Mental health during COVID-19: A silent pandemic

The Black Swan alike year 2020 came with a deadly disease, COVID-19 that severely affected the whole world. It has been declared as a public health emergency by WHO(World Health Organization). Coronavirus has triggered physical health as well as mental health issues worldwide. People facing tough times dealing with anxiety, loneliness, depression, loss of appetite, during lockdown times, and after it as well. The mental health issue is like a silent pandemic which is even deadlier than the COVID-19 pandemic. Social distancing is preventing people from coronavirus infection but at the same time harming mental health because of staying in isolation for so long. It has already been nine months till now but this virus is not coming to an end.

The mental health crisis in India

India implemented one of the world’s most severe lockdowns over 1.3 billion population, locking that huge number of people inside their houses is no easy task to do but it was essential to prevent the spread of coronavirus across the country. It has pushed millions of people into isolation and unemployment. Suddenly everything was closed, people were feeling the trauma of getting infected and fear to step out.
According to WHO, 7.5 percent of the Indian population is under mental health disorders. During the COVID-19 pandemic, reduced social contact, increased household chores, fear of infection, and infecting loved ones, lack of economic stability are increasing individuals' distress and has given rise to situations where the population suffers the risk of anxiety and depression, substance use, loneliness, and domestic violence; and with schools closed, there is a very real possibility of an epidemic of child abuse. This pandemic has triggered a new mental health crisis in India and "may substantially increase the risk of suicide."
According to Oxfam India, healthcare is a luxury in India, with 63 million people being pushed into poverty each year due to health care costs every 2 seconds. If healthcare is a luxury, then mental healthcare is far behind. With 80% of healthcare in India being delivered by the private sector, the affordability of mental healthcare has always been a challenge. Income has been the most commonly identified cause of inequity in healthcare in the country (61.2%) followed by education (45.4%) and gender (36.1%). Even no one wants to talk about mental health. National mental health surveyed around 12 states in India and find around 50 derogatory words used for mental health problems and people having them.

Effects of COVID-19 on the mental health of different gender/age groups

• Doctors and frontline workers
  Doctors came like saviors in this pandemic. They are on the frontline from the very first day of the outbreak. Even in lockdown, doctors, police, and cleaning workers are on their job. Burdened with extended working hours and fear of virus infection while dealing with the patients very closely are the causes of anxiety and depression. They had to put on the PPE kit all the time, it was suffocating and they sweated all over the body. Even after doing everything they had to go on strike because of disrespect by people and unpaid work.
  
• Women’s
  Again and again, in history, women have proven to be the backbone of the communities because women always stand with their family and try to attain everything for their family during difficult times. During this pandemic, many women suffered from anxiety and depression due to increased household work along with full-time jobs and kids. Some of them faced domestic violence which is the basic cause of depression in India and it is not even reposted sometimes because they accept to rationalize the abuse with the love they are getting from the partner.
  
• Daily wage Labor workers
  Thousands of daily wage workers lost their work and found themselves helpless when the government announced a lockdown for 21 days on March 24. With the fear of hunger, men, women with their children decided to go back to their home but there were no trains and buses to take them back. Some of them started their journey with cycling or hitching rides on tuk-tuks, lorries, and milk vans but some didn’t have any option except walking. Hundreds of families walked hundreds of kilometers to reach their homes without food and with the fear of infection. This situation became a mental health issue for them because they had to worry about the livelihood of their family after losing their work.
  
• IT companies employees
  Most of the IT companies all over the world have implied a “work from home” strategy for their employees. Generally IT people go to the office for 8 hours for work and come home but during this pandemic, time is not the barrier. Working hours and load has been increased to save your job. Due to loss in business worldwide, companies are firing their employees. People feeling a lot of distress, anxiety, lack of sleep due to the fear of loss of a job, domestic survivals in the lockdown period, family health, etc

• Children
  Children are the most fragile minds in the universe. We always think twice before saying anything wrong to them. According to general reports, it was found that more than 50 percent of children had experienced agitation and anxiety during the lockdown. Children are facing these issues due to restrictions of going out and playing with their friends, stress because of long hours on-screen during online classes. Some of the children faced child abuse and domestic violence in their homes. 

• People with substance use addiction
  The sudden shut down of all liquor shops in the country and the restricted drug supplies have resulted in withdrawal symptoms in many people with alcohol and substance use dependence. Many alcohol ‘addicts’ distressed by their craving have also consumed poisonous substances such as hand sanitizers as substitutes and died or died by suicide.

• People having a pre-mental health problem
  
  Many people had pre-mental health problems before the pandemic. Lockdown in the country made this problem worse for them to deal with because of the disruption of mental health services. They suffered more panic attacks, anxiety, sleepless nights, lack of appetite, etc. Restriction on travel led them to decrease or stop their medicine dosage as they could not find the prescription nearby.

Challenges and responses towards mental health in India

• India has enough time to understand the COVID-19 and the Indian government did so well to prevent the spread of the virus. On 30 January 2020, India reported the first case of coronavirus and cases were spiking steadily, then the Indian government reacted immediately and adequately to control the spreading of coronavirus implementing a 21-day total lockdown. But during this lockdown, people started reporting issues of anxiety, trauma, depression, suicidal thoughts, etc. Some people having pre-mental problems also suffered during this period.
• The Ministry of Health and Family Welfare, Government of India has taken several steps to deal with mental health challenges posed by COVID-19, which includes the development of various guidelines in collaboration with the National Institute of Mental Health and Neuroscience. This was majorly focused to develop resilience against mental health problems. The Ministry of Health and Family Welfare has also established a helpline for behavioral and psychosocial help.
• Lack of knowledge about mental illness and appropriate mental health services are the major setbacks for the Indian mental health system and people as well. People have so many misconceptions about mental illness. people think that “talking about your mental illness makes you weak and incompetent”. In India, there is no proper terminology for mental health and depression. People started ignoring those people who suffered from any such issues.
• India has very little support for mental health-related problems in comparison to other countries. India has a very low number of psychiatrists (only 0.3 per 100k people).
• Now it's high time for communities to come together building a healthy environment in which everyone can speak about their inner feelings and problems. There should be an open discussion on mental wellbeing, health, and resilience in schools, communities, and within families. Especially parents should ask their children how they are feeling and make them strong about the feelings that it's good to be sad sometimes.
• The Government of India’s Rashtriya Kishor Swasthya Karyakram (National Adolescent Health Programme) can play a pivotal role in social and behavioral change and enhance adolescent resilience against mental health challenges posed by the pandemic.
• There is an emergent need for a systematic psychological health care system with well-educated health care staff. It should be operated on higher priority treating patients with harmful impacts of COVID-19 and social distancing.

What you can do to cope with stress during this pandemic

Be mindful of your body needs and health. Always health comes first. Here are some common ways to take care of your body at home during this hard time:

1. Good sleep: Always try to get good sleep, maintain a routine of sleeping every day at the same time.
2. Eating healthy: Healthy food is the key to good health. Take proper and healthy food full of vegetables, carbohydrates, and protein. Make yourself hydrated all day.
3. Physical activity: engage yourself in some physical activity in daily routine. It could be dance, games, cycling, exercising, anything you like. Physical activities make your muscles in motion and good for digestion as well.
4. Limit screen time: Keep yourself away from screens for some time in a day or at least 30 minutes before bed. Switch off all electronic gadgets for an hour anytime in a day to relax.
5. Avoid alcohol, drugs, and tobacco: Alcohol and any type of drug unless it is prescribed by a doctor could put you at high risk of deadly diseases. So avoid taking such things to make yourself healthy.

Helpline numbers from where you can get help in India

1. The mental health rehabilitation helpline, launched by the Indian central government in the view of growing incidents during the pandemic.

KIRAN:  1800-599-0019

2. Mumbai-based mental health organization mPower and the government of Maharashtra and BMC: 1800-120-820050
3. Live love laugh foundation
4. Health collectives
5. Opencounselling 

References

1. “NGO Working For Child Education, Inequality, Women Empowerment.”www.oxfamindia.org/
2. Golechha, Mahaveer. “COVID-19, India, Lockdown, and Psychosocial Challenges: What next?” The International Journal of Social Psychiatry, SAGE Publications, Dec. 2020,www.ncbi.nlm.nih.gov/pmc/articles/PMC7443955/
3. Mitra, Esha. “India Didn't Prioritize Mental Health before Covid-19. Now It's Paying the Price.” CNN, Cable News Network, 7 Sept. 2020, ,URL
4. “Mental Health and COVID-19 in India - What We Know so Far and Where We Go from Here.” Mental Health and COVID-19 in India - What We Know so Far and Where We Go from Here | Inter Press Service, URL
5. Bhatt, Shephali. “How Covid-19 Has Affected India's Mental Healthcare Support System.” The Economic Times, Economic Times, 11 Apr. 2020, URL