The pandemic has forced many into the pit of mental health issues and those who were already in it are drowning. Is the Indian government paying attention to this crisis?
Mental health. This has been one topic which got a great boost in terms of discussions after the COVID-19 lockdown started to mess with everyone’s headspace.
Jagriti, a 24-year-old mass communication student, was so fond of her college and friends that she was unwilling to leave the hostel even after the administration asked all students to go home in wake of the coronavirus outbreak.
Three months later she’s on the phone with a mutual friend and the conversation was not something any of us expected to have.
“I am throwing anything at anyone. I shout, I sob and then I am okay. I have no idea what has happened but there’s something wrong. Maybe I’m too overwhelmed because I’m so far away from home for such a long time. I need to talk to a therapist. Can you please share Astha’s phone number with me?” she asked.
I was surprised, of course. But I was more relieved to realise that others were feeling the same things that I was going through since the lockdown began. It was all real and I had company. It has been hard to come to terms with the pandemic, the lockdown that followed and the expectation to keep going like normal, functional and even productive individuals.
“Anyone who knows me will tell you that I am a bit impulsive. But I was never the way I am right now,” she said. “Everything and everyone makes me angry. I have become violent,” she continued in a thickening voice. “After completing the course, we were supposed to sit for job interviews. What will my future be? I don’t know. I am in the dark.”
Jagriti is one of the lucky few who lives with her boyfriend without getting grief about it from her family. In a conservative society like India, that is still something both men and women have to deal with. Women a little more than men, of course. She has been living with Gyan, a government school teacher, in their home in Varanasi since the lockdown began.
Gyan said, “Maybe I shouldn’t have asked her to come back home. She was always someone with an active social life. But now she doesn’t even want to talk to anyone. She switched off her mobile phone for an entire month. One minute she would have an emotional breakdown and be absolutely fine the next moment like nothing had happened. It’s true. She is even violent sometimes.”
Jagriti is probably one of the millions who are struggling with their mental health due to the lockdown. Like a wise man once said, “to be locked up in a cage is not a natural thing.”
Lost jobs. Broken relationships. Failed careers. Any of these can have a profound impact on the psyche and lead to hopelessness and despair. And it is harder to ask for help in a relatively conservative country like India. A cough, a cold or a broken leg get a doctor. A stressed out mind gets unhelpful free advice like “shake it off,” or “you are stronger than this,” or “who doesn’t have problems?” from friends and family. This makes it harder to talk to anyone about seeking professional help.
This mindset is not limited to the illiterate or the older generation. In July, a 25-year-old junior doctor, who works at the Department of Psychiatry in New Delhi’s AIIMS, died from suicide. He had a “severe depressive episode” and admitted to feeling “empty and low.
In 2018, the WHO found that India was the “most depressed country” in the world, followed by China and the USA. And a crisis like COVID-19, which pushes everyone to their wits end in a country with questionable mental health resources, might just be the last ingredient to cook up a storm.
The lack of sensitivity and awareness is leading to total neglect and failing so many individuals who need help. That mental health issues aren’t even considered to be health problems might be the first problem we have. Words like “crazy,” “lunatic” and “retarded” are used rather casually to describe those who are in distress. This has further alienated those in pain, invalidated their feelings and has led to shame about seeking medical attention.
You wouldn’t be ashamed if you broke an arm, would you? That is because in that scenario you will be called crazy if you don’t go to a doctor. So, your pain – physical and emotional – are validated and you are encouraged to seek professional help.
The handful of psychiatric institutions in India have been dubbed “mental hospitals” and anyone going to see a therapist is deemed “mad.” There is no denying that there is a cultural aspect to these misgivings. And successive governments have done close to nothing to dispel these myths and create awareness towards these health issues.
A Leap into the Past
The American Psychiatric Association defines mental illness as health conditions involving changes in emotions, thinking or behaviours. Mental illnesses are associated with distress and/or problems one experiences while functioning in active society or just among family members.
In India, the Mental Health Act of 1987 was a significant move towards recognising mental health problems as medical conditions. But the focus was largely on those who showed severe symptoms.
Three decades later, the Mental Healthcare Act of 2017 gave the much-needed boost to mental health. The Act says that every citizen has the right to mental healthcare while calling for decriminalisation of suicide. While that was hailed as a milestone, what followed the passage of the legislation was not promising.
In 2019, the budget allocated for the National Mental Health Programme (NMPH) was brought down to 400 million rupees, down from 500 million rupees allocated in 2018. And even in that, an abysmal 50 million was spent.
In 2020, the NMHP was given just 0.05 percent of the total health budget of about 692 billion rupees, which amounts to 34 million rupees.
In a country with 1.38 billion people, about 7.5 percent of them are suffering from different mental health illnesses. And the government is spending only 0.024 rupees per person.
|Year||Allocated Budget||Per Person Spending|
|2018||50 million rupees||0.036 rupees|
|2019||40 million rupees||0.028 rupees|
|2020||34 million rupees||0.024 rupees|
The Indian Psychiatry Institute’s estimated annual cost for the implementation of the National Mental Healthcare Act, 2017, was 940 billion rupees. It is 2020, and the actual spending is light years away from the required amount.
That was spending. Now, to resources.
According to the WHO, India has 0.3 psychiatrists and 0.07 psychologists per 100,000 people.
What’s the Government Doing?
Unemployment, layoffs, debt, domestic violence and being locked up are causing a lot of uncertainty and helplessness. India’s mental health crisis is now impossible to ignore.
According to an Oxfam India report, a 24×7 mental health helpline received nearly 45,000 calls in just two months. Fifty-two percent of the calls were about anxiety, 22 percent about isolation and adjusting to it, 11 percent about depression, 5 percent about trouble sleeping and 4 percent about escalation of existing mental health illnesses.
Also, a survey conducted by the Indian Psychiatry Society revealed that the first week of lockdown saw a 20 percent rise in the number of reported cases of mental illnesses.
As the number of confirmed COVID-19 cases crossed 1.5 million in India, patients, their families and healthcare workers are experiencing an unprecedented level of stress and fear. As per a joint report by the Ministry of Health and Family Welfare and the National Institute of Mental Health and Neuro-Sciences, frontline health workers are especially vulnerable due to the pandemic and need urgent attention.
The government is promoting tele-medicines through mobile applications and dedicated helpline numbers. There is a toll-free helpline – 08046110007 – for all those whose mental health has been disturbed by the pandemic.
But 60 percent of India’s population lives in rural areas where there is neither awareness nor access to the internet. So unfortunately, these services mean little to nothing even if they serve the privileged urban population. These are services that need to reach the far corners of the country.
The coronavirus pandemic is a devastating one but it gives us the opportunity to talk about crucial aspects of life like mental health. Only a small part of the population is aware of mental health illnesses and how to take care of them. It’s time we took down the double standards for physical and mental health.
As far as the government is concerned, it has already made some promises in the Mental Healthcare Act of 2017. It’s time to do good on that promise.
Surabhi Singh works with StoriesAsia. She is a graduate from Indian Institute of Mass Communication in Delhi.