India did not prioritize mental health until Covid-19. Now it pays the price

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“The worst part is the headaches and the pain in my eyes,” said Paul, who lives in Kolkata, West Bengal. “I have had more panic attacks this year than in my entire life combined. ”

Research conducted by the Suicide Prevention Foundation of India (SPIF) in May found that nearly 65% ​​of 159 mental health professionals surveyed reported an increase in self-harm in their patients. Over 85% of therapists surveyed said they suffered from caregiver fatigue and over 75% said fatigue had an impact on their work.

Another survey conducted in April by the Indian Psychiatric Society showed that of 1,685 participants, 40% suffered from common mental health conditions, such as anxiety and depression, due to the pandemic.

The lockdown may have eased, but the situation is not improving. The report’s authors told CNN in August that there was growing anxiety and uncertainty about the end of the pandemic.Before Covid-19, India had the highest suicide rate in Southeast Asia – today medical experts say the country’s mental health system is being pushed to the limit.

“The system was already creaking and overloaded, now with Covid we are living through the catastrophe of increased demand, dismal supply and tired frontline workers,” said Nelson Moses, founder of SPIF.

No words for sanity

India does not have a long history of discussing mental health.

In 2016, a national mental health survey conducted in 12 states documented a list of more than 50 derogatory terms used for people with mental illness. “Usually, the public believes that people with psychiatric illnesses are incompetent, irrational and untrustworthy, therefore, they are unlikely to get married,” said one of the participants.

“People think that talking about your feelings makes you weak – there are a lot of misconceptions,” said Baldev Singh, 23, a volunteer advisor to MINDS Foundation, an Indian nonprofit that aims to reduce stigma surrounding mental health. .

Experts say the historic reluctance to tackle mental health in India may be partly due to a lack of terminology. None of India’s 22 languages ​​contain words that mean “mental health” or “depression”.

“People think that talking about your feelings makes you weak – there are a lot of misconceptions. “Baldev Singh, volunteer advisor

Although there are terms for sadness (udaasi), pain (shok) or devastation (bejasi) in Urdu and other Indian languages, specific terminology for dealing with various mental illnesses is lacking. This is because the practice of psychiatry is largely Western, said Dr SK Chaturvedi, chief of service at the National Institute of Mental Health and Neuroscience (NIMHANS) in Bangalore. “It’s easier for people to talk about physical symptoms and illnesses than it is to tell their families that they are feeling down or depressed,” he said.

Growing up, Paul says his middle-class Indian family didn’t talk about negative feelings.

“Since I was a kid it was ingrained not to talk about things that bother us. ”

The problems were dismissed and downplayed, she said. “They might just compare it to someone else’s problem and make you feel guilty. “

Stressful mental health system

The stigma surrounding mental health can prevent some people from recognizing that they need help. For those who want treatment, facilities are limited.

According to the 2016 National Mental Health Survey, 83% of people with mental health issues in India did not have access to adequate mental health treatment.

That same year, India had three psychiatrists for every million people and even fewer psychologists, according to the World Health Organization (WHO). By comparison, the United States had 100 psychiatrists and almost 300 psychologists for every million people.

In many cases, accessing mental health treatment in India depends on where you live.

“The divide is basically between urban and rural areas, so if I look at Mumbai I know today I can just get up and go to a hospital in my own area,” said Pragya Lodha, program director. of Mumbai for the MINDS Foundation. .

For people in rural India it is much more difficult.

The sub-district hospitals accommodate around 30,000 people or 15 to 20 villages. However, these hospitals generally do not have mental health services, according to Amul Joshi, program director of the MINDS Foundation in Gujarat.

Some villagers may have to travel up to 60 kilometers (37 miles) to seek treatment, Joshi said. It takes time – and money. “We sometimes pay for their trip to the hospital as an incentive. However, this means that treatment is usually limited to drugs because people cannot continue to go to the district hospital for therapy, ”he said.

People in rural India tend to have other priorities.

“The struggle in rural communities is often a grassroots issue, so mental health tends to take a back seat,” Lodha said.

The urban-rural divide

India was heading into harvest season when the government announced its nationwide lockdown in March. Farmers were unsure whether they could hire migrant workers amid the ban on cross-border movements and whether the crops could be transported to market, said Singh, the volunteer advisor.

“People have to deal with a lot of stress in the villages – farmers have to deal with the deterioration of their produce when they cannot bring it to market or distribute it on time,” said Singh, who lives in the village. Nara village, a rural farming community of about 2,000 people in Gujarat.

Singh said people in rural India felt more isolated than ever.

“In rural India, where people are unaware of mental health issues and cannot talk to their friends about their stress, the situation is only getting worse.Baldev Singh, volunteer advisor

“In urban areas of India, maybe this has led to more dialogue between family members. In rural areas of India, where people are unaware of mental health issues and cannot talk to their friends about their stress, the situation is only getting worse ”. he said.

Technology has become crucial for the mental health response in many communities during the pandemic. However, online therapy is not often available to people in villages who do not have access to smartphones or the Internet.

The MIND Foundation trains volunteers – like Singh – to become “community leaders” to raise awareness about mental health and encourage people to seek help when they need it.

Government programs

Changing attitudes in a country of 1.3 billion people is a huge challenge. But in recent months, there have been signs of change.

Chaturvedi, of NIMHANS, is part of a central government initiative to tackle the mental health of migrants who have been disproportionately affected by the 68-day lockdown.

“(This is) definitely proof that there is a change in attitude and people understand the importance of mental health,” Chaturvedi said.

Millions of migrant workers lost their jobs and found themselves stranded in cities when lockdown rules closed workplaces and froze public transport. Some have been forced to take refuge under bridges or other public spaces or to travel hundreds of kilometers to return home.

Migrant workers (were) displaced, forced to return to their villages, ignored by the state apparatus, treated as collateral damage, ”said Moses. Sometimes they were not welcome in their own villages, he added, fearing they might be carriers of the virus. .

“Thanks to Covid, everyone is in the same boat of despair and discouragement. “Nelson Moses, founder of the Suicide Prevention in India Foundation

Under the leadership of the Ministry of Health and Family Welfare, NIMHANS has set up a helpline that refers potential patients to mental health professionals. Separately, the government issued guidelines on addressing the mental health issues of migrants and healthcare workers, as well as advice on identifying patients whose mental health had suffered during the pandemic. And the Department of Health shared posters highlighting the importance of wellness practices, such as yoga, to improve mental health.

However, some mental health practitioners say these initiatives are insufficient. “These are useful but seem reductive and seem like lip service,” Moses said.

Mental health experts say what is needed is more funding. Of India’s total budget for 2020-2021, only 2% has been earmarked for healthcare. And of that figure, less than 1% has been allocated to mental health.

Moses believes the time has come for the Indian government to start prioritizing mental health services.

“Never before have we seen more engagement in mental health. Thanks to Covid, everyone is in the same boat of desperation and discouragement, ”said Moses. “He went from (being) swept under the carpet to touching the ceiling. ”

Paul chose to talk about his panic attacks to raise awareness of an often overlooked problem in India. “It is no longer acceptable to call mental health a ‘taboo’ and move on without addressing the problem,” she said.

“There has to be a lot more communication… we have to start from scratch in schools and colleges and put parents at ease and put them at ease, so that their children can be comfortable talking to them. of their problems. “

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