The coronavirus disease (COVID-19) pandemic has been declared a public health emergency by the World Health Organisation (WHO) and most countries in the world. The virus is rapidly spreading and the number of persons infected across nations is drastically increasing. The virus has been claiming victims irrespective of their caste, class and gender. Consequently, the crisis is generating stress and anxiety among people globally. The WHO has also issued mental health and psychosocial considerations during the COVID-19 outbreak.
India has the world’s second-largest population and limited public health resources. If COVID-19 reaches stage three in the country, it will be a dangerous situation. This article investigates the possible mental health issues and crises at the individual and community level due to COVID-19 in India.
Mental health crisis at the individual level
A state of panic: The current state of panic is leading people to experience anxiety and stress, due to an inability to cope. The urge to consult doctors even in case of regular cold and cough, and the hoarding of hand sanitizers and face masks since the declaration of COVID-19 as a pandemic, are examples of this panic. The hoarding has led to a scarcity of hand sanitizers and face masks in the market and prices have risen multiple times, even as experts assure us that regular soap is sufficient to maintain personal hygiene. The rush to consult doctors, while legitimate at times, has also been placing an unnecessary burden on the healthcare sector in this situation.
People in isolation: People in isolation wards for treatment of COVID-19 face a high chance of a mental health crisis. This is because having to stay in the isolation wards may increase their fear and stress, and cause trauma.
Additionally, those who are in observation wards of various hospitals, including psychiatric hospitals, face a high probability of contracting the virus if they are not infected already. This tragedy has already happened in South Korea, where all the in-patients in a psychiatric department were found COVID-positive. People who are tested positive or are suspected are facing stigmatised attitudes and discriminatory behaviour from society. People returning to their countries from abroad are treated as aliens in their community.
People who have COVID-19: The people tested positive for COVID-19 face significant social stigma and negative associations extending to their family members as well. “In an outbreak, this may mean people are labelled, stereotyped, discriminated against, treated separately, and/or experience loss of status because of a perceived link with a disease”, a WHO report states. These individuals and their families may face derogatory language and rejection from society, even after recovery. This will cause them to be isolated and alienated within society. There has also been an exponential increase in the number of suicides due to panic and social marginalisation.
It may be more appropriate for the government to use the term ‘physical distance’ instead of ‘social distance’ in public communications, because of how the latter could aggravate social marginalisation.
Stress among the frontline health staff: Health professionals including medical and paramedical staff are working 24×7 to provide the best possible services to manage the pandemic. The work pressure, fear of infection, overtime workload, discrimination, lack of family and social interaction, and exhaustion may lead to mental health problems among them. The situation may cause stress, anxiety, depression, insomnia, anger, fear and denial.
They are also facing a kind of social isolation due to their job profile. They are being denied houses on rent, and landlords are forcing them to vacate their houses as they are in direct and regular contact with people who have COVID-19. In this outbreak situation, it is imperative to maintain positive mental health of frontline health workers, only then do we have better chances of controlling this pandemic.
The effect at the community level
Economy: The Indian economy has been grossly affected due to the impact of this virus. Both Sensex and Nifty went down and affected most companies. COVID severely hits some sectors, namely aviation, retail, manufacturing, automobile, service, travel, hospitality and so on. As a result, employees have been sent on a short leave without pay or are facing cuts in their existing salary. For many of these persons, their salary is the only source of income on which the family depends; for them, it is a mental health crisis in the family. For entrepreneurs as well, it is a crisis situation.
90% of India’s workers belong to the informal or unorganised sectors. This accounts for a population of 450 million. These workers are the most severely affected by the COVID-19 lockdown across the country. Though the government urges employers to pay their wages during this lockdown period, there are no actual measures to help them ensure this. Different state governments, as well as the central government, have offered some financial relief to the informal workers, but whether it can reach this large population is in question. This means they may struggle even for food. Their helplessness in the situation is likely to precipitate mental health crises.
The current situation is affecting mental health across all classes of the population, from big industrialists to the common man. However, it stands to reason that the working class being more vulnerable is being affected and marginalised in unimaginable ways.
Mental health services in India: The above situation is likely to bring about a mental health emergency in India. Kirmayer and Pedersen state that war, trauma, poverty, unemployment, and ongoing forms of regional violence contribute to mental distress. This situation may be termed as an ecological emergency for humans, creating trauma for many. It may lead to and aggravate various mental health issues like anxiety, stress or depression. People in quarantine run a high risk of acute stress disorder and major depressive disorder. Children under quarantine are observed to have a mean post-traumatic stress score four times higher than children outside of quarantine. In this critical situation where the health hazard is affecting the community, the family and the individual, it is necessary to promote mental wellness.
In India, we have limited mental health resources. As per the National Mental Health Survey (NMHS), India is struggling with poor mental health care services due to the lack of integrated and comprehensive health care. The existing treatment gap is about 83%. However, there are indigenous practices that help to close this gap. The so-called unscientific traditional healing practices like folk healing or temple healing are predominant choices among a large population in India due to their cultural ascendancy. People often prefer to consult religious gurus (a so-called baba) rather than consulting psychiatrists.
Mental health is a major public health issue as it affects the human resource and productivity of the nation. Hence, necessary steps have to be taken to manage it. Limited availability of mental health services in the country including psychiatrists, clinical psychologists, psychiatric social workers may not meet these emerging cases. How will we accommodate new and emerging demands for psychosocial support?
Especially during the pandemic, online mental health services will be urgently required where people are restricted inside their homes. In addition, people should be encouraged to practise self-care, exercise, and take to other prescriptions, like art or writing as therapy.
Disclaimer: The opinions expressed in this article are the views of the author and may not be endorsed by Mad in Asia Pacific.
Chittaranjan Subudhi is working as Assistant Professor, Department of Social Work, School of Social Sciences and Humanities, Central University of Tamil Nadu. He has conducted research in various areas like Health and Mental Health, Medical Anthropology, Family and Child Welfare, Disability studies, and Tribal Health issues. He teaches Psychiatric Social Work, Working with Individuals and Communities, Qualitative Research, ICTs in Social Development and Health System Management.