Onset of Mental Health Crisis: Changing the Conversation in Pandemic times

Jitamanyu Sahoo & Syed Mujtaba Hussain

The current pandemic situation across the globe has accentuated the pre-existing trend of mental health issues to the global forefront.  What is more alarming is most of the world is under complete or partial lockdown and people living or developing mental health issues are unable to access the basic treatment. The emergence of mental health issues which is visible now in the low and middle income countries and its address has been thwarted by the pandemic on the run.

The COVID-19 as it unfolds is going to have lasting and profound effects on the mental health. Under the sub-text of ‘Changing the Conversation’ we would be writing series of articles on how to put forward a public health response on mental health challenges from different vantage points. The deniability of mental health treatments to individuals and vulnerable groups is due to lack of awareness and stigma attached to it. This stigma multiplies over a period of time having an enduring effect on mental health. Moreover, absence of coherent data, form, extent, duration and distribution has led to difficulties in mitigating the mental health issues now. Here, we look at the onset of mental health problems which is looming before us and how we must start a conversation.

Distress, Disorders and Disabilities

There is no health without mental health. A healthy person should have a healthy mind. A healthy person should be able to think clearly. A healthy person should be able to find solutions to her problem. A healthy person should be able to have good relations and be satisfied. It is in these essential aspects of our health which is known as mental health. Prof. Vikram Patel (one of the leading psychiatrist of the world) says mental health problem is ‘a problem experienced by a person which affects their emotions, thoughts or behaviour, which is out of keeping with their cultural beliefs and personality, and which is producing a negative effect on their lives or the lives of their families.’ The way a physical body can be ill, the mind too can be ill.

However, it is important to understand there is severity in which mental health problems can be categorized as it affects the impact of the individual.

• Distress is the most common type of mental health problem. Distress is characterised by a mixture of different complaints (such asfeeling sad, worried, tense or angry), often of short duration, and in response to difficulties in one’s life (such as the loss of a loved one).

• Disorder is a more severe, but less common,type of mental health problem. Disorders are characterised by more clearly defined groups of complaints which can be classified using a medical diagnosis, typically of a longer duration than distress, and not necessarily associated with, or explained by, difficulties in one’s life.

• Disability is the most severe, and least common, type of mental health problem. Disabilities are characterised by enduring impairments in a person’s daily functioning (e.g. the ability to communicate with others) and may be present from birth or very early childhood, or appear later in life as a consequence of a mental disorder.

The categories lay emphasis as Prof. Patel highlights on mental health problems which can be suspected and thrive on an individual even in the absence of physical disease.

Identification and Assessment of mental health problems

According to the survey conducted by The Indian Psychiatry Society after 21 days of the lockdown in India revealed a rise of 20 percent rise in mental health cases. This survey has raised pertinent questions on the need for early recognition of mental health issues during a health crisis and the consequences for the person affected by it. Can we say that the rapid propagation of online surveys which claim some representation and media attention captured atleast the broader mental health problem during the pandemic? How can the value of the data collected through the samples be measured against the use of the data? Does larger sample sizes in identifying the mental health issues solve the biases attached?

There is inter-dependency on how we identify the mental health problems and which lead to timely assessment and treatment. The causes of identification problems includes lack of knowledge of health and social care staff, about the symptoms ( be it emotional, cognitive, behavioral or perceptual), not addressing the learning and physical disabilities, lack of information being shared among peers and difficulties for an individual to communicate her distress. Since the identification of the mental health problems is impaired; assessment and resource allocation becomes ineffective. We need now comprehensive evidence through surveys with detail sample strategy which is currently unavailable to mitigate the mental health challenges before us today.

Starting the Conversation

Mental health problems, depression, anxiety and so on are conversation which the society till now is not willing to engage with and take note of. The individuals going through the traumatic experience are categorized as weak, attention seeking and they need to toughen up. This belief which lingers on in a community is one of the central reasons why stigma is attached to mental health education.

In this health crisis another crisis of mental health has emerged. How do you a start a conversation in this pervasive atmosphere. The community needs to be receptive and take the initiative. If someone you know, or even don’t know needs assistance and to have a conversation ask them “Are you OK?”, “I’ve got time to talk” “So tell me about..? “Lots of people go through this sort of thing. Getting help will make it easier” “There are people that can help. Have you thought of visiting your doctor?”.

Moreover, the role of family members and caregivers becomes paramount to identify for instance the behavior, signs of distress, loss of skills or onset of cognitive systems. Since family is the first point of contact to an individual, when families raise concern the treatment by paid career or psychologist could be carried out. The lockdown due to pandemic have forced the persistence of mental health problems and denied access to diagnostic interventions.  But community and family can be integrated to promote mental health at all levels of care.

We can and must do better.