Age of anxiety: Mental health is the next looming crisis in Covid-19 times

It needs swift, sensible attention, writes Nikita Puri

It’s been weeks since he returned to India, but Suhel Mehta (name changed), still gets anxious when he thinks about his last few days in Italy. Mehta was in Lombardy, at the centre of the Covid-19 outbreak. He locked himself up, choosing to virtually starve than step out of his room and risk infection.

He flew out as soon as he could, abandoning the work he had travelled for. 

“It had become so bad, he had begun to feel that just breathing would make him ill,” says Debanjan Banerjee, a psychiatrist at Bengaluru’s National Institute of Mental Health and Neuro-Sciences (Nimhans).

Soon after India went into lockdown, health professionals realised there were many more challenges they would have to confront, apart from people’s fear of getting sick. “Initially we saw stigma against those sick or in quarantine, but that has now evolved into a more generalised anxiety,” says Kiran P S, state nodal officer, mental health programme, Kerala.

In India, a 23-year-old jumped to his death from the seventh floor of a hospital in Delhi soon after he was tested. Posthumously, his results proved negative. A 50-year-old in Andhra Pradesh, a father of three who’d watch coronavirus-related videos all day, convinced himself he had Covid-19 after he developed flu-like symptoms. He’d beg people not to come close and would pelt anyone who approached with stones.

The pandemic has travelled across the globe leaving a trail of grim stories. “The focus on the death toll or infection rate of this pandemic unfortunately eclipses its massive psycho-social impact,” says Banerjee. With masks and sanitisers becoming precious commodities and social media and news focusing primarily on Covid-19, the virus, he observes, has “come to occupy the deepest corners of our minds”.

A review of different studies published this February in the The Lancet finds a high prevalence of psychological distress, anger, depression and post-traumatic stress disorder (PTSD) after episodes of people living in isolation or quarantine in the face of epidemics such as severe acute respiratory syndrome (SARS). It adds that the impact of quarantine is wide-ranging, substantial and long-lasting. A key takeaway from the studies: the physical spread of a disease can be halted through isolation and distancing protocols, but there is no saying what effects it will have on mental health, and how long those effects could last.

The primary ways of containing a pandemic — isolation and physical distancing — have made the world a place we’ve never seen before. Now the mere sight of people standing close together sets off a mental alert. This is a time when we stay away from those we love — to keep them safe. Even as states attempt to flatten the curve by patrolling streets and borders, mental health also has to be made a priority. The relief that will follow once the spread of the virus is halted will otherwise be bittersweet in the wake of a different kind of disaster — a chronic mental health crisis.  

Early every morning, Zirak Maker, a child and adult psychiatrist and psychotherapist with Mumbai-headquartered mental health organisation Mpower, takes a count of the number of calls on their helpline. They received over 2,000 calls in five days on the toll-free number set up on April 3 in partnership with the Maharashtra government and the Brihanmumbai Municipal Corporation.

Calls on other helplines, like the one Nimhans has set up, echo the same story: lockdown is making people anxious. The calls make clear the uncertainty created by the pandemic, the reality of job losses and salary cuts, of suspended examinations and unsure college admissions. After getting 300 calls in the first 48 hours of launching the helpline last week, Nimhans is now working on partnering with regional institutes (such as Christian Medical College, Vellore) to make help more widely accessible.

Among states, Kerala has a well-rounded approach to tackle mental health issues. Besides having dedicated helplines for all its 14 districts, it has roped in professionals to call those in quarantine every three to five days. Beginning with counselling for health professionals, the state is now aiming to offer others on the frontline counselling services too, including the police. 

As this stay-at-home trend continues, some have also been feeling the pressure to be even more productive than usual. Simple things such as deciding to finish reading a book you’ve been putting off, or dust off the guitar to learn new tunes, itself creates pressure. “The pressure to be productive is heightened by social media, especially when superstars paint a rosy picture of perfect lives,” says Marker. There are stories galore of young people living alone, or elderly parents cut off from their support systems. “Many have been displaced because of the sudden lockdown. Now people are constantly worrying about their siblings, parents and children,” says Marker.

There’s never been a better time to turn to self-help. The guidelines for living with families are similar to those living alone: make a schedule, stick to it. Don’t skip exercise if you can’t go out, do it at home. “From waking up at a specific time to meals and bedtimes, stick to this schedule not just to restore your work-life balance, but to also cater to your physical, emotional and psychological needs,” says Marker. With families, ensure quality time. “Take the time to play board games,” he advises. Staying in touch with loved ones should also be part of our schedules, he adds. “Acknowledge that this is a difficult phase — there will be anxiety, there will be insecurity. But optimise technology and reach out.”

For those with pre-existing conditions, trauma can manifest itself in multiple ways. A man diagnosed with an obsessive-compulsive disorder (OCD) now washes his hands 30 to 40 times in a day. “There’s more paranoia now. He’s wearing a mask and gloves even at home,” says Marker. His family doesn’t have it easy: he’s agitated and aggressive, insisting they clean the house five to 10 times a day. Pre-existing mental health disorders are likely to worsen due to unavailability of medicine or limited access to help.

The next three to six months will be crucial, with cases of PTSD going up, says Banerjee. “This won’t be classic PTSD, which usually happens with an acute traumatic event, like experiencing a war or sexual assault,” he says. Instead, it’ll be a chronic form faced by those who’ve lost loved ones to the pandemic, or were distanced from them, or have been in isolation for a significant period of time. Marker agrees: “It’s going to get worse in the coming months.”

Rabia Sen (name changed), a 24-year-old from West Bengal, is one of the many showing signs of PTSD. She talks of a fear she can’t pinpoint, has weeping bouts and has started having trouble sleeping and focusing on anything in the last few days. An anti-trafficking activist, Rabia herself was rescued over five years ago. Staying indoors has brought back memories of the past. Even in the unorganised sector, says Roop Sen of Kolkata-based technical resource organisation Sanjog, people need to find “support groups, a network that can communicate through social media,” besides reaching out to health officers.   

One way to move forward is to inculcate a sense of collective responsibility, says Marker. “We tell people that this is not a city- or country-specific thing. You have to safeguard not just yourself but your loved ones as well.” This rationale of collective responsibility needs to be constantly reiterated. And, as unwilling participants in an anxious moment in history, it’s imperative that we identify our problems: there can be no antidote without first recognising what ails us. Mindfulness has graduated from being a trend to a need of this long hour.

“We don’t know if it’s going to last for another two weeks or two months. Existential hypothetical questions only create more panic and anxiety. You have to collect your thoughts and move forward with gratitude for what you do have,” says Marker. Being kind to oneself and others has always been good advice; it’s even more relevant today.

There’s no handbook that could have prepared us for living in this period in history, for the adults who thought they knew what life’s challenges were, for the children who’ll be known as the Covid-19 Generation, for those whose lives will now forever be defined by changes wrought in this time. What do exist are support systems. Tap into them. Reach out.