Covid-19: India is watching a mental health crisis – analysis
The social and economic fissures exposed by the pandemic will result in mass unemployment, exhausted social safety nets, starvation, increased gender-based violence, homelessness, alcoholism, loan defaults, and millions falling into poverty. This post-Covid landscape will be a fertile breeding ground for increased chronic stress, anxiety, depression, alcohol dependence, and self-harm.
As coronavirus disease (Covid-19) continues to take lives around the world, there is another public health crisis that is raising its ugly head. This new danger may perhaps unleash more death and despair than the coronavirus itself.
Following the history of pandemics and the side effects of an inevitable economic downturn, India is looking at a mental health crisis, with suicide-related deaths as its primary indicator.
After the stock market crash of 1929, the suicide rate in the United States (USA) increased by 50%; to 18.1 per 100,000 from 12.1 per 100,000 from 1920 to 1928 and remained at 15.4 per 100,000 between 1930 and 1940. In 2008, researchers from the University of Oxford and the London School of Hygiene & Tropical Medicine noted an additional 10,000 “economic suicides” in the United States, Canada and Europe, due to the financial crisis. These suicides were attributed to post-recession financial difficulties.
The social and economic fissures exposed by the pandemic will result in mass unemployment, exhausted social safety nets, starvation, increased gender-based violence, homelessness, alcoholism, loan defaults, and millions falling into poverty. This will be a fertile breeding ground for increased chronic stress, anxiety, depression, alcohol dependence, and self-harm; leading to an overall increase in morbidity, suicides, and the number of disability-adjusted life years linked to mental health.
Populations at risk include the 150 million with pre-existing mental health problems, Covid-19 survivors, frontline medical workers, youth, people with disabilities, women, unorganized sector workers, and the elderly.
For a country with the highest number of poor and malnourished, and people with depression and anxiety, this is the perfect storm. How many suicides can we expect? India reported 1.34,516 suicides in 2018. Most independent estimates are much more. The World Health Organization (WHO) set 2016 suicides at 215,872, with a suicide rate of 16.5 suicides, compared to the overall suicide rate of 10.5. History tells us that India should prepare for a large number of suicides, even by the thousands. In addition to human suffering, suicide has an economic dimension, each death costs Rs 265,000 in the first year alone, according to a study by Gopala Sarma Poduri at Indian journal of psychological medicine. Short-term costs include hospital expenses for the act that led to death, autopsy expenses, police investigations, funeral expenses, etc. Long-term costs include lost income that the person could have earned through retirement, taxes that the government lost from that income, among other things.
Since the second wave is expected, most of these deaths are preventable.
First, India can appoint a cabinet-level minister as head of mental health and wellness, and create an emergency task force of public health experts to create and execute evidence-based interventions.
Second, work on a war base to push forward the implementation of the 2017 Mental Health Act (MHCA) that promises mental health care for all and introduce a suicide prevention policy. Many countries, including China, have been able to significantly reduce suicides after implementing a suicide prevention policy.
India’s investment in mental health (the last Union Budget cut it by 20% from Rs 50 million to Rs 40 million) will need a boost. According to estimates, it will take Rs 93 billion to implement MHCA, 2017. This could come from the PM Cares Fund, corporate social responsibility initiatives, private equity and perhaps a new national lottery.
Rural India may be particularly susceptible to suicide due to the influx of migrant workers, and also because it is the home of the community of farmers at risk. Central pesticide storage in the farming community, decreased pesticide lethality, and interventions to dispel suicidal infections could be key.
At the heart of this should be a large public participation campaign to increase the search for help. This must be centrally driven, backed by state governments, and backed by influencers. Mental health and suicide must be treated as a public health crisis that needs immediate solution. The mainstream media and social media giants can connect to create and spread awareness.
There is a good chance that alcohol addiction will increase after Covid-19. It will be beneficial to provide rehabilitation services that address both physical and psychological aspects. Community-based interventions such as community volunteers from Atmiyata in Maharashtra and Gujarat, SCARF mobile mental health vans in Tamil Nadu and VISHRAM from Sangath, using community health workers for the first line of treatment (depression reduced by 22% and the prevalence of suicidal thoughts fell by 51%), can be expanded
To reduce pressure on the overworked primary and secondary mental health task force, care should focus on personal, family, community and primary care. Group psychological support for the unemployed through non-profit organizations and the community will help. Training millions in suicide prevention techniques and combining crisis intervention by providing psychological first aid will help save lives and reduce emotional distress, preventing trauma in the long term.
Digitally mediated therapy and telepsychiatry (NIMHANS carries out a successful telepsychiatry intervention in Karnataka) should be expanded. A mental health startup incubator (funded by the Startup India program) should provide the impetus to generate innovations that leverage technologies such as artificial intelligence, machine learning, and chatbots. Using low-tech text messages can be very effective in raising awareness, decreasing stigma, and inducing help-seeking behavior.
Finally, each crisis is an opportunity. The global flu epidemic of 1918 prompted many European countries to create national health services. While mental health issues can reduce 3-4% of GDP, each dollar investment pays four to six times. Mental health and suicide prevention interventions can not only save lives, but also have immense economic sense.
Nelson Vinod Moses is the founder of the Suicide Prevention India Foundation and a freelance journalist.
The opinions expressed are personal.