Nelson Vinod Moses, Founder, SPIF, said, “We believe the data will contribute to understanding COVID-19 on how it may have exacerbated mental health conditions, trends in help-seeking behavior, key demographics impacted, and the increase in self-harm/suicide ideation during this time”.
Even before COVID-19 ripped through India, the state of mental health was already in crisis with 150 million Indians in need of mental health services, and only 30 million receiving any form of care (National Mental Health Survey of India, 2016). With the lengthy lockdown, forced isolation, fear of the virus, financial insecurity, domestic violence, and rising anxiety the crisis has deepened and is perhaps heading towards a catastrophe.
According to "COVID-19 Blues", an online survey where 'SPIF' interviewed 159 'MHPs' from across the country, suicide ideation, self-harm and relapses have all risen.
Noor Malik, Research Consultant, SPIF, said “Being locked down in the face of the pandemic has increased the already prevalent risk related to mental illness, financial insecurity, and work stress while triggering new anxieties, feelings of not being in control, depletion of social networks, job uncertainty, abuse, and social isolation. This, in turn, has led to an increase in mental health-related issues affecting almost all sections of the population regardless of economic and social backgrounds”.
While the pandemic has been an equalizer affecting everyone in some way, the data reveals that some groups have been impacted more than others in the context of mental health. Help-seeking was highest amongst individuals aged 25-40 years, followed by those aged 18-25 years and 40-60 years, as reported by therapists. The highest increase in help-seeking through therapy was found among females followed by males. A considerable number of therapists said they experienced an increase in gender diverse individuals and a few saw an increase in trans individuals seeking therapy. 79.9% of the therapists saw a rise in the number of working professionals opting for therapy. 59.7% of the therapists saw an increasing number of students seeking counseling. 52.2% of the therapists observed an increase in the number of individuals with a pre-existing mental health condition.
Noor added, “Younger individuals, working professionals, and women are seeking more help during these times. This could mean that they are most open to help-seeking but this doesn’t take away from the fact that almost all demographics are affected adversely in the current situation”.
The concerning: Nearly 29% of the therapists have observed an increase in clients who have self-harmed, as well as those who have expressed suicidal ideation or death wish. Over 42% of the therapists reported a possible increase in individuals presenting with suicidal ideation and 35.8% reported an increase in people having self-harmed. While most therapists (48.4%) said the increase in suicide ideation has been below 10%, some (22.6%) have reported an up to 50% spike. The increase in persons who have self-harmed also shows a similar pattern.
While many groups of people are vulnerable to triggers inherent in the uncertainty that comes with a pandemic, those with an existing mental health condition are at a higher risk. More than half of the therapists (57.9%) who took the survey said that individuals who had previously recovered or were making a recovery, have now relapsed. Nearly a third of them said this may be the case with people they work with too. While the majority of them (42.8%) found that the increase was below 10%, many (37.7%) observed an up to 50% hike in relapses, with one therapist having experienced a doubled rate.
“India already has the highest number of suicides globally. With the COVID-induced lockdown, self-harm and suicide ideation have upped. Other than creating awareness, reducing stigma related to help-seeking, and providing psycho-social support, the government will need to increase socio-economic safety nets, and think of ways to support those suffering abuse,” noted Nelson.
The concerning: With longer hours spent virtually connected with their clients, the therapists’ mental and emotional investment in their work has gone up. Most therapists (62.3%) are experiencing caregiver fatigue as a result of the current COVID-19 situation, lockdown pressures, and doing only/mostly telepsychiatry. The pressures of the pandemic have impacted the therapists’ personal lives as well, in turn, affecting their ability to work at their full capacity. While most (64.8%) therapists reported being mildly impacted, a portion (11%) have been severely impacted by this. Some suggested that they were not impacted by the current situation, which could imply that they have either been sheltered from the negative impacts of the pandemic or that they have been able to effectively deal with the changes.
The good: Close to 54.7% of mental health professionals reported that there has been an increase in the number of people seeking therapy for the first time. Considering that the country has an 80 percent treatment gap, where most of those who need behavioral healthcare do not have access or are hesitant to access it due to shame or stigma, this is a green shoot.
Further, therapists across the country have witnessed an overall increase in help-seeking in the form of therapy. A whopping 68.6% of the therapists reported an increase in the number of clients and in the hours they spend counseling after the pandemic hit. A few others reported a possible increase.
The increased anonymity, accessibility, and ease of use that comes with online counseling might have helped people overcome their resistance towards therapy. Additionally, the fact that a large number of therapists have considerately offered their services for free at this trying time, may have also made the choice of seeking help easier, by making it financially accessible to many more.
Nelson said, “This might be a good time for the government to more seriously implement the Mental Health Care Act, 2017 that promises mental healthcare for all with a rights-based approach. It is time to mainstream the mental health conversation so that there’s awareness, increase in help-seeking, and shedding of stigma. It is time for a mental health movement that normalizes these conversations and leads to a focus on mental well-being right from a young age”.
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