Mental Health and COVID-19

The year 2020 has seemed merciless in the challenges it has thrown at Indians. It has taken a significant toll on the nation's psyche and its well-being. Although there is reassuring news about vaccines, specialists hold it will be quite a while before COVID-19 is restrained— a HE report.

When the first case of coronavirus was identified in India, most people would not have predicted that by November, India would have 9.14 millions of cases.

The daily death tolls soon froze the country in despair. Today many are desensitised, tired and engrossed with economic survival. The struggle is there nonetheless playing out more inaudibly in hospitals and residences.

How coronavirus complicates the grieving process

Take the case of Amrit Bakhshy. Lockdown was exhausting for him as his wife was in a coma in palliative care. Due to lockdown and fear of the pandemic, he was not allowed even to meet her.

"She passed away when the lockdown was being enforced very strictly. I started grieving unabated only after I immersed her ashes in the river Indrayani. I will live with this grief and guilt till the last day of my life," says Bakhshy.

Bakhshy has been a caregiver since 1991. "It was a big challenge to keep my daughter, living with schizophrenia, engaged as inactivity and seeing only her father 24 hours a day could have aggravated her symptoms. There was no domestic help available due to lockdown, and I had to do all the chores cooking meals, washing dishes, sweeping and swabbing. It was very tiring for me at the age of 79," says Bakshy.

Bakshi would persuade his daughter to help him. "She would do it sometime when voices were not haunting her, which was some relief for me and some engagement for her. All the calls that I would receive during the day from friends and relatives, I would persuade her to talk to the callers so that she has some limited socialisation. In the evening, I would take her for a walk in our campus, and I would make her feed the starving stray dogs. I would also give her some crumbs to put it in the window sill for birds. This would attract a different type of birds, and we would try to identify them and take their pictures," he adds.

Time to talk about Mental Health

According to the World Health Organization, being mentally healthy is about our ability to realise our potential, cope with the everyday stresses of life, work productively and fruitfully and make a contribution to their community. If we are in an emotional state that hampers any of these abilities and creates temporary or permanent disability, it can be said that we are in emotional distress.

Dr Michelle Frank, Director, Women's Health, Sheroes, asserts that anxiety is a common phenomenon across our globe today because we are all faced with a common threat, the coronavirus. "The virus is continually being shown in a negative light, with the depiction of death tolls and rapid spread, a potentially ominous outlook. So, when faced with such environmental factors, our minds relate to the threat as persistent and look towards tackling it for ourselves and relatives. With the uncertainty that the situation has presented, in terms of jobs, quality of life, vaccination, our mental health is currently within its defensive phase, which on its own is a state of anxiety. The constant sanitising, bathing, changing clothes, and even checking social media, spring out of the anxiety response our body has conditioned itself into during this time," she adds.

Anxiety can be brought upon as situation-based or through environmental triggers.

Franks maintains that there has always been an increased need for mental health services in India. "The mental health struggles differ among various parts of our diverse socio-economic population. As recorded in the India Journal of Psychiatry, there are only about 9000 psychiatrists in India, with so few graduating into the profession each year. And mental health services are currently considered a luxury for the well-to-do. Shortage of psychiatrists means adequate mental health awareness and services are not trickling down to the rest of the population, especially in areas where rates of suicides, drug abuse, are at an all-time high. Research, data, and cost-effective solutions are the way moving forward, to ensure a nation tackling mental health concerns more effectively," she explains.

Tips for handling Mental Health

The Alternative Story is a social enterprise that provides accessible, affordable, and politically informed emotional and psychological well-being services, for individuals and organisations.

So, are there any powerful distractors that one can use to crowd out anxiety? "One of the best grounding exercises is called Sensory grounding," explains Paras Sharma, Director - Programmes and Services, The Alternative Story. "This involves tuning out your thoughts and focusing outwards to hear the different sounds, see the different sights, touch different textures, smell different fragrances, and repetitively experience distinct tastes until one feels more safe, grounded, and stable. I find that people find this more useful than even meditation at times," he adds.

How can one stay socially connected during the time of social distancing in India? Isn't social media a shallow form of social interaction? "I've found that constantly trying to treat social media as a replacement for real-life contact will always lead to disappointment. It's okay to acknowledge that a zoom call or a voice note isn't a replacement for a hug from a loved one. At the same time, it's not inaccurate to say that a free of cost real-time video call, interactive online games, online classes where hundreds, if not thousands of individuals can learn and interact are nothing short of impressive objectively. If we were to look at online communication as the best that we can get right now, rather than 'just like meeting in person' I think it will temper the expectations from it," he adds.

So, what are some of the strategies that one can use to manage isolation? How can we establish some structure?

"Structure is an antidote to the anxiety that emanates from uncertainty. It's still vital for us to have a starting time to our day, regular times for meals where we take a break, a stop time for work, some self-care/decompressing activities, and getting enough sleep, even if one isn't going to office/going out regularly. I've found that group chats with friends, supportive online communities, group therapy/support groups are all great ways to challenge the isolation right now," he says.

Mental Health and Physical Health

Anna Chandy, Chairperson, The Live Love Laugh Foundation says that typically, Indians tend to think of mental and physical health as two completely separate entities. But, despite being different, they are strongly connected. "Poor mental health can push people to neglect their physical health, hygiene and other routines which can aggravate various conditions making them vulnerable to infections and infectious diseases. Therefore, even when the treatment procedures are different for mental and physical ailments, the relationship between the two has to be carefully understood and evaluated during any therapy or delivery of other healthcare services," she explains.

Sleep Disorders

Sleep disorder is another outcome of COVID. Do Indians generally ignore this problem?

Chandy says that sleep disorder is very much prevalent in India, but something that has again remained mostly unrecognised. "While changing lifestyles, eating habits, and work-related stress have been the usual causes, COVID-19, and the stress it has brought along has also led to a lot of people experiencing sleep-related disorders and insomnia. As per a study, close to 20% of respondents reported suffering from insomnia, and it is estimated that about 30% of Indians suffer from occasional insomnia," she says.

Looking after Mental Health

It is too early to know how long the crisis will last or what the ultimate toll will be. And clearly, the ripple effects of a pandemic is distinct from that of floods or other natural disasters. Chandy says that the COVID-19 pandemic had made a significant impact in India, and people are experiencing various socio-economic stresses apart from the fear of getting infected. "This is causing a surge in insomnia, anxiety and depression. The sudden changes in lifestyle such as working from home, children not going to schools and other uncertainties are impacting all age groups. These factors are driving up a mental health pandemic alongside the contagion that we are already dealing with. The need of the hour is to ensure that we or anyone in our families doesn't ignore mental health issues and seeks help whenever needed," she concludes.

Manoj Chandran, Founding CEO of White Swan Foundation for Mental Health, seconds her views "We should not try to find reasons and ways to cope with the problem by ourselves. If the services are not affordable, it is best to seek the help of a professional in a government hospital for an initial consultation. There may be some situation that could be managed with a little self-care and discipline. However, if the problem persists, we must seek the help of a professional practitioner."

Resources

Chandran also adds that in some states, there are government mental health hospitals, such as NIMHANS in Bangalore, that are offering good quality mental healthcare services. Here's a list of such organisations: https://www.whiteswanfoundation.org/resources

"There are private hospitals in larger towns that offer psychiatric, clinical psychology and counselling services. An internet search will also throw up names of psychologists, counsellors and therapists who are practising independently," he concludes.