By: Chaitanya Singh & Niharikaa Mehta
The Corona virus is not just physically present around us, but it is omnipresent in our minds as well. The outbreak of the deadly virus has affected more than 14,000 people in India, and over 2.2 million people on the global front. After the first case was reported in Wuhan City of China in the month of December, COVID-19 now has been declared as a ‘pandemic’ by the World Health Organization (WHO). The Indian Government ordered for a nation-wide lockdown for 21 days initially from 25th March and advised the citizens to practice social distancing, resulting in ‘separation and restriction in the movement of people’ in order to curb the spread of the virus. The government might be able to eliminate this deadly virus, but it raises some important questions which need to be addressed. What will be the impact of COVID-19 on mental health? Does the government take any actions to take care of the mental health of people? What could be the possible solutions to this problem?
How mental health has been affected?
We have seen that physical health is always given more attention over mental health- this unequal treatment of the two kinds of health is consistent with our society’s ongoing disregard to psychological stability. After the announcement of lockdown, while the people are isolating in their homes, there are rising concerns regarding COVID-19 impact on Mental Health. As Debanjan Banerjee, psychiatrist at NIMHANS (Bengaluru), posits mental health takes a toll as people face the fear of transmission, fear of losing jobs, a constant state of insecurity and worry about essentials. As reported by the American Psychological Association, it is possible that social isolation leads to a highly affected sleep cycle, poor cardiovascular health and depressive symptoms and impairment in executive functioning. All these fears and insecurities lead to depression, anxiety and stress, which affect the mental health. Moreover, people staying in social isolation and quarantine can succumb to “touch deprivation”, as ‘touch’ is important for the immunity level which reduces the cortisol-stress hormone, and those people need to be embraced, as argued by Dr. Tiffany Field, Director, Touch Research Institute at the University of Miami’s Miller School of Medicine.
Even the health-care professionals might suffer from mental health issues, as they are dealing with a lot of patients every day. Hence, they too get anxious and stressed. Further, it was recently reported from Madhya Pradesh that the people are physically beating and boycotting doctors who are trying to help them. It must be understood that, apart from physical casualties, this will take a terrible toll on the minds of many of those who will survive. Adding on to it, as studies from China shows, those who have recovered from this turmoil of COVID-19 might face acute post traumatic stress disorders (PTSD). Further, Santosh K. Chaturvedi, Department of Psychiatry (NIMHANS, Bengaluru), says people with disorders like obsessive compulsive disorders (due to repeated hand washing), alcoholism, eating disorders and other lifestyle related disorders are also adversely affected and others might suffer from these as well. Also recently, according to an article, people who are infected by COVID-19 and admitted in ICU (Intensive care unit) might face Post Intensive Care Syndrome (PICS), due to which patients will have “new or worsening impairment in physical (ICU-acquired neuromuscular weakness), cognitive (thinking and judgment), or mental health status arising after critical illness and persisting beyond discharge from the acute care setting”.
All around the world, people have become paranoid of the ‘invisible enemy”. Soon after lockdown was announced in India, apart from the fear of getting sick, there has been a stigma against those who are sick or in quarantine. Recently, a 38-year old man from Himachal committed suicide after the social boycott from the village and the taunts of the neighbours as he was linked to Tablighi-Jamaat. Later on, it was revealed that he was tested negative. This type of social boycotts, taunts, jokes etc are affecting the mental health of people. Nikita Puri rightly said, “The Pandemic has travelled across the globe leaving a trail of grim stories”.
The recurrent display of infection rate of Covid-19 has left massive psycho-social impact on the masses. The most effective way to stop this invisible enemy from spreading is isolation and social distancing, which have led to many psychological concerns. Now the question arises, what could be done? What measures could be taken by the administration to help people who are already suffering from psychological problems? In such times of social-distancing, mental health has become really important and it must be prioritized.
Is the Government doing ‘enough’?
Mental health is never an issue in elections or any political party’s manifesto, but under the Indian Constitution, it is the fundamental right of every person to have the right to access to healthcare facilities and every mentally ill person has the fundamental right to receive mental health care. The constitution does not differentiate between mental or physical health and keeps both of them at the same pedestal. The Hon’ble Supreme Court has also laid down the maintenance and improvement of public health as one of the obligations of the government that flow from Article 21 of the constitution. Despite such obligations, is the government taking sufficient steps to ensure mental health during the pandemic?
In a letter dated 3rd April, Vandana Gurnani, additional secretary and director, National Health Mission, told states they could use the Centers of Excellence supported under the NMHP, and other state government mental health institutions for providing counseling and other support through institutions like NIMHANS in Bangalore. Further, at NIMHANS, the service for healthy use of technology (SHUT), has issued a toll free number (080-46110007) for mental health. But here, a few questions arise. Are the citizens made aware of such services? Are there any advertisements on television or social media? If the policies do not reach the needy citizens, it becomes a ‘dead-letter’.
According to a study by Indian Psychiatric Association, there has been a steep rise by 20% in patients with mental illness after the outbreak of corona virus. Post lockdown, there are a large number of migrant workers (many of whom are daily wage workers) who have lost their jobs and daily wage, which will affect their mental health as they are likely to suffer from extreme emotional anxiety, fear and loss of dignity and uncertainty of food and shelter. They might get two times food and money from the government, but are they getting any emotional support (which they could have got at their homes)? Do we have the infrastructure and resources to even diagnose those workers? This takes us to a very critical point, how much budget is allocated for mental health every year?
Being the fifth largest economy, India in the financial year 2019, brought down the budget allocated to the National Mental Health Programme (NMHP) to Rs 40 crore from Rs 50 crore in the previous financial year. This is 0.06 per cent of the country’s health budget of Rs 62,398 crore. The funds actually spent were much lower – only about Rs 5 crore each during the years. This implies that the government is spending only 33 paise per mental health patient to 150 million people in need of urgent help. The fund allocated to NMHP by the Union Government clearly shows the lack of concern and during these tough times (and in the normal course of time as well), we need better mental health care facilities. Further the ratio of mental health professionals to the population is astonishing as we only have around one doctor for every 100,000 people. This means there are only 9000 mental health professionals in the population of 1.38 billion. Further according to the Telangana Health and Family Welfare Department, there are only 53 people under national health mission who are trained on COVID-19 mental health and counseling.
There are a lot of advertisements on TV, radio and social media, making people aware about social distancing, lockdown etc. But there is nothing to make people aware about mental health. There is not even a mention about the same. We need to listen to migrant workers, people with mental health problems, health care workers, COVID-19 patients with empathy, compassion and patience and provide counseling to address their problems.
A possible solution?
According to an article published in the International Journal of Biological Sciences, in order to tackle the mental health crisis, the National Health Commission of China (NHC) has integrated psychological crisis intervention into the general deployment of disease prevention. The NHC has conducted training for mental health professionals to treat people during the COVID-19 outbreak. Furthermore, the mental health experts along with the help of the NHC have uploaded videos of ‘mental health education’ for the general public and there has been widespread publication of the same through online platforms at the early stage of the outbreak in Wuhan. Also, a notice was issued by the government in China for patients with severe mental illness (SMI) which included three guidelines, [1.] Prevention of nosocomial infections; [2.] timely treatment and care for SMI patients infected with COVID-19; and [3.] Township/subdistrict-level integrated mental health management unit for treatment and community care for SMI patients at home only. Considering the very strict laws regarding lockdown and social distancing, Chinese government has put enormous efforts for the healthy mental-health of its citizens from a very early stage.
After the lessons learnt from China and other parts of the world, mental health of the citizens must be prioritized and public mental health interventions must be included formally in the guidelines issued by the government of India to effectively curb both mental and physical outbreaks. Even WHO has suggested in its guidelines that management of mental health conditions and ‘critical inpatient therapies’ must be included into ‘essential services’.
Keeping this in mind and the widespread usage of technology, the government must encourage ‘telemedicine’ to reduce the barriers. Further, task shifting or sharing, which means that specific tasks done by the professionals should be given to less qualified people or a group of providers with specific training. In addition, the mental health associations and academic societies must conduct psychological counseling and establish psychological assistance expert groups to provide professional guidance to the needy.
The government must use its resources, through advertisements, media as well as with the help of mental health care professionals, to spread awareness about COVID-19 and educate the public about mental health. In regards to the anxiety caused to the large population the government should rightly identify the essential services and prioritize the continuity of such services as well as make sure the limited resources are used at the optimal benefit of the people, in order to reduce the panic caused or else, the aftermath of this pandemic will be “bittersweet” in the wake of a different kind of disaster- a chronic mental health crisis.