Social distancing adding to mental health woes

As the country battles coronavirus with social distancing, experts fear that isolation may lead to wide-scale mental health crisis, writes ASAD ASHRAF

A day after Delhi is under total lockdown, on March 23, 25-year-old Delhiite, Saima Rehman called upon her counsellor to learn ways to cope with her anxiety and depression with social distancing and quarantine becoming the norm amid large scale Corona fears across India.

“It has just been two days of being at home and not meeting many people; my anxiety and panic attacks have already shot up. As an extrovert, this self-isolation, social-distancing, quarantine is taking a toll on my mental health. It is bad. The longer I am in quarantine, the worse my mental health gets, and the way the situation in our country is escalating, I don’t know what’s ahead for us,” Saima told the Tehelka.

“As advised by my counsellor, I am trying to distract myself by offering prayers, sharing jokes, cooking, reading, and watching stuff on Netflix. But at the end of the day, I am still scared, angry, and my anxiety is through the roof,” she added.

Saima is one among millions of Indians coping up with mental health issues in the country. Mental health experts believe that social distancing and isolation of people living with depression and mental health issues might aggravate their illnesses further. More so, anxiety and panic combined with social distancing and loneliness could be lethal and further complicate mental health cases.

According to National Mental Health Survey commissioned by the Indian government and executed by Mental Health and Neurosciences (Nimhans), pointed out that in 2016, 150 million Indians (10.6 per cent of adults) were suffering from a mental health disorder. Subsequently, a report by World Health Organisation in 2017 highlighted that mental illnesses comprise one-sixth of all health-related problems, and India accounted for nearly 15 per cent of the global mental, neurological, and substance abuse disorder burden.

The report also predicted that by the end of 2020, 20 per cent of Indians would be living with some form of mental illness. The organization estimates that between 2012-30, India’s mental health emergency will cost the economy as much $1 trillion.

The experts accept that with Coronavirus and efforts like social distancing to curb it, a psychological health crisis in India will emerge.

Dr Sanchari Mukhopadhyay, mental health professional and Ex-senior resident of Lady Harding Medical College, New Delhi, believes that even though in people not predisposed to have a mental illness, it is unlikely they will have extended time life-changing experience. However, fear, anxiety and distancing may cause adjustment issues and that is trauma-related and stress reactions.

Nevertheless, it is pertinent to mention that even the slightest increase in mental health cases will make India vulnerable further to socio-economic losses as we do not have the necessary infrastructure to deal with psychiatric issues. The 2017 WHO report had pointed out that there were fewer than two mental health professionals for every 1,00,000 people.

“Social distancing and isolation can aggravate things for people already facing mental health issues, and it is valid for quite a lot of psychiatric illnesses like psychoses, mood disorders. Fear and distancing may cause adjustment issues, anxiety, trauma-related and stress reactions. But in people otherwise not predisposed to having mental illnesses, it’s doubtful that they’ll have a long-term life-changing experience. If at a mild to moderate level, trauma-focused therapies or behavioural activation scheduling or developing healthy coping strategies should be sufficient to deal with it,” says Sanchari Mukhopadhyay.

For other patients like Gurmehar (name changed), 28, a fellow with Delhi government, obsessive compulsion disorder along with anxiety, social distancing can add to her misery and bring down her work productivity.

“Although I would often put myself to isolation due to interest in life, now enforced social distancing has made that mandatory. I do not feel anything as of now as isolating myself from the world has been not new for me, but I also understand the consequences quite well and it will exacerbate my health conditions in the long run,” Gurmehar said.

“It was only last year that I had started working as a full-time fellow with the Delhi government and could see that mental health condition was improving. Now with this isolation amid the practice of social distancing, my symptoms will rebound in some form,” she added.

According to a senior doctor at the department of Physiatry at All India Institute of Medical Sciences, coronavirus pandemic has already led to an increase of 30  per cent cases. And most of the government hospitals did not have the necessary infrastructure to deal with such a surge in the number of cases. And growth in mental cases will also adversely affect the economy visa vis decreased productivity of the workforce.

The outbreak of the virus has already caused anxiety for one’s health among individuals. With the government putting a complete lockdown now to prevent transmission of the virus, people are also experiencing “fear of social isolation, loneliness, financial lockdown, constraints at home… accompanied by feelings of low”, the doctor said.

The medical journal, The Lancet, published a study on the psychological impacts of quarantine that suggests several negative consequences such as post-traumatic stress, confusion and anger. The study highlights the reason f0r stressors will include fears of infection, a longer quarantine duration, frustration, boredom, inadequate information, lack of supplies, financial loss and stigma.

Commenting on the general conditions to tackle any surge in mental health cases, Dr Mukhopadhyay said, “As of now, awareness of the people regarding mental health is not very satisfactory. We still stigmatize persons with mental illness. We surely need more knowledge, more readiness to appreciate and accept and more accessible mental healthcare (available for all- rural/ urban, male/female, educated/ not formally educated, employed/ unemployed and so on). Though we’ve come a long way from when all illnesses were considered witchcraft or ghostly, we still have a long way to go.”

Meanwhile, two deaths by suicide, allegedly linked to the pandemic, have been reported. In what is most likely as the first death by suicide anywhere in the world related to the epidemic, a 50-year-old man died by committing suicide after becoming convinced that he had contracted the virus. According to the deceased’s son, the man would continuously watch coronavirus-related videos circulating online. On March 18, a 35-year-old man, suspected to be a coronavirus patient, committed suicide at Safdarjung Hospital.