'A Mental Health Crisis Is Brewing'
Mumbai: Most of us in India have been in some form of a lockdown for more than 50 days. Even if there will be lifting, it will be phased. How are we as a populace or as individuals ready for this new world? What is happening to us right now, as we sit at home, engage with our families? Are there concerns or issues we should have been grappling with or are grappling that perhaps will have an impact downstream as we emerge back into the real world?
The issue of mental health is important at all times but usually does not get the attention it deserves, and this is perhaps one of those occasions that has made it important for us to focus on, to acknowledge, to discuss, and to find solutions.
We speak with Shekhar Saxena, professor of Practice of Global Mental Health at Harvard T H Chan School of Public Health, previously director for Mental Health and Substance Abuse at the World Health Organization (WHO); Amit Malik, who has had specialist training in psychiatry in the United Kingdom, spent 13 years in the National Health Services, been part of the Royal College of Psychiatry and the European Board of Psychiatry, and also holds an MBA from the London Business School; and finally Neha Kripal, who founded India's first international art fair, sold it to MCH Basel but more importantly has been actively and passionately involved with the world of public health and is co-founder of Innerhour, a digital mental health platform.
As we go back into the real world, things would have changed and are changing right now. What are they? What are the mental health challenges we should be aware of, acknowledge, and then look for solutions?
SS: One in four of us is impacted by mental health in one way or the other throughout our life. And during these times, prevalence of mental health problems and disorders increases markedly. We know from international studies and also figures from India that the likelihood that many of us will have mental health problems and some of us will have disorders is very high. And we need to give special attention to our mental health during times like these for ourselves, our family, and our colleagues. As the lockdown lifts, we need to be especially aware that we should not have a release phenomenon. That means we have been waiting for a long time now to do certain things, and suddenly if the lockdown lifts, we go all out and do it, ignoring all the precautions that we still need to take. So, the first thing is safety. Are we following the reasonable precautions for public health that have been advised but maybe not ordered? So even if the lockdown is lifted, are we taking good care of ourselves based on good advice?
The second is: are we able to look after our mental health in the best possible manner? With the impact of all these restrictions, what measures have we taken, what measures are further needed, and are we seeking the help that many of us need because we always deny that we could have mental health problems. We should stop doing that and seek the kind of help that we all need. These times, all of us need that kind of thing.
Loneliness and isolation are intrinsic to this period, but it can transition to depression and need help? How do we know that, about ourselves, about people in our family, and what should be the next steps?
AM: The easiest thing our team and therapists always ask people to look out for, is any change in functioning. What is your baseline level of functioning--whether it is your interaction with your family, whether it is your ability to do work or housework or professional work? Has that shifted consistently for a few days or weeks? Now if that functioning has shifted, then you need to start looking at other things. Are you more irritable, how is your interaction with family members, how are your sleep and appetite patterns? If these things are affected, then you really need to start thinking, do I need more help than I can really provide for myself right now? I would probably focus on your level of functioning compared to your baseline as the first indicator.
What has changed since the lockdown?
NK: There was a large unmet need already before COVID and very few platforms and services. India has very few specialists, therefore digital therapies and remote access is very important to try and add more efficiency and reach more people. But it is also about reaching them earlier in their life course. So, post COVID, now we are seeing higher financial anxiety, health anxiety, caregiver anxiety, people relapsing with existing conditions, people tipping over, there is a lot of grief, relationship conflicts, domestic abuse. I mean, this is just the beginning of what is going to be yet another big surge in this pandemic. So, India really needs to step up and try and address mental health head on, not just for the immediate, but also for the mid-term and long-term.
There are three constituencies that we could perhaps address--governments, organisations and employers, employees or individuals, employed or not employed. What do these three constituencies need to do to be better prepared for the people they will finally bring back into their workforces or workplaces?
SS: I think all of us need to be active and pay more attention to mental health and be very prepared for the surge of mental health issues that are already there and are going to become even more impactful. From the government side, the investment in mental health has been extremely poor. As a staff of WHO, I collected information from all countries about the preparedness of mental health that they have as a part of the healthcare system and India fares very poorly indeed, in terms of financial investment as well as the trained personnel that are there as a part of the government mechanism to provide mental healthcare. We have a mental health policy, we have a mental health law, which are actually very progressive and nice. But it is the implementation of that which is the problem. So, the government--whether it is the state government or the central government, or even the district and municipality levels--we need to really invest in mental health by putting our money and also by training more people to provide the kind of health that is needed.
Organisations and businesses, and employers, need to be much more perceptive about the mental health strain that their employees are facing, much more than earlier times and create a supportive environment. Supportive with practical help like the payment of wages, maybe some advances, but also adaptation to the work because people are facing a lot of problems and employers could be much more perceptive--there are some very good examples--but many more could be more perceptive about how the employees can perform better and but also look at their mental health needs in a better way. And as civil society, we need to provide help to others who need it at this point of time because there are many vulnerable groups including the very poor people and migrants who need help and cannot help themselves because they do not have the resources. Civil society has the responsibility to provide that kind of thing immediately and continue with that because this is not a matter of weeks, it is a matter of months and years. So, we need to gear ourselves to provide that kind of sustainable help.
it is going to be weeks and months or even years before vaccines are found and longer-term solutions emerge. But in the meanwhile, our lives would have changed. Work from home, for instance, is going to be blended as a part of our lives. The way organisations assess may have to change, maybe the way in which we interact with organisations and our expectations from it will have to change. And all of this has to do with our sanity in a manner of speaking. How are you advocating the way forward?
AM: The first thing I would say is: I hope 'not' years before the vaccine comes out. A part of the psychiatrist's job is to provide optimism and hope and I am both optimistic and hopeful that it will be much sooner than that.
But coming to your question, first, is this the new normal now right? So, accepting change and living with the change and developing a new routine is important. Routine gives us structure and control and really helps in adjustments.
It is important that people find things to look forward to post lockdown ending and use their excitement to be motivated. But at the same time, as Shekhar said, still maintain the hygiene practices and safety standards once the lockdown is lifted--the release is very dangerous, as a society and community. People doing lots of things suddenly and not following guidelines is a very, very dangerous thing.
The other thing is developing a flexible mindset. Things are going to be uncertain over the next few months, maybe 12-18 months as well. Develop a flexible mindset and don't expect things to be normal because that will lead to disappointment continuously and that will affect your mental health. Next, communicate--with people at work, people at home; as you develop new routines, managing expectations externally and internally is critical. Finally, maintain a level of energy, which can be done only if you take regular breaks and you have spurts of energy.
So just a few things--develop a new normal routine, develop a flexible mindset, communicate, still maintain hygiene practices and safety standards, and maintain your energy levels. All of these are very important in what is going to be your new normal in the next 12-18 months.
What would be your one piece of recommendation for everyone getting back to work?
SS: During these times, where we are talking about a new normal for the environment, we need to think about how we can rediscover ourselves, our values, our ways of working, the ways in which we derive pleasure, the way in which we adapt to change. We need to rediscover ourselves as the environment is changing so massively. Can we adjust better to the circumstances that are around us but also to our own needs, desires and values?
AM: Developing a new routine for a new normal and not falling into it by accident. Recognising new normals whether at home, at the office or both--and developing a routine around that can really help in adjusting to the new normal. Communicate more. Expectations may change, your ability to deliver might change, so it is important to communicate that to each other.
NK: These times have made us realise the importance of social connectedness and that applies at work, in relationships and everywhere. We recognise that our biggest joys come from that, also our biggest problems sometimes. We must be conscious of mental health all the time, in every aspect of our life and in every kind of relationship and physical space we inhabit in the course of our lives.
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