Dr Abhishek Chowhan
Our mental health system is facing something of a perfect storm. The stress of the COVID-19 contagion, the civil strife and social disruption, and economic insecurity is causing an increased demand on mental health services. COVID-19 has disrupted our lives and our livelihoods, and the wide-ranging personal, social and economic impacts of this pandemic will continue to be felt for many months and years. A mental illness crisis is looming as millions of people worldwide are surrounded by death and disease and forced into isolation, poverty and anxiety by the pandemic of COVID-19. The isolation, the fear, the uncertainty, the economic turmoil – they all cause or could cause psychological distress. Yet, government agencies and health care institutions are incurring budget deficits, and without government funding to cover these losses, existing treatment programs are in jeopardy. The simultaneous increased demand and decrease in available services could generate a second phase of the COVID-19 crisis-the mental health pandemic.
People are already reporting psychological distress during the pandemic. And we’re just starting to collect data. One preliminary study shows about 30% of population have moderate to high levels of anxiety and depression. Domestic violence is rising, and health workers are reporting an increased need for psychological support. Imposition of unfamiliar public health measures that infringe on personal freedoms, large and growing financial losses, and conflicting messages from authorities are among the major stressors that undoubtedly are contributing to widespread emotional distress and increased risk for psychiatric illness associated with COVID-19.
Decades of neglect and underinvestment in addressing people’s mental health needs have been exposed by the COVID-19 pandemic. Even when the pandemic is brought under control, grief, anxiety and depression will continue to affect people and communities. The “two-pronged” approach is to deal with the virus – preventing transmission and ramping up our health-care system to cope – also provides an excellent blueprint for managing the pandemic’s mental health impacts.
We need to focus on preventing new cases of mental disorders and we need to increase the capacity of our mental health-care system to manage any increase in people needing help.
The government also needs to address some of the underlying issues that are key social determinants of mental health – to ensure equitable access to education, employment, and income and housing security – in the longer term (and beyond the current crisis) The mental well-being of children, young people, their parents and carers should be a priority. Some parents are struggling with the loss of work. Others are working from home and home-schooling their children. All are less able to access their usual social supports. Preventing work-related mental-health conditions is also important. This needs employers and employees to collaborate to reduce the chance of these conditions developing as they confront new stressors, including changes in work practices caused by COVID-19. Many people will need more than medications and therapy, and could benefit from supported employment, supported education, wellness and various other vocational and support services.
India is well placed in this scenario as a nation having both National Mental Health Policy as well as a Mental Health (care) Act both of which highly patient centric. However, what is needed is implementation of the policies and legislations in letter and spirit. During implementation of these policies special focus should be on educating the society regarding mental health problems, addressing the myths associated with mental health and strategies targeting the reduction of stigma associated with mental illness. This is significant as it will help to reduce the treatment gap associated with mental illnesses. Treatment gap is the term given to the mismatch of total number of patients with an illness in community and number of patients which seek treatment for the said illness. In psychiatric illnesses treatment gap is particularly large, i.e., very few people seek treatment for psychiatric problems. This is particularly due to ignorance about mental illnesses and the associated stigma.
Recently UN has called for a strategic shift in health policies to tackle the imminent mental health crisis. This is encouraging for mental health. It has recommended using the current momentum of interest in mental health to catalyse mental health reforms, for example by developing and funding the implementation of national services and re-organization strategies that shift care away from institutions to community services. To making sure that mental health is part of universal health coverage, for example by including care for mental, neurological and substance use disorders in health care benefit packages and insurance schemes. Additionally it is important to build human resource capacity to deliver mental health and social care, for example among community workers so that they can provide support. Organizing community-based services that protect and promote people’s human rights, for example by involving people with lived experience in the design, implementation and monitoring of services will also help. UN has urged to make research to be part of recovery efforts. It is important to understand the extent of the mental health consequences – including the neurological and substance use impact- of COVID-19 and the social and economic effects of the pandemic, directly consulting with the affected populations. Such research will likely strengthen advocacy efforts for mental health. Rapid knowledge acquisition will require establishment of research priorities, research coordination, open-data sharing and funding.
These are difficult and challenging times for all of us. The mental health week is perfect occasion for us to start taking care of our psychological health more vigorously. Getting to know more about psychiatric illnesses, knowing when to seek help, knowing where to get help and following practices which promote mental health can help to cope with stresses post pandemic. Recognising early signs of mental illnesses in self or others like sleep disturbances, mood changes, increased indulgence in alcohol and other substances are all indicators of present or oncoming psychiatric illnesses. Persons with pre-existing mental health problems may face a particularly challenging times as they fear relapse or worsening of their illness. Help and support is vital for persons with mental illness from their families and other care givers. Health helplines can provide support, in addition to regular taking of prescribed medication, a regular daily routine, keeping engaged and positive. And most importantly it is very important not to shun or judge persons with current or past COVID infection. They may get better physically but such treatment from society may scar them emotionally.
Remember, good mental status in the difficult times may win you the battle more easily!
(The author is Consultant Psychiatrist Government Medical College, Jammu)
Dr Abhishek Chowhan