The state of Mental health in Post-Pandemic India

The Covid-19 pandemic killed millions. It disrupted global supply chains. It brought the world to a startling halt and confined us to our homes for months. Four years after it was officially declared a Public Health Emergency of International Concern, we are still unsure of the larger effects of what doctors and scientists call Long Covid. It only makes sense that this illness — this event — has had a tremendous impact on our mental health.“The expectation may have been that once the lockdowns were lifted and the threat of Covid-19 subsided that our collective mental health would begin a recovery towards its pre-pandemic levels,” wrote Tara Thiagarajan and Jennifer Newson in The Mental State of the World Report 2023 published by Sapien Labs. “However, the effects of diminished global mental wellbeing have become a new normal.”

MENTAL WELLBEING IN INDIA AND THE WORLD

The survey, conducted with more than four lakh people across 71 countries (46,982 in India), found that 30.4 per cent of Indians are distressed and struggling with their mental health, compared to 27.1 per cent globally. More people in the United Kingdom, South Africa, Brazil, and Australia suffer from mental distress than in India. In contrast, people in Canada, the US, Singapore, France, Israel, Italy, and Sri Lanka have better mental health.Many of the shifts that the pandemic brought about persist, the report argues, from an increase in remote work to increased use of single-use plastics, and all of these could have a contributing effect. Notably, Phthalates and other chemicals found directly in plastic may be linked to an increased risk for developing depression, anxiety, ADD, or psychotic symptoms such as those found in schizophrenia, according a report by Surfrider Foundation.

EFFECT OF AGE AND GENDER ON MENTAL HEALTH

The report found that the younger age of first smartphone ownership and ultra-processed food consumption are two major contributors to mental health challenges. Younger generations, particularly those under age 35, saw the steepest declines in mental well-being during the Covid-19 pandemic while those over 65 stayed steady. With these declines persisting across all age groups, the pandemic amplified a pre-existing trend of poorer mental well-being for younger generations that is now visible.In India, more than half of the respondents (50.7 per cent) in the age group of 18-24 years were distressed and struggling mentally. This number stood at 42.9 per cent in the age group of 25-34 years, 28.7 per cent for those between 35-44 years, and 17.6 per cent in the age group of 45-54 years. The proportion is significantly less among the population group above the age of 55 years.Gender-wise, mental well-being is lower among women than in men. Globally 28.7 per cent of women are distressed and struggling; the share is higher at 32.1 per cent in India. Among men, too, the share of distressed and struggling men in India (28.8 per cent) is higher than the global average of 25.5 per cent.

EFFECT OF EDUCATION AND PROFESSION ON MENTAL HEALTH

The survey found that education and mental health had a strict correlation. The higher the education, the lesser the stress and vice-versa. Nearly 48 per cent of respondents with primary education were distressed and struggling while only 14.4 per cent of those with PhD degrees were in such a mental state in India.

Socio-economic Factors and Environmental Factors

Not only individual attributes but also socio-economic factors and environmental factors such as national policies, social protection, and so on play a role in the mental health of a person. Although poverty and low education levels are the key among these factors, the findings in this study indicate that the normal individuals are vulnerable to stress and anxiety because of the COVID-19 pandemic. Prevention of mental disorders and treatment and rehabilitation of people affected by mental disorders need interventions, with focus on awareness of mental health issues. Comprehensive strategies for promotion, prevention, treatment, and recovery in a whole-of-government approach to address the mental health issues are needed. Mental Health and Sustainable Development goals are now an integral part in India, and its Target 3.4 is “By 2030, reduce by one-third pre-mature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” Now, to achieve such goals, India needs to rather focus on the alarming mental situation because of the COVID-19 situation. A recent article in Nature Medicine, Editorial (May 4, 2020), also supports that surge in mental-health problems related to the COVID-19 pandemic is on the horizon and the mental health crisis wave may be the next one that the world needs to fight. Past studies have shown that one in seven Indians was affected by mental disorders in 2017 and the contribution to the total disease burden in India has almost doubled since 1990. Other studies also indicate the COVID-19 effect on mental health and need to keep mental health in mind.A recent study based on the interview showed negatives, frustrations associated with patient care, and personal fears and annoyances experienced by doctors involved in care of the COVID-19/suspected COVID-19 patients in the hospital in North India.

The New Telemedicine Guideline and Telepsychiatry for Mental Health

As on March 25, 2020, India released new telemedicine practice guidelines during the period when the global pandemic situation worsened day by day. Telemedicine can be the key to tackle the health-care crisis as it prevents the over-crowding of emergency rooms and limits the exposure of health-care works to the infected people, where social distancing is the only option until a vaccine for COVID-19 is made and reaches the people. If the long-term benefits of telemedicine practices are well understood, its implementation in India impedes barriers too. Several factors such as the lack of diagnostic facilities, frequent power failure, lack of manpower, funding problems, lack of awareness, patient resistance toward telemedicine, cable cut in remote and difficult regions, other mismanagement of telemedicine practices, and so on, are a matter of great concern in India.

Strong regulations for components such as data privacy, doctor–patient relationship, negligence, liability, and so on are needed without any variability across different telemedicine platforms. Recognition and disclosure of interest are important in making the telemedicine platforms strong, and the patients need to be made aware of this. Tying up of tele-consultations (including diagnosis) and treatment to pharmacy lines (including sales of medicine) will scale up the telemedicine platforms. This requires identification of conflict of interest and creation of regulations and laws for effective implementation of telemedicine. However, the regulatory framework in the new telemedicine guideline released in March 2020 is not clear about this. The new guideline lacks clear-cut regulations for online platforms in spite of the fact that it has a big business opportunity.

Use of telemedicine consultations by child psychiatrists and other child mental health specialists has a great impact for the population of children in need of services as it is more accessible and provides higher quality psychiatric care services in remote locations. One of the greatest advantages of telemedicine is that it has dramatically decreased emergency room wait times and revolutionized where and how patients get their care as per reports from the Carolinas HealthCare System, one of the largest free-standing psychiatric emergency departments in the country, USA. A study on reactions of psychiatric patients to telepsychiatry showed that over 90% of patients were comfortable with their telepsychiatric care, and 84.5% found it as beneficial as a direct physical presence. The reliability and acceptability of telepsychiatric evaluation of older Spanish-speaking Latino adults with mild cognitive impairment in the rural county of Imperial in California have also been reported. Even though telepsychiatry adds more flexibly by providing mental health services into primary care practices, it encounters many difficulties to access health care, for example, legal issues, confidentiality, validity, and reliability.

Conclusions

Systematic and regular surveys need to be conducted to allow for monitoring of the mental health impact of COVID-19 in India. As the uncertain future because of COVID-19 is becoming dominant, it is high time to prepare ourselves so as to prevent the second wave of mental health crises post the COVID-19 pandemic.