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.

COVID-19 will go down as a landmark in recent human history. It has unleashed an element of unpredictability and played havoc with our notions of undisturbed existence and lifestyle settled into long-familiar patterns. The lockdown that followed the onset of the pandemic saw us confined indoors. All this has been stressful on the human being. Dr Aditya Gopinathan Nair is a consultant psychiatrist with extensive clinical experience in general and child/adolescent psychiatry and his areas of interest include sexual psychology and post-traumatic stress. He consults at several clinics and hospitals in the Mumbai region. He responds to questions pertaining to mental health amid this ongoing phase of the pandemic.

Dr Aditya Gopinathan Nair

How do psychiatrists define good mental health? Is there a thing like that or is mental health measured in relation to person and context?

When we speak about mental health, it is important to understand the spectrum. Like physical illnesses and physical well-being, there is mental health illness and mental well-being. Mental well-being is indicated by an individual’s ability to function well in all domains of his/her life; social, interpersonal, and occupational. It is the ability to handle physical, mental, and emotional stresses without them overwhelming an individual and making him/her susceptible to mental illnesses. It is a state of mind that nurtures and assists personal growth, development, and relationships.

Mental illness, on the other hand, represents neurochemical changes in the brain which bring about a change in behaviour or level of functioning of an individual, it can also be maladaptive behaviour and thought patterns that reduce the ability to efficiently cope with day-to-day stress and makes one susceptible to eventually develop other mental illnesses or may further complicate already existing illnesses. So, the presence of mental health illnesses which are diagnosed based on symptoms and duration indicate deterioration in an individual’s mental health.

Around-March 2020, we had two new realities to cope with – a highly infectious and potentially fatal disease we knew little of and lockdown. If the regular pre-pandemic life is taken as ‘the norm’, how do you think these two developments altered it from the point of view of mental health? What attributes changed in our surroundings and how did that impact the ingredients of mental health in human beings?

The entire environment created by COVID-19; be it the threat of the illness and its outcomes, the information overload, the isolation, the quarantine, and the stigma – it has led to a tsunami of psychological distress. For a lot of people, this period involved separation from their loved ones over long periods and with that came, crippling loneliness.

There were anxieties regarding the illness, contracting the illness, spreading it to loved ones, the outcomes, the stigma etc. All these stressors along with the physical restrictions of the lockdown affected the 4 “R’s” of our life which are already responsible for the day-to-day stresses: roles, responsibilities, routines, and relationships. So, it was – additional stress along with reduced options and boundaries within which to resolve them. What was required was a complete 180-degree change in our approach which is difficult given the lack of resources and preparation for an event and change of this magnitude.

Looking back, do you think mental health featured prominently in the list of things we were told to watch out for as our life was turned upside down by the pandemic? Or did that awareness sink in only with a lag?

Yes, mental health was prominently featured worldwide among the list of things to watch out for as regards the general population as well as frontline health workers, police etc. The entire mental health community worldwide – including in India – had guidelines on how to get through lockdowns and quarantines.

Psychiatrists and psychologists nationwide were working behind the scenes and were observing a change in trends and a rise in distress. It is also important to understand that such situations have both acute and long-term effects based on our emotional and behavioural response to this stress; we are continuing to see this.

As a practising psychiatrist, did you notice any increase in problems related to mental health during the pandemic? If we take the period from April 2020 to now, what were the common types of complaints you dealt with? Did you find people you hadn’t treated before or people who hadn’t consulted a psychiatrist before seeking help because the environment was suddenly too stressful?

Worldwide we have seen a threefold increase in psychological distress. There has been worsening of a lot of pre-existing conditions and new cases amongst those with no previous history of psychiatric issues. We have seen a huge spike in the cases of common conditions such as anxiety and depression.

Given the nature of the preventive measures of COVID-19, we have seen an increase in existing obsessive-compulsive disorders (OCD) and a rise in new cases of the same. OCD is characterized by repetitive behaviour such as hand washing, obsessive and intrusive thoughts regarding contamination and cleanliness amongst others. Suicide during the lockdown period had become a serious issue and experts expect it to be a problem going forward, as a complication of the lockdown and the pandemic, especially amongst high-risk groups. Increase in substance use and withdrawal-related issues; domestic abuse became a cause of major concern. Behavioural issues amongst children and adolescents were also on the rise.

Did you notice any gender or age group-related patterns in these complaints? For instance, were the young coping better compared to senior citizens? Was any broad distinction visible in the complaints of the young and the old?

Most definitely. The elderly have been hit far worse than any age group. For one, they were in the high-risk group when it came to COVID-19 and coping at an advanced age is more difficult. Symptoms have been broadly similar across both age groups. Most common among them would be – issues of fatigue, irritability, mood swings, difficulty concentrating and focusing, sleep disturbances, anxieties regarding the illness and outcomes, feeling low for a large part of the day, lack of productivity, feelings of hopelessness and helplessness and repetitive thoughts and ruminations. In the young although coping has been better, it has also been easier to pick up unhealthy behaviours and patterns. For example: increased substance use.

The isolation, quarantine, anxieties regarding the illness and even the treatment have not only contributed to a rise in anxiety disorders and depression but also made a lot of the young prone to future mental health issues such as post-traumatic stress and suicide. The ability to work from home has been a boon for many but there has been a significant rise in burnout also.

Senior citizens have been among the most vulnerable segments all through the pandemic. They also had their mobility restricted (for their safety) under pandemic regulations. In your experience, how did this age group fare on the mental health front?

Falling into the high-risk category with a host of pre-existing conditions, the geriatric or the senior citizens’ group has had it the worst. They have been practically under house arrest. Disruption in the supply of medical services and resources have only added to their worries and led to a significant exacerbation of pre-existing medical conditions which have indirectly or directly contributed to susceptibility to mental health conditions. Within the boundaries of their homes, even the physically challenged have been pushed to take up additional workload.

Separation from primary caretakers due to unavailability of services or from family members due to the quarantine has increased the chances of neglect from every angle possible. Due to age and pre-existing psychological conditions such as mild cognitive impairment and dementia the susceptibility to experience depression or anxiety is multifold and has made this quarantine journey a very challenging one. However, studies have shown that the elderly who have been able to access the internet and other communication services have done better than their less tech-savvy counterparts.

The medical infrastructure for treating COVID-19, facilities for isolation – all these were ramped up during the pandemic. Almost a year into the pandemic, do you think helplines and other support facilities for mental health issues caused by stress and the continued absence of regular human life, are adequate? Or is there still a demand-supply gap?

Although helplines and other facilities are available and are overworked due to the skewed resource-to-patient ratio, it is the lack of awareness of general mental health issues and complications due to drastic changes in life such as the pandemic and lockdown, which continue to be a significant hurdle.

What steps would you recommend that people take to maintain good mental health in the new normal?

It is extremely important to start preparing for post-COVID or lockdown life which will come with its own set of challenges. Try maintaining a regular productive routine; regular exercises, meditation, deep breathing exercises are beneficial, dedicate time to spend with the family, during trying and testing times, it’s okay to lower expectations from oneself and others, avoid confrontation at home, abstain from substance abuse to reduce or cope with stress, follow a healthy diet with balanced proportions, prepare for post lockdown life, spend time outside with proper preventive measures such as mask and social distancing.

Concern, worry, and anxiety are acceptable to a certain extent given the circumstances but in excess, they will merely aggravate the situation. If these emotions tend to become overwhelming, then try speaking to someone or step out for a breather. Distraction in short bursts is beneficial. Identify thought situations and information that tend to trigger anxiety; reduce exposure to begin with, communicate your concerns regarding these to your loved ones, friends and physician and discuss how they have been dealing with similar situations.

(The author, Shyam G Menon, is a freelance writer based in Mumbai.)