World Mental Health day: Pandemic worsening mental health for millions

India accounts for more than a third of female suicides globally

“To fully realise the mental health crisis that India faces in relation to Covid-19, one has to begin with recognising the very serious situation that existed even before the pandemic. Neither the government nor the citizens have taken mental health seriously and now we are paying a price for it,” says Dr Rakhi Anand, a clinical psychologist at Apollo Hospital, New Delhi.

In July, the National Mental Health Survey reported that about 10 pc of adults in India meet diagnostic criteria for a mental health condition, ranging from mood and anxiety disorders to severe mental illness. The Global Burden of Disease study, conducted by a psychiatry journal, estimated that 200 million people in India have experienced a mental disorder, nearly half of whom suffer from depressive or anxiety disorders.

India accounts for more than a third of female suicides globally, a fourth of all male suicides and suicide has been the leading cause of death among young adults in India. According to the WHO’s data, till the previous year, India held an unfortunate record of one suicide death every seven minutes which has now worsened to one suicide death every four minutes.

“Yet, the government has spent very little on mental healthcare,  estimated at less than one percent of the health budget, which itself is amongst the lowest in the world. Most of this budget is almost entirely spent on doctors, drugs and hospitals in urban areas,” Dr Anand adds.

In the financial year 2019, the budget allocated to the National Mental Health Programme (NMHP) was brought down to USD 400 million USD 500 million in FY18. The latest budget in 2020 has not increased the allocation for NMHP, even though the total healthcare budget saw a seven pc increase. “The budget allocated for mental health is 0.05 per cent of the total healthcare budget. The average percentage of the total healthcare budget allocated to mental health in developed countries is at least 5 per cent,” says Dr Anand.

Pandemic and impact on mental health

Dr Anand explains that the impact of the pandemic on mental health will unfold in the months ahead, as the virus starts to get contained but the economic fallout of the pandemic begins to bite deeper.

“Right now, people are terrified of the virus, of dying or their loved ones contracting this disease. They are also scared of being quarantined, maintaining physical distancing and being isolated. For millions, these fears only add to the already daunting apprehensions about their livelihoods. These are not abstract anxieties; these are real, everyday worries,” she says.

She further says “If one considers all these factors and adds to them the increase in domestic violence, the disruption of public transportation, the lack of access to routine health services and the shortage of medical supplies, it seems almost normative that people are going to be very distressed during this period.”

Groups with mental health issues

Certain groups have emerged as especially vulnerable to mental diseases and breakdown during the pandemic. Studies report many women suffering from anxiety and depression. Dr Anand attributes this to women facing the brunt of increased household responsibilities and domestic violence during the lockdown.

Covid19 pandemic has worsened mental health for certain vulnerable groups (MIG Photos/Aman Kanojiya)

Indian Journal of Psychiatry reported that 65 pc of people aged 18-32 years felt lonely during the lockdown and 37 percent felt that their mental health had been strongly impacted. “This is not surprising given that about 30 million young people lost their jobs in April 2020 alone and 320 million students have been affected by the closing of educational institutions and the postponement of exams,” Dr Anand adds.

Another survey of 152 doctors found that more than a third of them are experiencing depression and anxiety due to the pandemic. Frontline workers are reportedly burdened by over-work and anxiety about contracting the virus.

The anxieties described earlier, as Dr Anand says, have been overwhelming for people with pre-existing mental health conditions. “Problems may also have worsened for individuals because of the disruption of mental health services and the difficulty of travel, which led to people reducing doses of prescribed medication,” Dr Anand says.

Immediate need for response

Mental healthcare in India has been in a state of crisis for quite some time now. According to the WHO, there are less than 4,000 mental health professionals in India. This translates to the availability of one psychiatrist for every 350,000 people in India. However, despite the crisis, Dr Anand says that the pandemic and the coming few months are crucial in shaping the mental health of a whole generation.

“This is a timely moment for all those concerned with mental health-from mental health professionals to civil society advocates should unite for one issue which is the COVID-19 response and addressing mental health alongside containment of the pandemic itself. This is also a historic opportunity for us to completely reimagine what mental healthcare means. To acknowledge and embrace the plural ways in which mental health problems are experienced and expand the models of mental healthcare in our country. If it is not addressed immediately, we may have to pay a huge price,” Dr Anand sums up.