India witnessed the biggest containment experiment in history when its 1.3 billion citizens battened down the hatches in an attempt to flatten the Covid curve. The lockdown may be ending in a few weeks but a new epidemic is emerging. According to a survey conducted by the Indian Psychiatry Society, within a week of the lockdown, mental illness increased by up to 20 percent. As we slowly emerge from lockdown, we are completely unprepared for the Mental Health Crisis that follows.
In the weeks and months ahead, due to increased job losses, alcohol abuse, economic hardships, domestic violence, and indebtedness the country will stare at a massive mental health crisis. While this will affect most of its population it will disproportionately affect the poor, most vulnerable and marginalized.
“At-risk populations include the 150 million with pre-existing mental health issues, Covid-19 survivors, frontline medical workers, young people, differently abled people, women, workers in the un-organised sector, and the elderly,” says Nelson Vinod Moses, a leading suicide prevention advocate in India.
When we launched a volunteer mental health support helpline – Let’s Talk in early April, we knew we had to get as many resources as possible to support existing efforts led by state governments and other civil society organisations. We have hence built a team of mental health professionals and augmented the relief efforts of organisations like GAME, FORDA, AIMSA, Dhriti and Ministry of Health, Govt of Maharashtra.
Even with a team of 300+ volunteers at Let’s Talk, we are acutely aware that it is impossible for us to provide long-term support to the community. Neither can the formal mental health system, with a limited number of specialists – 9000 psychiatrists for 1.3 billion. Shekar Saxena, Former Director of the WHO’s Mental Health Division, says ”Mental health systems have always been very scanty in India and during this time, the gap between what is needed and what is available has widened markedly”.
The real need is to build community-based capacity, to handle local issues long after the acute phase of the epidemic. A small team of peer counselors working under a local administrator, and trained on established models like Dr. Vikram Patel’s Sangath or the Atmiyata model by Centre for Mental Health Law and Policy (CMHLP) might be the way forward. This will require a close partnership between civil society, local administration, and a standardized training and tech backbone, to deliver consistent quality support. The local anchors will build accountability and ownership, and contextualize it for their own surroundings. Unless the community is empowered to take care of itself, we are staring at an ever-growing shadow of mental distress which will last much longer than the pandemic. Dr Soumitra Pathare, Director, CMHLP is championing this, but is also realistic about what to expect. “When everybody is looking for shortcuts, this is a very long route to build capacity. In the world of apps to quickly revolutionize mental health, the community part doesn’t get the attention is needed” says Dr Pathare.
Based on our experience fielding calls from people in distress, we believe India’s already overburdened mental health infrastructure will be unable to handle the situation, and will need to leverage communities, with evidence-based solutions that are locally devised. What is needed is a technology infrastructure to enable any municipal/district administration to launch a helpline within 72 hours, and a playbook for training volunteers and ensuring a consistent quality of mental health support. And this has to be led by a coalition of organisations, united by the mission of supporting community mental health champions – to build resilience, both for the current and the future pandemics.
While we try to manage the urgent task at hand – containing the viral pandemic, let us not forget to focus on the long-term well-being of the community.