Since the Covid-19 pandemic, public mental health services have to become a State priority to address the growing mental health challenges
“When the mind is in a stage of dullness, stimulate and awaken it. When the awakened mind thus becomes turbulent, calm it down. In the process, recognise the dirt that surfaced. When the mind reaches a state of equanimity, do not disturb it further”. — MandukyaUpnishad (3.44)
Recently a 77-year-old NRI came to India to visit Kartarpur Corridor and was found missing from his hotel room in Delhi. On his wife’s complaint, Delhi police formed six teams to search him and could only trace him after 24 hours when an army officer informed the police about a suspicious person loitering in a restricted area in casuals wearing hotel slippers. On examination, it was revealed that the man had a problem. He was forgetful, a common for his age.
Many people do have such problems, associate it with aging or some past incidence but seldom consult a Psychiatrist or Psychiatric Social Worker. So is the habit of smoking, stealing, overeating, lying, fidgeting, sleeplessness etc. but the community and common man do not consider them a problem and keep suffering, making fun of himself/ herself or showing pity at times.
Health is defined as physical, mental, social and spiritual well-being which has posed a cumulative challenge during covid19 and thereafter. With the loss of lives and livelihoods, the people found themselves in a state of anomie which resulted in an increased pace of depression, anxiety and suicide. India has an estimated 197.3 million people suffering from mental disorders and the majority of them have either no or limited access to mental health services. Thus, the country has a huge burden of mental disorders marred by appalling ignorance with a significant treatment gap. Public mental health services have to become a state priority to address the growing mental health challenges.
According to WHO estimates, COVID caused a 25 per cent increase in the prevalence of anxiety and 27 per cent in depression worldwide. An estimated 12 million work days are lost each year due to anxiety and depression costing the world economy nearly $ 1 trillion. Growing social and economic inequalities and conflicts, violence and public health emergencies are threatening human well-being.
Stigma and discrimination prevent many people from getting qualified care. One out of every seven (1:7) persons is suffering from one or the other mental illness. In 2021 people dying from heart attacks increased 6 times over the previous year which has aggravated family mental health concerns such as fear and uncertainties of life and emotional trauma due to loss of intimate relatives.
Gaps in Quality Mental Health Care are in the range of 40 to 95 per cent depending on the geophysical and socio-economic conditions and cultural beliefs. There are only .75 qualified psychiatrists per 1 lakh population in India. It gives scope for the proliferation of quacks and faith healers including an emerging clan of prayer warriors.
A mental illness results from difficulty to cope with real-life situations which hammer out the person’s psycho-emotive balance responsible for a reasoned response to real-life challenges taking place in day-to-day life. It has a substantial impact on how an individual believes, interprets, and responds. Various types of mental illnesses differ in their severity and symptoms. Common mental illnesses include depression, anxiety, phobias, eating disorders, and stress while critical mental Illnesses include schizophrenia, bipolar disorders, manic-depression, clinical depression, suicidal tendency, personality disorder etc.
Pandemic Effect
It was an ordeal in the true sense when a person suffered extended periods of isolation and loneliness at his/ her own home when one’s own near and dear ones were behaving like a stranger with all love lost. It led to a state of serious mental disturbances such as an acute feelings of depression, alienation and suicide. Loss of job and hard-earned money and inefficacy of medicines resulted in hopelessness, helplessness and the state of anomie.
There was a prolonged disconnect with family and friends which was equally affecting frontline workers and patients as they were unable to physically interact with their family members and see or meet with loved ones including infants, ailing parents and life partners. It led to emotional trauma and an existential vacuum.
The constant fear of death led to untimely ageing, fatigue, loss of energy and fear of losing everything. Some stayed back home due to prolonged lockdown and increased their screen time due to monotony and boredom, total disruption of work-life balance and some also resorted to domestic violence more often than not, due to frustration and blocked emotions.
NCERT survey which covered 3.8 lakh students across the country shows 81% of school students are anxious about studies and exam results. It identified frequent mood swings as an area of concern across grades, gender and types of schools along with body image, and lack of social interaction are several other reasons why school students suffer from bad mental health. The need for an effective school mental health program is felt as never before with the mandatory appointment of a trained school social worker so that mental health concerns of the students can be nipped in the bud.
There is an urgent need for a comprehensive database reflecting on mental health concerns based on the perception of the own selves, self as viewed in the social context, satisfaction with life (personal, family, peer/ social groups and society), emotions experienced, fears and challenges and strategies for coping and managing their emotions etc.
Current Initiatives
Ministry of Health, Government of India with technical support of the National Institute of Mental Health and Neurosciences, Bangalore has initiated the All Accessible Quality Mental Health Care Programme and initiated Tele MANAS on Oct. 10, 2022, on the occasion of World Mental Health Day: (Tele Mental Health Assistance and Networking Across States) with 24x7 toll-free Helplines: 14416 and 1-800-91-4416. This offers online qualified help in the language chosen by the caller. This is going to be a breakthrough towards addressing mental health problems without fear of social stigma and with assured confidentiality. Mental Healthcare Act, 2017 de-criminalises attempted suicide as well as suicide assistance by amending Section 309 of the Indian Penal Code.
The Insurance Regulatory and Development Authority of India (IRDAI) has mandated that major mental illnesses will be covered under medical/ health insurance from October 31, 2022, as per section 21(4) of the Mental Health Care Act 2017 and the Insurance Companies must amend their policy document/ bond accordingly. The Act specifically provides that ‘every Insurer shall make provisions for medical insurance for the treatment of mental illness on the same basis as is available for the treatment of physical illness.’ However, it was delayed due to the reluctance of insurance companies but finally, they could fall in line due to the intervention of the Supreme Court of India.
It is incumbent on the people to be aware and assertive while buying medical/ health insurance that their policy covers mental illness as well. The states must improve the mental health infrastructure and facilities for treatment. The services of the private sector and community mental health initiatives should be recognised and availed as and when required. Mental Health counsellors must be appointed in Primary Health Centres to attend to patients and link them to appropriate psychiatric services.
(Dr. P.K. Bajpai is a Principal at Maharaja Agrasen College, Jagadhri affiliated with Kurukshetra University and Anukriti Bajpai is an Assistant Professor, at Vivekanand Institute of Professional Studies, Indraprastha University, Delhi)
