Invest heavily in post Covid mental health infrastructure and research
Given the situation we faced over the last three years, there is an urgent need to quantify post-pandemic mental health problems in India.
Washington DC: The fear of Covid-19 virus may have vanished in thin air, with health planners and citizens in India treating it as an “almost-over case”. But it is not. Given the news about long-term Covid infection still rattling many around the world, there is one worrying factor. It is the deep impact the virus has left on the mental health of many, including in India, where the population is ageing, underserved by the health care system, and is uninformed and poor. While we kept analyzing Covid-19 impacts primarily from business, jobs and economy angles, the pandemic has, in fact, exposed the fragility of the health system in India. Further, Bill Gates, the billionaire philanthropist, in his latest 304-page book, How to Prevent the Next Pandemic, talks about these fragile health systems and the need to develop a strong infrastructure to combat pandemics in the future.
One of the components of the health systems that was particularly exposed during the Covid-19 pandemic was the mental health system. While no national-level epidemiological studies have been undertaken in this regard, anecdotal evidence points out that stress, anxiety, depression, and exaggeration of other mental disorders have increased multifold after the pandemic.
That said, health planners, including in the Narendra Modi government, and medical experts were quick to channelize all resources to contain the virus in the second wave when India was worst hit. Undoubtedly, they succeeded to a large extent. But we undermined the after-effects of Covid-19 virus from the point of mental health, associated stigma, depression, anxiety, and stress among those affected directly, and indirectly by losing someone close in the family and in the social community. At least as a prime health policy among the planners in the national and state governments. The western countries, including in the United States, have started to invest heavily into the research surrounding the impact of pandemics on human communities and their mental health status. India, which has entered the coveted club of top five global economies, and is aiming to be a $5 trillion economy needs to take a cue from here, and channelize its resources to a large-scale epidemiological study on the effects of Covid-19 on its people. This has been missing to shape our future national public health policy.
The only epidemiological study in India on mental health dates to 2015-2016 and is called the National Mental Health Survey (NMHS). It cost the nation around Rs 5 crore and even then, provided limited data. It covered only 12 states across six regions: 1) North (Punjab and Uttar Pradesh); 2) South (Tamil Nadu and Kerala); 3) East (Jharkhand and West Bengal); 4) West (Rajasthan and Gujarat); 5) Central (Madhya Pradesh and Chhattisgarh); and 6) Northeast (Assam and Manipur). The survey found that 13.7% of the population at the time suffered from mental illnesses during their lifetime and 10.6% were current sufferers. This is a substantial burden of morbidity.
Given the situation we faced over the last three years, there is an urgent need to quantify post-pandemic mental health problems in India. Detection of the burden of mental illnesses at the population level is only part of the solution. Such epidemiological diagnosis needs to pave the way to the development of concerted prevention programs, counseling interventions, and treatment options. Indian society still has a lot of stigmas, myths, misconceptions, and discrimination associated with mental illness that are a hindrance to addressing the problem. A lot goes undisclosed in social communities, families and friend circles due to the stigma attached to a mental health patient. The same is the case among health planners, who have not treated it as of utmost importance. In India, the Mental Health Care Act 2017 was a landmark move to protect the rights of people with mental disabilities. It was hailed as a bold move by the British Journal of Psychiatry. However, even after seven years of passing, the plight of the people with mental illnesses has not improved drastically. One of the ways to reduce the stigma is to enhance social contact between people with mental illnesses and those who apparently do not have it, have credible role models come forth with their battles against mental illnesses, sharing stories of successful people with mental illnesses, and use of newer behaviour change models for changing attitudes among the masses toward mental illness.
Health interventions, including social media platforms for larger information sharing hold key to a changed attitude among mentally sick patients. There is an urgent need to propagate the advantages of stigma-free behaviour over stigmatized thinking through participatory dialogue in educational and awareness-building programs. We need to demystify the causation of mental illnesses which are often due to imbalances in bio-psycho-social domains and can be rectified. Likewise, the behavioral confidence of the public in dealing with mentally sick people needs to be improved. This can be done by advocating the transient nature of most illnesses and the availability of myriad effective treatment options. Secondly, changes in the physical environment can be encouraged with enhanced treatment facilities for those with mental illnesses. There must be incentives and policies at the governmental level to promote the education of counsellors, health educators, psychologists and psychiatrists, and alongside increase the financial outlay of resources for facilities. Not to miss, at our family and community levels, we need to promote the understanding of the oneness of all humans are at the core of developing compassion toward the less fortunate mentally sick people, in a way it seeks the emotional touch while dealing with mentally ill patients, and not with a bias and disdain. Mental sickness may not be permanent, and may need a quick attention and therapeutic remedies.
The urgency to look at the post-Covid mental health burden is also from the fact that some studies have aired the fear in media recently that one of every 20 people who had Covid still have not recovered completely from their initial infection six to 18 months later. Long Covid infection is a serious health challenge amidst the fears that the virus is here to stay, and we must adapt to this health risk which is becoming a lifestyle. Experts fear that the long-Covid infection also brings with itself stress and depression tendencies, mostly due to isolation and frustrating health conditions, and some patients have started developing suicidal tendencies. Most of them hospitalized with long Covid-19 infection were older individuals, women, those from deprived communities and people with pre-existing physical or mental health problems, the study pointed out, and it stands true in India’s case too. There is a human side to the economic hardships India’s unregulated migrant labour population suffered, and the stress they faced to keep their kitchen stoves burning. Stress, stigma and survival challenges are here to stay for a while. Stress has a spiral effect on one’s health even in the later part of life, something we tend to ignore.
Like the battle India fought against breast cancer or small pox or polio, it’s time to wage a new war against mental health sickness. But this one has to be an emotional one, and well researched and a thought-out blueprint to deal with the growing mental health burden in the country. The key is that the mental health policy must be executed with tender touch and utmost care.
Prof Manoj Sharma is Chair of the Social and Behavioral Health Department at the University of Nevada, Las Vegas.
Maneesh Pandeya is a Fulbright Professor and PhD Scholar at Howard University in Washington DC.