Empower family physicians to give psychological first aid: Dr Parikh

Increasing awareness in the country about mental health, says consultant psychiatrist

Family physicians must be “empowered a lot more” to help people in their mental wellbeing as the country doesn’t have enough psychiatrists and counsellors, says Dr SAMIR PARIKH, consultant psychiatrist and chairperson of Fortis National Mental Health Program, Fortis Healthcare. People should be encouraged to talk about their mental health and such conversations must have empathy, he told Namrata Kohli in an interview in Delhi. Edited excerpts:

A premier engineering college in the country had three student suicides in three months. How can suicides be prevented?

Suicide is a concern. Several hundred thousand people die by suicide. In young people, suicides continue to be a concern globally. Whenever we talk about suicide, we must always focus on suicide prevention. To say suicide is an extreme form of mental illness is not the correct way to look at things. That probably also creates more stigma both around mental illness and suicide. There are two aspects at play which may lead to a suicide: One is longitudinal [over A period] and other is the short term/immediate issue. The longitudinal could be a mental illness, like say depression. Let’s say if I am having depressive features for a couple of weeks or months and then there is an immediate stressor, such as exams or academic pressure. Already my moods, thoughts were affected and then when I had a trigger I could not cope.  

Certain illnesses by themselves give thoughts around not wanting to live, like depression. A student who is trying to prepare for exams and has chronic depression for 8-10 months and is also dealing with parental/peer/teacher pressure makes that one exam everything. With this approach, she/he loses a bit of social connect, self-confidence and then a perceived bad result makes that individual feel that there is nothing left in the world. Rather than being able to speak to someone because of the disconnect that has happened, she/he ends up opting for self-harm.

Is there a spurt in mental illnesses?

I don’t think there is a spurt as such of mental illness even though the WHO (World Health Organization) talks about a 25 per cent increase post pandemic for both depression and anxiety. I think the right approach to look at this is, whether a pandemic or otherwise, mental ailments have always continued to be. It’s just that some of us are talking (about it) more, and through social media we get more feeds and information around it because the algorithm sends it to us. Yes, because of overall increasing awareness, access to help and efficacy of the help, you go for help, you get treatment and you become better. That in itself starts a cycle. That’s why more people may be reaching out for help now. But at the same time, almost 75 per cent of the people who need help do not seek help because of the stigma and perceived discrimination.

What should be done to be mentally well?

I think prevention needs to be looked at from a couple of angles. If I look at schools, then from the early years there needs to be an emphasis on balance of lifestyle with a lot more physical activity, exercise, yoga, sports, inculcating life skills such as communication, social assertiveness, and coping with stress. I feel schools also must have a mental health curriculum – and (there should be) focus on emphasising the role of community in supporting individuals – be it family and friends, or at school peers and teachers, or in workplace scenarios or neighbourhood at home. Help-seeking behaviour needs to be encouraged and not looked down upon, and also ensure that access to experts is available.

If one has anxiety or depression, whom should they approach. People talk to general physicians. Is that the right approach?

I am of the opinion that the primary family physician needs to be empowered a lot more. I don’t think we have the kind of experts in terms of ratio to population that every person in the first episode of depression should go rush to a psychiatrist. That’s not a doable thing. I think three things need to be done. First is to strengthen the family physicians’ network and let them decide what is the next step and whether the patient requires a psychiatrist or a psychologist. Second, the digital medium needs to be encouraged as it removes the inequity in terms of access. In some parts of the country, you will have very few experts available than others but digital could be the solution. Finally, we should encourage people to speak to each other and if you notice someone struggling with a mental health issue, be the one to help him get psychological first aid. Be the one to talk to them with empathy, positivity, without any judgement and help them find the solution by linking them to a professional.

How should we ideally be conditioning our mind to be mentally healthy?

Look at the more positive side of things. Every now and then, you will feel negative about something or the other but flip it and see if you can change your thoughts. Focus on social communication and social support. Have a balanced life where apart from your work or academics, you have time for friends and family and also some ‘me’ time. Plus, time to indulge in sports, physical activity, pets, plants, art; basically things that you like. Try to build meaningful relationships which is especially important in this era of social media where we are lost in scrolling our phones all the time. It is very important to ensure that you have time and energy left to cultivate some real relationships.

Work on developing a more problem-solving attitude. Problems are bound to come but try to figure out a solution. If you are struggling with anything and are not able to navigate issues on your own, do not hesitate to seek help from friends, family, and experts.