No data to handle mental health crisis during COVID-19

The coronavirus is known to be extremely multifaceted, in the sense that it is able to attack different organs in the human body—the lungs, liver, kidneys and even the heart.
For representational purposes
For representational purposes

The coronavirus is known to be extremely multifaceted, in the sense that it is able to attack different organs in the human body—the lungs, liver, kidneys and even the heart. However, there is another organ that the virus attacks silently, but the effects of this are most often not visible: the human mind, and that too with extremely debilitating consequences. Several reports in the past few months have highlighted a range of mental health issues stemming from the virus. 

The WHO states that the lockdown(s) imposed in several countries, including India, have induced social isolation, fear, stress and anxiety in many older adults, care providers and people with underlying health conditions. Concomitant financial distress and loss of livelihoods during this period have aggravated the aforementioned issues. 

Indian situation critical: A recent survey by the Indian Psychiatry Society found that the number of mental illness cases had increased by 20% since the lockdown, and that at least one in five Indians were affected. The situation is dire in India because of pre-existing neglect, ignorance and the taboo surrounding mental health as well as due to limited accessibility and availability of medical support. For instance, according to the National Mental Health Survey (2016), 83% of people suffering from mental health problems in India did not have access to treatment. 

While the Mental Health Care Act of 2017 guarantees that persons with mental illness are to be treated as equal to those with any regular physical ailment, outdoor patient services still remain unavailable, resulting in people having to go to expensive private hospitals, thus increasing their out-of-pocket expenses manifold. The situation is further aggravated by the absence of insurance cover either in the public or private sector. 

Amidst other mental health concerns triggered by these lockdowns, an increase in suicides has been reported. For instance, based on the latest police data, Kolkata has seen an alarming 100% increase in suicide rates since the lockdown was imposed. Diverse factors such as alcohol withdrawal, fear of contracting the virus, loss of loved ones, rising debt and economic uncertainty have played a crucial role in the alleged suicides. Student suicides in relation to competitive examinations like NEET have also been reported. Alarmingly, this has affected people and families from disenfranchised backgrounds much more acutely.

Absence of data: Concerned at the increasing suicide rates and other mental health issues, I had posed an unstarred question during the brief Monsoon Session of Parliament (252nd Session). The ministry has replied that no study was conducted by the government to assess the pandemic’s impact on mental health, which is a pity if true. It must be considered that assessing the pandemic’s impact on the mental well-being of the public is a necessary step in the prevention of suicides and in efforts to provide a healthy environment for the country’s citizens.

Such data would have enabled a better understanding of this complex issue and resulted in the production of better health-related research and policies. In fact, the primary reason for absence of insurance products for mental health patients is the lack of data on mortality and morbidity related to this disease. Except Odisha’s Biju Swasthya Kalyan Yojana, where cost of treatment of psychiatric disorders is covered with free treatment in government hospitals, most other states do not cover it. Though Ayushman Bharat covers this, insurance is not available in private hospitals.

Although the government has taken several initiatives to indicate that mental health is not missing from its agenda, it cannot be denied that a thorough follow-up of the efficacy, availability, accessibility, affordability and quality is not possible unless there is accurate data. Furthermore, with nationwide variations in health and disease distribution, any mental well-being plan needs to address not only regional and state-wise differences but also a lack of awareness amongst a majority of Indians who stigmatise the disease, particularly in rural areas.

Most important is the equity aspect that needs to be kept in mind while designing and implementing any mental health policy. Therefore, to address the wide range of mental health issues, especially during this period of crisis, what we need is a tailor-made approach to the different regions and socio-cultural groups instead of a one-size-fits-all package that can only be designed if there is adequate data collected. 

Conclusion: Finally, mental health issues need to be embedded in a broader public health discourse to allow for it to be treated like any other health issue as envisaged in our national health policies and programmes; only then can effective community participation take place. Any plan to manage mental health issues should also consider the parameters of age and sex. For instance, according to a recent study, 27% of women reported an increase in challenges associated with mental illness as compared to 10% of men. Medical experts warn that amidst the pandemic, a nationwide mental health crisis is imminent, which is the silent pandemic waiting to happen unless addressed immediately. 

Amar Patnaik (amar_patnaik@yahoo.com)
Rajya Sabha MP and former CAG official with a PhD in management

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