COVID-19 and the lockdown that followed have triggered stress and mental health issues of a magnitude not seen in recent times. Amidst the general distress, there is also newfound respect for mental health. The phase of pandemic has served as a reminder on the importance of mental health and as an opportunity to live such that mental health is protected and maintained. The Banyan Academy of Leadership in Mental Health (BALM) is a sister organization of The Banyan, a 26-year-old pro-impact organization that engages in capacity building, research and individualized evidence-based problem-solving to meet the complex needs of persons in psychosocial distress in low-resource settings. Dr. Lakshmi Ravikanth (PhD) is co-dean of BALM; she has been associated with The Banyan since its inception. She responded to questions on the issue of mental health during the pandemic and whether the pandemic has fundamentally changed our perception of mental health.
In the first quarter of 2020 as life slipped into pandemic protocols and lockdown, one sector that saw a major paradigm shift was education. Schools shut; classrooms went ‘virtual’ and teachers became images on electronic screens. The impact was felt at the Bengaluru-based Bubbles Centre for Autism too.
At the start of the pandemic various agencies chipped in with precautions to take and protocols to follow. Do you recall mental health finding mention in such lists? Or did all of us wake up to its significance only a bit late?
To my immediate recall the early advisories were confined to physical health protocols. However, very quickly there were advisories by WHO / ICMR etc telling us to be aware of uncertainties, fears and the state of feeling confused. I won’t say we woke up ‘late’ but as signs appeared apt responses were sent. Very early at The Banyan/BALM where I work, our psychiatrists, counsellors and other allied professionals alerted people that the pandemic is a global phenomenon and since it hit so suddenly and is spreading so rapidly…what we all are experiencing is a normal response to an extraordinary occurrence. So, we should not panic and take hasty steps from a health/mental health point of view. Instead, we should be aware and seek help without fear.
The Banyan did vigorous outreach and after care by training and enabling our alumni/student body to reach out telephonically and give accurate and timely information; we also developed local networks to offer help. Our health care professionals worked and still work round the clock. Maybe because we are a mental health organization we sensed and responded to real and envisaged needs such as social care benefits, medicine disbursement and other emergent needs for in-patient and out-patient and their families, fast.
From what you noticed, did the pandemic cause any increase in mental health issues? What were the common problems reported?
Yes, the pandemic precipitated many mental health issues…I will put them in three categories
- Those with proclivity to a mental health condition a priori, found it escalated as in panic attacks, fear and anxiety, restlessness, sleep deprivation, depression and confusion.
- Those who were never symptomatic found surge of recurring bouts of anger, sorrow, fear, many new somatic manifestations, social withdrawal and excessive worry.
- Increase in co-dependent conditions such as increased substance use, smoking, social media use, hypertension and anxiety, cardiac issues and palpitation, depression and excess eating (I have not segregated mental health distress as mild, moderate, severe, excluding or including psychopharmacology).
The common problems and psychosocial disabilities were the same as above. Besides excess or under food consumption and excess sleep or lack of it there was lethargy, anger, frustration, bouts of violence, isolation fears, fear of death/fatality, domestic violence, child sexual abuse, lack of concentration, weeping, lowered libido, motivation, suicidal ideation, self-harm, etc.
The problems among health workers included frustration, fatigue, isolation, worry of being stigmatized, fears about self and family, headaches, indigestion etc. Then there is the issue of grief and bereavement at the loss of a loved one…we must have grief counselling as dealing with loss, that too suddenly, can impair one for life. Medical health professionals also need to work within boundaries and not over stretch.
The pandemic and the lockdown it caused have left a lasting impression on everyone. It was a period of stress due to suddenly altered lifestyle and work patterns, restricted mobility and worry over what next. Do you think a year of such existence has fundamentally changed the perception of mental health in our society? Will the subject of mental health be seen in a different light hereon?
Yes, the pandemic has highlighted several new nuances in mental health. Health and mental health are integral; ‘no health without mental health’ – both are synchronous. Preventive mental health care or early warning signals, talking about emotions and seeking help has become crucial. Mental health, well-being and wellness fall along a continuum of self-care. This is a reality.
I feel people are trying to be more accepting, resilient, hopeful, valuing self and relationships and becoming more grounded (psycho-socio-eco impacts of COVID on self). Focus on mental health, awareness and open talk forums have definitely emerged be it for children, adults or the elderly.
Mental health of persons with acute vulnerabilities such as the very poor and socially marginalized must become adequate and receive greater attention. See what happened with migrant worker movements across the country, the loss of livelihood of daily wage earners, the plight of very small enterprises, domestic helps (the informal work force) etc. We can’t even imagine their mental health status as a result of overnight socio-economic deprivation. Generations have been impacted.
How are we placed in terms of trained hands to address mental health problems? Do we have the required number of psychiatrists and trained counselors or are we lagging both with reference to the traditional levels of demand for intervention and what those levels now seem, a year into the pandemic?
Treatment gaps are prevalent owing to accessibility, availability and affordability of mental health professionals in this country. Our overall allocation for health is still low (total expenditure by the Center and states for FY20 was 1.29 percent of GDP; total spending on healthcare, out-of-pocket and public, was 3.6 percent of GDP as per OECD. Source: Mint, December 17, 2020). In the absence of in person consultative work and lack of access for all to communication and technology, gaps may widen. Hence local community health-mobilization with capacity building measures is a must. It can include non-specialist work force. More public health systems of care should be provided especially where access and affordability are a huge challenge. There should be tele medicine/counselling etc. Peer support programs in academic institutions, corporates, with firm referral systems …these must be the way forward.
Training and capacity building via short courses to equip lay people to be sensitive to the needs of mental health must be introduced in schools colleges, civil society, corporates etc; something on the lines of Mental Health First Aid (MHFA).
Can you outline a few steps people can take to ensure they stay in good mental health in these trying times
- Preventive:
- Focus on preventive measures including maintaining mental health hygiene. Combat negative self-talk if it emerges.
- Connect with people.
- Read/maintain journals.
- Relax, know early warning triggers.
- Exercise, develop hobbies, go inward…music, meditation, spiritual pursuits, keep body routines healthy, food, diet, sleep, contain excess consumption. Holistic mental health today is all about bio-psychosocial spiritual health. Build hope and resilience.
- Intervention:
If any symptom physical, psychological or behavioral prevails for more than two months, then please consult a physician. Don’t shy off from medication if it is required. Sometimes psychopharmacological intervention maybe needed.- Seek a therapist, counsellor, social worker.
- Stay connected with a social circle.
- Nurture pets, a small garden etc.
- Never self-medicate over medicate and make medicine cocktails. Each system of treatment has its value.
- Do not stigmatize self and others with or without COVID.
- Balance work, leisure and make the most of one’s time. This equilibrium is a must. Be in the present…this is imp for all times. Many people tend to ruminate about the past or worry in excess about the future. Avoid excess.
- Don’t nurse grudges and resentments or keep one’s anger bottled up. They can become illness at some point.
- Forgive, believe in gratitude, compassion and love, care for self, family and others – all these are important.
- Do something novel; it does not have to be expensive.
- Learn to let go…even of COVID. I don’t like to be prescriptive; these are tips and people must figure out the best combination that works for them to maintain homeostasis and move ahead with acceptance and realistic optimism.
(Interviewed by Shyam G Menon, freelance writer based in Mumbai.)