COVID-19 lockdown: A recipe for mental health crisis

Incident 1: A 29-year-old woman, resident of Worli in Mumbai, committed suicide by hanging inside the bathroom of Nair Hospital on April 14, after testing positive for Covid-19.

Incident 2: A 52-year-old man in Uttar Pradesh’s Banda district hanged himself from a tree on the outskirts of Jaari village on April 11, after he failed to get any labour to harvest his wheat crop.

Incident 3: A 30-year-old member of Tablighi Jamaat committed suicide inside the washroom of a hospital in Akola in Maharashtra on April 10, following a medical examination that revealed his status as a novel coronavirus positive patient.

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The three incidents in the last seven days don’t figure in India’s official Covid-19 death count. But they should, as they represent the less talked-about underside of the virus story — how mental trauma and agony associated with the pandemic, lockdown and social distancing decimate the mental balance of an individual who prefers death rather than dealing with the disease or crisis. The three cases cited above could just be a tip of the iceberg.

“Suicides are a recognised concern from earlier epidemics. For example, the SARS epidemic in Hong Kong was associated with a 30% increase (of suicides) in older people. There are many reasons for this, ranging from anxiety and panic around contracting the infection to acute despair due to the loss of livelihood. We must prepare to address the long-term mental health consequences of the economic impact of the epidemic, which include suicide,” said Dr Vikram Patel, one of the world’s leading experts on mental health.

Some of the early research suggests a long-lasting psychological impact of the pandemic, as people experience increased level of anxiety and stress not only because of the six-week-long lockdown period but also the fear of uncertainty post the shutdown, as the economy has tanked, sniffing out the livelihood options for many. A similar trend, earlier seen after the 2008 recession in the USA, is likely to repeat.

“A toxic combination of absolute poverty with vulgar levels of inequality is a recipe for a similar surge of depths of despair in India,” Patel said.

Psycho-social issues

A helpline set up by the National Institute of Mental Health and Neurosciences (Nimhans), Bengaluru receives 400-500 calls each day, seeking support for psycho-social and mental health issues.

When it started on March 28, the telephone lines were flooded with calls seeking general information on Covid-19, out of which only a small section of callers seeking specialised psychological support were separated.

“Initially we were giving about five minutes at the secondary line where we filtered the persons with mental health issues or psycho-social concerns. Now, we have increased the time to 15-30 minutes for each person,” K Sekar, head of the Centre for Disaster Management and Psychosocial support, and Mental Health Services at Nimhans, who runs the National Covid-19 Coordination Helpline, told DH. The Central Institute of Psychiatry, Ranchi and Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur too have been roped into the helpline to cater to a wider section of people from several states.

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“The concerns have shifted from emotional issues to psycho-social issues like frustration, intolerance and how to manage the lockdown period as it extends to May 3,” he said.

Initially, nearly 40% of queries were from people with psycho-social issues, 15-20% with mental health issues and 40% was miscellaneous queries. Miscellaneous queries have gradually disappeared with people reporting more and more psychological, social and mental health issues.

“We receive calls from both men and women, and from across the country. The common questions are: ‘Why am I becoming tense? Why am I becoming angry? This was not my character earlier. The lockdown is affecting people’s psyche,” Sekar said. The reasons for people to call the helpline are anxiety, depression and certain obsessions, which are common reactions to an uncommon event.

Pratima Murthy, Head of Psychiatry at Nimhans, explained that while the institute was initially beset by calls from people with concerns about the virus, much of the queries have now migrated to matters associated with the lockdown, such as future security, job retention, money issues, and strained interpersonal relationships.

“The lockdown has created serious difficulties, especially for people living in uncomfortable circumstances without space, privacy or enough facilities. The other factor is for people with interpersonal difficulties and adjustment difficulties. For people with high expressive emotions, increased face-to-face contact (due to an extended stay at home) can increase various psychological responses,” Murthy said.

A similar helpline is being run by the Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi.

Vulnerable groups

Broadly, there are two types of issues. The first one comes from an extended stay at home, leading to inter-personal problems like domestic violence and managing the kids, who are cut-off from their daily routine. The second set of problems deals with the impending economic and livelihood issues that will crop up once the lockdown ends. As with many other ailments, people from the lowest socio-economic strata are the most vulnerable.

For 25-year-old Chhotey Ram, the journey from Delhi to his village near Hardoi in Uttar Pradesh was a harrowing one. He was among hundreds of migrant workers who could board a bus to travel to his village after the lockdown was announced. But trouble started the day he reached his village Gosave. The village head refused entry for him and a few others and the entire group was shifted to a school, about a two-hour drive away from the village. The school was an isolation facility for Covid-19 suspects. The real anxious moments came when they had to undergo medical check-up every day.

While Chhotey could at least travel to his village, thousands of migrant labourers and daily wage earners were not as lucky, as transportation services came to a standstill. Some of them set out on foot but were stopped by the administration.

In most places, the migrant labourers are stuck in makeshift camps, with poor infrastructure and inadequate food supply. Rumours on the resumption of train services and complaints about the food led to unrest among labourers in Mumbai and Surat last week. While timely intervention prevented a larger flare up, such incidents are also likely to scar the mental make of people who are already under stress.

“For migrant labourers, it is more of a problem of basic needs not being met, leading to anxieties. Their plight may be shocking and disturbing, but understandable too. Hopefully once the basic needs are met, they would act responsibly,” said Nimesh Desai, director, IHBAS.

For Sonu Kumar, a rickshaw puller in Ghaziabad, the lockdown has snatched his daily bread. Earnings have been reduced to zero and the uncertainty has left him worried. Anil Kumar, 35, who earned his livelihood by painting society flats in Noida for nearly a decade, is suddenly without a job. Out of his reserves within a week, he resorts to vegetable selling but the hardship is much more.

“The dominant experiences in these groups are of hunger, hopelessness and fear about if, and when, this nightmare will ever end,” Patel said.

The experts agree it was only a matter of time before a spurt is seen in the number of Covid-19 related mental disorder cases. “Currently we see only the beginning of such cases. When the lockdown ends, we will see more cases because people now find it difficult to reach out to mental healthcare centres,” said Desai.

(With inputs from Akhil Kadidal and Sagar Kulkarni)