India’s Modi government started easing the most severe restrictions on daily life in June, but the effects of the lockdown on residents’ mental health are still emerging, as the country battles one of the most severe COVID-19 outbreaks in the world. India now has over 4.2 million cases of the virus, giving it the second-highest tally of recorded cases globally, only behind the Unites States.
Research conducted by the Suicide Prevention in India Foundation (SPIF) in May found that nearly 65% of 159 mental health professionals surveyed reported an increase in self-harm among their patients. More than 85% of therapists surveyed said they were experiencing caregiver fatigue, and over 75% said fatigue had impacted their work.
Another survey in April, by the Indian Psychiatric Society, showed that, of 1,685 participants, 40% were suffering from common mental health disorders, such as anxiety and depression, due to the pandemic.
The lockdown may have eased, but the situation isn’t improving. In August that there’s growing anxiety and uncertainty about when the pandemic will end.
Before COVID-19, India had the highest suicide rate in south-east Asia — now medical experts say the country’s mental health system is being pushed to the limit.
“The system was already creaking and overburdened, now with COVID-19, we are experiencing the catastrophe of increased demand, woeful supply, and fatigued frontline workers,” said Nelson Moses, founder of SPIF.
Experts say the historical reluctance to address mental health in India could be partly due to a lack of terminology. None of India’s 22 languages have words that mean “mental health” or “depression.”
While there are terms for sadness (udaasi), grief (shok) or devastation (bejasi) in Urdu and other Indian languages, the specific terminology to address different mental illnesses is lacking. That’s also because the practice of psychiatry is largely Western. The stigma around mental health may prevent some people from recognizing that they need help. For those who do want treatment, facilities are limited.
According to the 2016 National Mental Health Survey, 83% of people suffering mental health problems in India did not have access to adequate mental health treatment. The same year, India had three psychiatrists for every million people and even fewer psychologists, according to the World Health Organization (WHO). For comparison, the US had 100 psychiatrists and almost 300 psychologists for every million people.
Technology has become crucial to mental health intervention in many communities during the pandemic. However, online therapy is not often available to people in villages who don’t have access to smartphones or the internet.
Changing attitudes in a country of 1.3 billion people is an immense challenge. But in recent months, there have been signs of change. Under the direction of the Ministry of Health and Family Welfare, NIMHANS set up a helpline that refers prospective patients to mental health professionals. Separately, the government released guidelines on addressing the mental health issues of migrants and health care workers, and advice on identifying patients whose mental health had suffered during the pandemic. And the Health Ministry shared posters stressing the importance of wellness practices, such as yoga to improve mental health.
However, some mental health practitioners say these initiatives are insufficient. Mental health experts say what’s needed is more funding. Of India’s total 2020-2021 budget, just 2% has been set aside for healthcare. And of that figure, less than 1% has been allocated to mental health.