Panic, anxiety, depression: what coronavirus lockdown means for India’s mental health

Coronavirus (file photo)

The 32-year-old Shraddha Kejriwal, who runs a merchandising shop in Pune, has been waking up with nightmares for a week. “I can’t handle this idea of ​​an uncertain future,” she said. Shraddha struggles with anxiety and obsessive-compulsive disorder. It is also immunodeficient.

The spread of the deadly novel corona virus, which has now forced large parts of the country to go under lock and key, has severely affected their mental health.

Coronavirus (file photo)

Coronavirus outbreak in India (file photo)

Maharashtra, where Shraddha lives, has reported the highest number of COVID-19 cases in India, including two deaths. To control the spread of the highly contagious disease, which affects more than 3.4 lakhs worldwide, the Maharashtra government has imposed a curfew until March 31, during which only essential services are allowed to function. Section 144 CrPC, which prohibits the gathering of five or more people in public places, was enforced.

“Indian business has been through a difficult time and now with this pandemic, I’m not just afraid for my health, I’m afraid for the future,” said Shraddha. Last week when Pune started closing down educational institutions and offices, she said, “It felt like the world was going to collapse.” She soon had to close the shop when customers stopped visiting. The online business also suffered after orders declined. “We have to pay salaries and rent, and there are so many other expenses – but without income and without knowing how long it will all take, I have lost all sleep,” said Shraddha.

While the outbreak has raised philosophical questions about survival, humanity and the future, the changes and chaos it brings to Indian life are difficult to deal with. It is a little more difficult than washing your hands.

According to the World Health Organization (WHO), over 90 million Indians, or 7.5 percent of the country’s 1.3 billion people, suffer from some form of mental disorder. Most of them get no help. The results of a 2015-2016 nationwide study by the Indian National Institute for Mental Health and Neuroscience (NIMHANS) – an autonomous body of the Ministry of Health and Family Care – showed that nearly 150 million Indians needed active intervention, while less than 30 million were affected it was.

The outbreak has caused scientists, doctors, public health officials, and governments around the world to seek a cure, but the question that is often ignored is already staring at us: How is India going to deal with the mental health crisis? bypass?

Everyone is worried: sleepless nights, worries

On March 19, a 23-year-old suspected of being infected with the novel coronavirus died after jumping from the seventh floor of Safdarjung Hospital in Delhi. The family complained that the doctors had not advised the man who had just returned from Sydney with his mother. The health ministry issued a statement saying, “The patient reached around 9:00 pm and was taken to the seventh floor for admission and examination. When the doctors reached the room, he was not inside. At the same time, another doctor was watching a body near 9:15 p.m. “

Ruchita Chandrashekar, a trauma therapist, said that the coronavirus lock can increase symptoms of depression and anxiety. “It also increases the risk factors,” she said. “People who need to be quarantined in toxic domestic environments can also have trauma triggers.” Chandrashekar, who focuses on the LGBT community, said the existing cases showed signs of depression relapse and increased anxiety symptoms.

“Throughout the past week, and even now, therapy patients have reported panic attacks, fatigue, anxiety-related headaches, sleep disorders, and overall increased anxiety in the light of COVID-19,” said Sonali Gupta, a Mumbai-based therapist and counseling psychologist, who said publishes a book entitled “ANXIETY: Overcoming to Live Without Fear”.

For Shraddha, it is the insecurity that has made her fearful. With the outbreak of the pandemic and the blocking measures imposed, however, there are many concerns: “Do I wash my hands enough? Will I pass the virus on to my grandparents? Should I retire with my parents? How safe is my job? How will I rent the property? pay the next month? How can I live alone with my own thoughts? “

A 30-year-old private banker in Ahmedabad, Tapasree, puts a drop of disinfectant on her palm after each customer’s turn at the counter. She gets up several times to wash her hands. “I’m almost obsessed with washing my hands,” she explained. “I work in a retail bank and that means meeting an average of 200 customers a day.”

When she goes home, she calls her husband in Mumbai, 500 kilometers away, by video. Tapasree was unable to return to Mumbai because her “transfer was paused” and quitting is not an option. She was concerned. Her mother, who lives in Kolkata, had to cancel her ticket to Ahmedabad because India reported more and more cases of coronaviruses. Her husband was supposed to meet her over the weekend, but they didn’t want to risk it. “I’m scared and scared,” she said.

Every fifth Indian suffers from an anxiety disorder.

A study published in The Lancet Psychiatry showed that the contribution of mental disorders to the overall disease burden doubled between 1990 and 2017. Depression and anxiety disorders, the most common mental disorders in India, are widespread across the country, according to the study. However, it is relatively higher in the southern states and among women. Depression is highest in older adults, which has a significant impact on India’s aging population.

The WHO had previously predicted that by 2020 around 20 percent of the Indian population will suffer from mental illnesses. This means that today more than 200 million Indians can suffer from mental illnesses. 9,000 psychiatrists are in charge of the mental health crisis in India. That is one doctor per 100,000 people. Assuming, as studies show, that the desired number of psychiatrists is three per 100,000 people, India has a shortage of 18,000 psychiatric doctors. However, the WHO predicted the outbreak of the novel coronavirus.

Self-isolation: how even?

Ritesh Singh, 30, a Pune software engineer, has moved to his parents’ home for quiet. Aditi Sharma, 26, an editor at a publishing house in Mumbai, cannot return to Lucknow because travel is “extremely risky”. She worked alone from home in her rented apartment. At first it seemed relaxing to Aditi, but not anymore.

News18 graphic about self-isolation or social distancing

News18 graphic about self-isolation or social distancing

In any event, domestic commercial airlines will not be allowed to fly for a week from midnight on March 24th. The Indian Railways has also canceled all passenger trains. However, this would mean longer periods of social isolation for people who in most cases live alone from home and family.

Aakriti Joanna, who runs an online consultancy platform ‘Kaha Mind’, said that the situation from home with a lock will mean the creation of new rules and routines. “Much of the information about the pandemic that we have received from social media and news agencies has been negative, and it can also cause mental health to deteriorate,” she said. Aakriti said that more people are now turning to them through their online platform to find ways and methods to deal with them during this time.

The trauma therapist Ruchita said that this long period of self-isolation affects people who already have mental health problems. “Mild and treated symptoms become moderate and severe,” she said. Your therapy sessions are now more devoted to safety planning and symptom management. Those who previously booked one session each week now book two.

Ruchita said that many who are locked in homes use the coping skills available. Some of them are not the healthiest. She listed them: “They resorted to older eating habits, where they sought consolation in sugary and salty foods because access to other coping strategies included out-of-home activities and more sleep than usual. They were overwhelmed and concerned by the news updates their loved ones, especially those who live far away. ”

While Ruchita’s therapy is exclusively online, ‘Kaha Mind’, which offered therapy sessions both online and offline, has postponed all sessions to videos and calls, considering the safety of therapy seekers.

However, Sonali pointed out that for many who live with families, videos or calls are not easy. “You feel like you don’t have privacy,” she said.

Lakshmi Sharath from Bengaluru is suffering from anxiety and has been in therapy for a year. The travel blogger, who recently discovered that she has endometriosis, was just learning to overcome the pain and continue with life. “The past few months have been difficult. The current crisis has made it worse,” she said. She moved to Chennai three weeks ago to take care of her mother. She did a session with her therapist in Bengaluru on Skype. A few days ago she had a mild attack. Lakshmi is still locked up in her mother’s house and is trying to find a place in her therapist’s busy schedule.

With schools and colleges closed, some of Ruchita’s younger patients, who have not informed their family that they are seeking clinical services, are often interrupted by their parents during their session. “A parent will come into his room and ask who he is talking to and he will have to lie and say that it is a friend. Then the parent will ask for the friend’s name and the patient will have to find an excuse or ask further questions Parents, so as not to disturb them for a while, “she said. She said that while causing some interference during the session, it is completely “understandable and inevitable”.

“Accept that this is unusual and we are all together. You are not alone,” said Aakriti, listing coping mechanisms for people who are concerned with fear. “Get it. If you want to talk to a therapist online, do it. If you want to schedule regular calls with friends, do it. Don’t isolate yourself emotionally, despite the substantial social distance,” she said. “Try journaling, cook, paint.” But above all, she said: “Take care of yourself”. “Eat well, hydrate and practice breathing exercises. Check in with each other. This friend who lives alone, an elderly couple, your family,” she added.

In one Twitter threadRuchita has listed warning signs of anxiety and how to deal with it.

Sonali stressed adherence to a schedule for those who work from home. “Have fixed meal times, take a bath in the first half, choose to work office hours,” she said.

The cost of mental health

A 26-year-old journalist in Delhi said the past few months had become so difficult for his mental health that he had to say goodbye to work. “First it was the riots in Delhi. And now that,” he said. His organization asked him to stop last week.

Aakriti said that people who are at the forefront of understanding, managing, and reporting on the global health crisis that has caused 15,000 deaths worldwide are more prone to mental health problems. She also pointed out that entrepreneurs – small and large – are also likely to be affected. “Many industries are facing a total drop in demand. Entrepreneurs and employees are concerned about how this will affect their markets and jobs,” she said. The therapist added that it could look bleak, “but we have to be there for each other.” “It is important to be more empathetic now than ever,” she said.

But India has not shown much enthusiasm for paying mental health costs. Not before and maybe not when a major health crisis is already looming.

In the 2019 financial year, the budget allocated to the National Mental Health Program (NMHP) was reduced from 50 billion rupees in the previous year to 40 billion rupees. This is 0.06 percent of the country’s health budget of 62,398 rupees. The funds actually spent were much lower – only around 5 billion rupees each over the years. The previous budget did not increase the allocation of psychiatric care.

While MHCA (Mental Healthcare Act) guarantees everyone affected access to mental health care, and treatment by government-operated or funded services has been advertised as an important step in destigmatizing mental illness, the resources are not available. According to a study by the Indian Journal of Psychiatry, the government’s conservative estimated annual costs for implementing the Mental Healthcare Act 2017 would be 94,073 rupees. However, actual current expenditure is not even a fraction of the number.

A medical journal in January estimated that India had 2.3 intensive care beds per 100,000 people. In the midst of a growing health crisis, the numbers paint a bleak future. With the public health system messed up, many view government measures with suspicion, which in turn leads to complications for health authorities. The biggest problem is the escape from quarantine facilities. In all of this, mental health takes a side note, but sits quietly and sometimes not so quietly.

“It’s a feeling of helplessness. The situation is so out of control,” said Shraddha. The disinfectants and disinfectants can keep the infection at bay, but it doesn’t change the feeling of insecurity.