COVID-19 distress in India: A psychiatrist's perspective

Dr Divya Ganesh Nallur wrote this blog post as part of the College's celebration of World Mental Health Day 2020.

It all started as a piece of distant news. But the reality of COVID-19 which would have to be endured for some long way into the future was shot by the speed it engulfed the globe.  It touched people and worse killed the weak as it rode on them swiftly into populations across the world, all before the news could be passed off as such. The ability of the virus to live in people quiet for a few days while it travelled quickly into people in contact puzzled epidemiologists and leaders of countries across the world.

News of the lockdown of a big city, from where the virus started its ride, surprised me no less than the rest of the world. 

We were all in disbelief only to see, ironically, the cities we lived in too were locked-down quickly - all within a couple of weeks, for weeks and for more weeks in a rush of effort to save the citizens from the virus that was feared potent to kill.

Nine months on now and we seem to be not even in the middle of it yet. Fear prevails.

Challenging times in India

COVID-19 has already knocked millions sick and killed many, presenting huge healthcare infrastructure and treatment challenges, in India as much as in the rest of the world.

The lockdowns and the inevitable ‘new normal’ practices to hide from the virus have largely restricted human activity, pushing millions of people into acute distress due to reduced and even absolute loss of income.  

The social isolation in the normally socially cohesive and busy Indian communities have left vulnerable groups of people very isolated and lonely.

The COVID-19 pandemic has vastly disrupted ongoing treatments for mental illnesses for many patients.  It has also caused a surge in the number of people having first episode anxiety, to a degree that needed treatment by a psychiatrist.  

The effect on mental health patients and consultations

Many of our outpatients suffered worsening of their symptoms, some leading to admissions. 

We had to also adopt non-direct consulting, causing a shift in the paradigm of psychiatric treatment. 

Inhibition, incomplete communication and difficulty in having a sense of connect, have all made psychiatric consultations difficult by the very sensitive nature of it.

Implications for families

While chance of relationships in families repairing or thriving in the lockdown are hearsay and not on record, we have seen in our practice, many cases that have turned bad and some worse.

They include cases of all kinds of domestic violence and relationship abuse. Many mental health presentations sprang from the stress of being restricted within the house igniting flash of family conflicts rooted in underlying grouse some of which turned worse with fear of COVID and the alarming financial distress.

With COVID in focus, anxious moments owing to difficulty in getting treatment for other ailments for members in the family too added up.

Addictions

COVID-19 in India highlighted the issue of addictions to substances and the government's dilemma being inextricably addicted to the revenue from them. 

Lockdowns, we observed, led to a spike in cases of withdrawal syndromes including very bad ones by the harder substances due to abrupt unavailability.

At my hospital we ran a campaign to advise those who called in with distress and to the general public to use the lockdown as an opportunity to cut the habit.

Un-lockdowns, ironically, led to over consumption leading to presentations with acute intoxications.

Taking care of mental inpatients was difficult with patients’ family attendants having to deal with movement restrictions coupled with staff shortage at the hospital to keep good watch on the patients.

Businesses and their staff

COVID-19 put all businesses in distress and mental health hospital was not an exception.

As with other specialty and general hospitals it was a challenge to talk to staff across levels on decisions arising due to unexpected and unprepared for financial distress due to deep drop in demand for the services especially in the two months of strict lockdown.

It was also a challenge to keep the staff wanting to take a long break or quit the service fearing infection.

For any psychiatrist loaded with the responsibility of many patients and to rise up to the challenge of sudden upsurge in cases and complications besides taking the shock of COVID for own aged and young family members was indeed quite stressful, to be frank.

The upside!

COVID-19 has changed certain things for good! The numbers of consultations online have increased significantly helping all critical connect with the patients. Quick guidelines released by the Indian Psychiatric Society on the practice in these trying times, though restrictive, were useful in adapting to the changed situation.

COVID-19 also mirrors deficiencies in our healthcare system in general. The gap in mental healthcare in India as estimated in a report of WHO was about 70% prior to COVID-19 which would only sharply widen due to socio economic challenges COVID-19 has caused and expected to last unpredictably long.

A 70% gap in the treatment of mental illness tells of poor awareness in the public on the ailments and treatment.  India continues to suffer significant stigma with mental illnesses.  People continue to believe in faith healers and ignorantly live with the distress and trauma.  There is an urgent need for mass education to raise awareness about mental illness and available effective treatments.

The Mental Healthcare Act 2017 was a very progressive step.  Ensuring that mental health gets appropriate funding and direction - that the act can be implemented in its true spirit and intent is a challenge our government would have to get set to tackle effectively.