of medical infrastructure.
While the person can choose their treatment method, lack of awareness and resources persist in India.
According to the 2011 WHO report, India spends 0.06% of its health budget on mental healthcare, which is lesser than what Bangladesh spends ( 0.44%). Most developed countries allocated above 4% of their budgets on mental health research, infrastructure, frameworks, and workforce.
The Act's main objective is to reduce distress, disability, and premature mortality related to mental illness and enhance recovery from mental illness by ensuring access to mental health care. This also aims to reduce stigma, community participation, ensure rights and generate awareness.
Funding should also be allocated towards digital mental health consultation startups as they have been working especially during the pandemic to make mental health accessible.
Mental health discussions are of utmost importance. WHO estimates that the economic loss due to mental health conditions could be about 1.03 trillion between 2012-2030.
By implementing community-based programmes, one can aim to reduce the treatment gap for mental disorders. School-based programmes, yoga, are some of the beneficial measures.
Media has been the cornerstone of the campaign for mental health awareness. Celebrity endorsements such as the one by Deepika Padukone, where she talks about depression enable more people to become aware of these issues.
But this means that the media has the responsibility to ensure that discussions around a nascent topic like this need to be dealt with carefully. In the recent death of some Bollywood actors, the media was tone-deaf to the issue that could push back the conversations needed at the moment.
“Companies need to realise the costs it would bear of the workers affected by stress and depression.
Social media is a great tool to amplify the right information about mental health and benefit people over the long term.
A 2019 study by a British charity, Mental Health Research UK, found that 42.5 percent of India's corporate sector employees suffer from depression or an anxiety disorder – almost every second employee.
Companies are also noting the changing patterns of narratives and are currently seeking to focus on mental health. Companies need to realise the costs it would bear of the workers affected by stress and depression. The workplace cultures need to be defined by healthy discussions on mental health. The CEO of Blackrock is looking into the challenges and implications for companies and society currently.
Future Generali India Insurance Company has released a video series portraying how extreme human emotions on inanimate objects could be the signs of an underlying mental illness.
The pandemic is still present at large. Tele Counselling or remote therapy is gaining momentum since the lockdown was imposed.
While 2020 was one of the most brutal years, the new year brings to light the innumerable ways we can bring change. India needs to revamp its discussions on mental health and start from the roots. We should prepare ourselves to deal with the grief, pain, and learn to be forgiving. In 2021, we should imbibe the lessons from 2020 and learn to be kinder—one step at a time.
(Parvathi Sajiv is a final year student of the Symbiosis Centre for Media and Communication, Pune and is an intern with The Leaflet. The views are personal.)