The ongoing Covid-19 pandemic and the lockdowns have changed the way we live. Besides the biological effects of the SARS-CoV-2 virus, there have been several psychological and social offshoots. Mental well-being and associated health issues have assumed a renewed importance, Covid-19 serving as an eye-opener. Global research has highlighted the increased rates of depression, anxiety, sleep disturbances, etc., in individuals affected by the virus.
On the other hand, long-term stress, social distancing, unemployment, financial insecurity, grief and fear of infection have led to several adverse mental health consequences for people worldwide. Of special mention are the vulnerable populations: children, adolescents, women, older people, gender and sexual minorities, the economically impoverished, migrant workers and frontline helpers. They have suffered from the dual brunt of Covid: physical and psychological adversities. Further, individuals already afflicted with mental illness and their families have struggled during the last couple of years with reduced access to mental healthcare, travel restrictions, lack of medicines, and symptoms being further worsened due to stress.
It’s often said that necessity is the mother of invention. History has proven that mass crises such as pandemics bring in changes in lifestyle that are at times retained for good. The telephonic and online practice of medicine was already in existence and social distancing as well as lockdowns during Covid added a new impetus to this. In 2020, the Ministry of Health and Family Welfare (MoHFW) together with the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru and the Indian Psychiatric Society (IPS) released the tele-psychiatry guidelines. This was the first-of-its-kind framework to guide mental health professionals across India to implement digital psychiatric consultations. Several research papers that followed showed that if successfully conducted, tele-mental health can be as effective as in-person consultations, besides reducing the travel expenditure and waiting time for patients and families.
The National Mental Health Survey (NMHS) 2015–2016 conducted by NIMHANS revealed that one in five individuals suffer from some sort of mental health disorder and only 15% of those affected receive the treatment required. This amounts to a massive untreated ‘mental health burden’ in our country. Added to this, there is just one qualified psychiatrist for 10 lakh people in India, the number of psychologists and psychiatric social workers being even fewer. Tele-mental healthcare can not only bridge this gap by connecting people from remote areas to health professionals in times of need but also help train general physicians and community health workers in mental healthcare. They form the backbone of our health infrastructure, and the ability to provide mental health services at a primary level under the tele guidance of psychiatrists is a fruitful and cost-effective exercise.
Keeping this in the background, the National Tele-Mental Health programme announced in this year’s Budget makes real sense. This rare but apt mention of mental health in the national Budget holds true promise of delivering tele-mental health services in the post-Covid future. A network of 23 tele-mental health centres of excellence with NIMHANS being the nodal centre and IIIT Bangalore being the technological support hub has been proposed by the Central government. This surely shifts the national narrative to normalising conversations on mental health, reducing stigma and misinformation, and encouraging help-seeking among individuals. In fact, tele psychiatry and tele psychotherapy/ counselling can pave the way for accessible, affordable and effective mental health services across the country delivered by recognised experts in the field. In addition, this will also help training and online certification in digital mental health courses. This can empower grassroots-level health workers and lay counsellors to provide basic psychological first aid.
That being said, like any other legal document, implementation is the key and a challenge at the same time. The Mental Healthcare Act (2017) came in with a lot of promises by revamping the old act of 1987. However, only a few of those promises have stood the test of time. Even with its best intentions, the government needs to be careful when incorporating the tele-mental health programme proposal. Digital illiteracy, limited data connectivity, network glitches, ethical and legal lacunae related to tele-psychiatry guidelines, limitations in medical assessment through a virtual medium and data safety are the main concerns that riddle tele-mental healthcare. Furthermore, as the Covid threat reduces with time, the inherent tendency of the masses to prefer in-person consultation will be on the rise. This may make virtual consultations redundant. Affordability issues related to telemedicine should also be borne in mind to prevent health inequalities. Hence, implementation of tele-mental healthcare cannot be decoupled from efforts to improve digital literacy, data security and enhanced accessibility to services. Advocacy by mental health professionals, media and policymakers are likely to make a lasting impact in this area.
To summarise, the proposed Tele-Mental Health Programme is a timely and much-needed move but whether it delivers in the long run depends on its implementation, advocacy and dealing with the associated digital challenges.
Consultant Geriatric Psychiatrist, Kolkata