By Dr Anita Mishra, Ritika Gupta*
Experts believe that there will be a surge in cases of mental illness in the aftermath of the COVID-19 pandemic due to lasting impact of physical distancing, quarantine and socio-economic factors. According to World Health Organization (WHO),every 40 seconds a person dies by suicide, and it is the second leading cause of deaths in the cohort of 15-29 year-olds. A paper by Indian Council for Medical Research (ICMR) showed thatin 2017, 197 million Indians were suffering from mental disorders of whom 46 million had depressive disorders and 45 million had anxiety disorders. The spread of the novel coronavirus has aggravated the situation. The disease was further declared as air borne, forcing people to limit their movement and physical contact, challenging the survival of humanity. Information through various mediums on the coronavirus is constantly developing fear, stress and anxiety making people often think, say or do what may not be considered ‘appropriate’ under ‘normal circumstances’. People with no history of mental illness have developed serious psychological problems for the first time, including borderline personality disorder, psychosis, mood disorders, depression and psychotic episodes, as a result of the lockdown. Anxiety, irritability, anger, insomnia, stress and emotional exhaustion stand out as being very common during the pandemic as evidenced by the increased number of suicides across the world. India is no exception to this crisis.
COVID-19 has sown the seed for a major health crisis
Beginning from the prolonged and unprecedented lockdown and subsequent phases of delayed unlocks have turned to be a massive psychological experiment on the people. Restricted movements and limited availability of public services to ensure the social distancing or physical distancing have made people isolated leading to increasing loneliness, stress and anxiety, stranding many people in rental apartments or boarding houses away from home. According to a survey conducted by the Indian Psychiatric Society, within a week of the lockdown, the number of reported cases of mental illness in India had risen by 20%. A report by WHO reveals that 7.5% of the Indian population suffers from some form of mental disorder. India accounted for nearly 15% of the global mental and the treatment gap is over 70%. WHO also predicts that by 2020, around 20% of India’s population will suffer from mental illnesses. India’s National Institute of Mental Health & Neurosciences (NIMHANS) reveals that nearly 150 million Indians needed active intervention, whereas fewer than 30 million were getting it.
Different people have been affected differently. Many are stuck at home with disoriented families or abusive relationships. This can be juxtaposed with several others who have been able to reconnect with their families and loved ones better during the lockdown, yet the consequences of the pandemic like loss of jobs and fear of death, etc. have led to the development of anxiety. In a recent study published in the medical journal The Lancet warned that mental health concerns ranges from anxiety and anger to sleep disturbances, depression, and post-traumatic stress disorder (PTSD).
Healthcare professionals on the frontline of this pandemic, with shortage of supplies and rapidly increasing cases have experienced stress and/or burnout. Delayed payments and reduced incomes are adding to the stress. People dealing with addictions like smoking, drinking, etc., can experience desperation and conditions of people in rehabilitation centers are likely to deteriorate. In addition, people are exposed to widespread fear fueled by the rapid spread of the virus, compounded by constant media communication about death and disease, which creates uncertainty and apprehension about their loved ones.
The prevailing characteristics of this period have been increased cases of domestic violence against women, uncertainty in education of children and livelihood of the people in the lurch . Between the beginning of March and April 5, 2020, the National Commission for Women received 310 grievances of domestic violence and 885 complaints for other forms of violence against women, many of which are domestic in nature—such as bigamy, polygamy, dowry deaths, and harassment for dowry. Because of the ancient orthodox norms of women being the central caretaker, the unpaid care work has increased among women due to reverse migration of the male folks and new normal like work from home.
With schools closed for the past few months the lives of about 253 million students in India are in limbo, leading to lack of personal space and separation from their friends. Incidences of digital divide has resulted in feelings of deprivation and abetment of suicides among them. The adult population is uncertain about their financial future with fear of retrenchment and job security. According to CMIE, there has been a sharp rise in unemployment to 27.11% with daily wage workers (urban poor and migrant laborers) being the worst hit. According to a survey conducted by Impact and Policy Research Institute (IMRI), 56% of the urban poor were found to be anxious and worried about their uncertain financial future. This is not only limited to individuals, even the families are committing suicide as evident by the case in Barabanki. Disabled and old people are in fear of being vulnerable to the virus, gaps in their healthcare, their dependency and wellness of their closed ones.
The newly COVID-19 infected human breed of coronavirus pandemic are more prone to severe mental health disorders. The experiences of many COVID recovered patients indicated the declining care by health professionals due to overburden of COVID patients in health care facilities and hospitals. Moreover, the isolation in hospital wards with no cell phones have reduced the communication further with families and relatives aggravating the fear and anxiety. The period of fourteen days is sufficient enough to turn normal human into mentally unwell person. Thus, fear exists across all sections of society.
The major factors contributing towards the mental stress consists of the following:
1. Complex socioeconomic factors:
According to a study in Massachusetts during 1994-2000, vulnerable socioeconomic conditions unemployment, poverty and housing unaffordability were correlated with a risk of mental illness. Unlike many other countries, India presents a unique case of lower life expectancy, higher fertility rate, and high infant mortality, vast illiteracy, poverty, poor sanitary conditions, open defecation, and manual scavenging. These health and social indicators underscore the gravity of the situation that can exacerbate conditions in the face of a massive community outbreak in a nation with a huge vulnerable population.
2. COVID Infodemic:
While there is health misinformation circulating rapidly across various social media platforms globally, India has its own culturally rooted and domestically driven misinformation and misconceptions. Misguidance by suggesting cow urine as protection against the virus, religiously-oriented obligations that discourage social distancing and mass refusal to adhere to rules which restrict/prohibit cultural gatherings have added fuel to the fire. Unfortunately, some of this misinformation is being spread by public figures and government agencies, which increases the traction of such misinformation.
Home remedies and dubious advisories that are rapidly spreading through WhatsApp and other social media platforms are leading to false sense of complacency and weaken the resolve for preventive behaviour. The Indian government’s Ministry of AYUSH, released an advisory on January 29 carried serious medical misinformation at a time when COVID-19 cases were rapidly spreading in different parts of the world. The advisory made claims regarding the ability of traditional Indian medicinal practices like Homeopathy, Ayurveda, and Unani in fighting the spread of the virus. However, no serious scientific evidence exists to corroborate such claims.
The director-general of the World Health Organization (WHO) has termed the phenomena as “coronavirus infodemic”. The deluge of misinformation has spread faster than the virus itself. This affects the efforts to contain the epidemic. More worrying is the fact that it appears to be “driving division” instead of promoting “solidarity and collaboration”. While the WHO, fact-checkers and journalists are working hard to counter this tide, their efforts at containing the “infodemic” face insurmountable odds. Social media misinformation may be eroding democratic processes and endangering efforts to protect people.
A disturbing trend in social media is xenophobic forwards around coronavirus that promotes surveillance, hyper-nationalism, obedience, and punitive action. Such sentiments associated with epidemics have had a long history. While social media is a democratic space, spreading manipulative messaging reduces it to a world filled with disagreements and enmity, where the wrongs done by “others” are reiterated and biases are spread.
3. Increased use of social media and internet:
Increasingly new crimes, trends and terms are being identified due to extreme use of social media. The lives of people are being run by social media which encourages jealousy, hatred and is breeding a judgmental group of people. According to the study conducted by Population Foundation of India, among youth of 3 states during lockdown, 68% respondents in Uttar Pradesh reported an increase in social media use during the lockdown. Of those respondents who reported feeling depressed, social media use was higher at 92%. These figures show that people in India are dealing with dual pandemics. The following trends and terms is making people feel inadequate and insecure in their lives.
- Fear of missing out (FOMO) compels a person to pick up the phone every few minutes to check for updates, or compulsively respond to every alert—even if that means taking risks while driving, missing out on sleep at night, or prioritizing social media interaction over real-world relationships.
- Isolation is viewed as excessive use of social media can often leave individuals with feeling of loneliness. A study at the University of Pennsylvania found that reducing usage of social media like Facebook, Snapchat, and Instagram etc. can make people feel less lonely and improve overall wellbeing. Human beings need face-to-face contact to be mentally healthy. A 2015 study published online in the Journal of the American Geriatrics Society revealed that in-person social contact reduced the risk of developing depression, but contact via phone, writing, or email did not.
- Cyberbullying is harassment through digital devices and can occur over social media, in chat rooms and on gaming platforms. It often leads to mental, psychological and emotional breakdown of victims of cyberbullying. According to a study by Child Rights and You (CRY), around 9.2% of 630 adolescents surveyed in the Delhi-NCR, 22.4% of respondents, aged 13-18 years, who use the internet for longer than three hours a day are vulnerable to online bullying, while up to 28% of respondents, who use the internet for more than four hours a day, face cyberbullying, as per the study titled Online Study and Internet Addiction.
- Self-absorption is sharing of selfies and innermost thoughts on social media. Such activities can create unhealthy self-centeredness and distance from real-life connections.
4. Estranged communal relations:
The coexistence of various cultural and religious beliefs adds a reason for more communal conflicts and estranged relationships among communities. Estranged communal relations and hatred towards some sections of the society lead to harassment, stereotyping, discrimination, social isolation, and in some instances, physical violence have increased the emotional disturbance, anxiety and depression among the people. The current times should be the period of solidarity instead of disharmony.
5. Ancient stigma related to mental health:
The stigma relating to mental health can be classified into two: public stigma and self-stigma.
Public stigma involves the prejudices and beliefs endorsed by general public. Prevalence of beliefs in society in general influences personal beliefs to certain extent.
Public stigma such as fear and exclusion; authoritarianism and benevolence leads to exclusion of the mentally ill people from the mainstream of the society. Research studies have shown that people are less likely to pity persons with mental illness, instead reacting to psychiatric disability with anger and believing that help is not deserved. The public stigma translated into self-stigma where an individual’s self-confidence is downgraded due to constant exclusion and fear and they start harming themselves resulting in suicides and sometimes murders of others in extreme cases. These stigmatize issues results in reluctance to seek help or treatment, lack of understanding by family, friends, co-workers or others, fewer opportunities for work, school or social activities or trouble finding housing, bullying, physical violence or harassment. The stereotype attached with the treatment of mental illness where it is believed that everyone with mental disorder have to be admitted in mental asylum is restricting people to engage in proper treatment.
6. Demand-supply gap in mental health consultations:
The availability of mental health treatment is expensive and meagre due to a gap in demand and supply. In India, there is also a wide gap between availability of qualified professionals for those seeking immediate access to such services. Even health insurance does not adequately cover mental illness treatment despite the existence of Mental Healthcare Act 2017, offering insurance for mental health ailments has been made mandatory by law. The available treatments costs ranges in thousands which effectively excludes the lower income class group. Moreover, there exists inadequate knowledge or awareness about the subject, coupled with inadequate availability of effective mental health care/treatment, which makes the situation dire.
Feasible solutions to mind mental health
India is having a proud legacy of various saints who preached mental health. Buddhism is part of the culture of India that emphasizes on practicing different techniques which boost mental health. The literature of Buddha, Mahavir etc. point towards practices which lead to a life with a healthy mind. Addressing mental health in times of the pandemic, WHO asserted that “this is not going to be a sprint, but a marathon”. By having a very realistic perspective of the situation based on facts and limiting the trust on social media can help in staying informed along with healthy routines and regular communications with close ones.
Fact check of viral information
The constant stream of social media updates and news reports and fake news make it difficult to differentiate between truth and rumours. Here fact checks such as Press Information Bureau plays an important role to deliver the truth to the people. Rely on fact checker for correct information.
Keep up healthy routines
Less mobility, loneliness and increased time on social media have increased the level of fear and anxiety. The first week of the lockdown saw citizens spend more than four hours a day on social media — an 87% increase compared to the previous week (Hammer Kopf Consumer Survey). Addiction to online social networking and internet surfing are recent and insufficiently investigated phenomena, frequently discussed and sometimes disputed in the psychiatric literature. Multiple studies have found a strong link between heavy social media use and an increased risk of depression, anxiety, loneliness, self-harm, and even schizophrenia.
To overcome this, it is important to inculcate healthy routines like engaging in physical exercises and practicing yoga and meditation.
Stay connected to others
Digital media have bridged the physical distance between friends and relatives. Emails, video calls, phone calls and messages are the ways to communicate with friends and relatives. Communication does not just reduce the fear and anxiety but keeps one well informed of of the well-being of the family and friends away from oneself. Moreover, sharing personal experiences with others can help to overcome unfounded anxieties and fears.
Online and phone supports
Face-to-face mental healthcare services are limited now because of the coronavirus outbreak. But some facilities are providing online and phone services. Telepsychiatry is also on the rise which provides psychiatric care through telecommunications technology, especially videoconferencing. Some online websites that provide assistance regarding mental health issues include National Institute of Mental Health (NIH), Live Laugh Love Foundation, AASRA, Let’s Talk etc.
The Way Forward
The above discussion points to the significance of ensuring dissemination of the right form of awareness and dispelling myths and pseudo-scientific practices. At the same time, global grassroots policy experiences suggest that in a country like India, health-related information alone helps little. It is imperative to bring behavioural changes to reap maximum benefits from public health interventions. To what extent such changes can be brought about in a short period is debatable, yet remains critical as the pandemic outbreak is expected to linger.
Social and behavioural change communication (SBCC) may be employed as a potential strategy to increase awareness of the effectiveness and the necessity of preventive measures. SBCC employs mass media, community-level activities, interpersonal communication, ICTs, and new media to carry out its objectives. Such evidence-based communication programs can help enhance knowledge, shift attitudes, and change public behaviours. Fighting the COVID-19 crisis essentially requires a holistic approach that sufficiently integrates the infrastructural, social, behavioural, and psychological aspects to prepare for any emergency response.
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*Dr Anita Mishra, Administrative Advisor at Impact and Policy Research Institute (IMPRI) and Assistant Professor, Santosh College of Teachers’ Training & Education, Ranchi, Jharkhand; Ms Ritika Gupta, Assistant Director, Impact and Policy Research Institute