Hypothesising a spike in mental health-related issues, Suicide Prevention India Foundation (SPIF), a Section-8 not-for-profit, reached out to mental health professionals (MHPs), that included psychotherapists and psychiatrists, across the country to explore common concerns people seeking therapy have been facing, the changes in help-seeking and how the pandemic is affecting the therapists personally.
This survey was conducted in the month of May, towards the end of the nation-wide lockdown imposed by the Government of India. Even before COVID-19 ripped through India, the state of mental health was already in crisis with 150 million Indians in need of mental health services, and only 30 million receiving any form of care (National Mental Health Survey of India, 2016). With the lengthy lockdown, forced isolation, fear of the virus, financial insecurity, domestic violence and rising anxiety the crisis has deepened and is perhaps heading towards a catastrophe.
According to COVID-19 Blues, an online survey where SPIF interviewed 159 MHPs from across the country, suicide ideation, self-harm and relapses have all risen.
Talking about the same, Nelson Vinod Moses, Founder, SPIF, said, “We believe the data will contribute to understanding COVID-19 on how it may have exacerbated mental health conditions, trends in help-seeking behaviour, key demographics impacted, and the increase in self-harm/suicide ideation during this time”.
Noor Malik, Research Consultant, SPIF, added “Being locked down in the face of the pandemic has increased the already prevalent risk related to mental illness, financial insecurity and work stress while triggering new anxieties, feelings of not being in control, depletion of social networks, job uncertainty, abuse and social isolation. This, in turn, has led to an increase in mental health-related issues affecting almost all sections of the population regardless of economic and social backgrounds”.
While the pandemic has been an equaliser affecting everyone in some way, the data reveals that some groups have been impacted more than others in the context of mental health. Help-seeking was highest amongst individuals aged 25-40 years, followed by those aged 18-25 years and 40-60 years, as reported by therapists. The highest increase in help-seeking through therapy was found among females followed by males.
A considerable number of therapists said they experienced an increase in gender diverse individuals and a few saw an increase in trans individuals seeking therapy. 79.9 per cent of the therapists saw a rise in the number of working professionals opting for therapy. 59.7 per cent of the therapists saw an increasing number of students seeking counselling. 52.2 per cent of the therapists observed an increase in the number of individuals with a pre-existing mental health condition.
Sharing more thoughts about the figures, Noor added, “Younger individuals, working professionals and women are seeking more help during these times. This could mean that they are most open to help-seeking but this doesn’t take away from the fact that almost all demographics are affected adversely in the current situation”.
What's concerning is the fact that 29 per cent of the therapists have observed an increase in clients who have self-harmed, as well as those who have expressed suicidal ideation or death wish. Over 42 per cent of the therapists reported a possible increase in individuals presenting with suicidal ideation and 35.8% reported an increase in people having self-harmed. While most therapists (48.4 per cent) said the increase in suicide ideation has been below 10 per cent, some (22.6 per cent) have reported an up to 50 per cent spike. The increase in persons who have self-harmed also shows a similar pattern.
While many groups of people are vulnerable to triggers inherent in the uncertainty that comes with a pandemic, those with an existing mental health condition are at a higher risk. More than half of the therapists (57.9 per cent) who took the survey said that individuals who had previously recovered or were making a recovery, have now relapsed. Nearly a third of them said this may be the case with people they work with too. While the majority of them (42.8 per cent) found that the increase was below 10 per cent, many (37.7 per cent) observed an up to 50 per cent hike in relapses, with one therapist having experienced a doubled rate.
“India already has the highest number of suicides globally. With the COVID-induced lockdown, self-harm and suicide ideation have upped. Other than creating awareness, reducing stigma related to help-seeking, and providing psycho-social support, the government will need to increase socio-economic safety nets, and think of ways to support those suffering abuse,” noted Nelson.
With longer hours spent virtually with their clients, the therapists’ mental and emotional investment into their work has gone up. Most therapists (62.3 per cent) are experiencing caregiver fatigue as a result of the current COVID-19 situation, lockdown pressures and doing only/mostly telepsychiatry. The pressures of the pandemic have impacted the therapists’ personal lives as well, in turn, affecting their ability to work at their full capacity. While most (64.8 per cent) therapists reported being mildly impacted, a portion (11 per cent) has been severely impacted by this. Some suggested that they were not impacted by the current situation, which could imply that they have either been sheltered from the negative impacts of the pandemic or that they have been able to effectively deal with the changes.
However, the good aspect is that close to 54.7 per cent of mental health professionals reported that there has been an increase in the number of people seeking therapy for the first time. Considering that the country has an 80 per cent treatment gap, where most of those who need behavioural healthcare do not have access or are hesitant to access it due to shame or stigma, this is a green shoot.
Further, therapists across the country have witnessed an overall increase in help-seeking in the form of therapy. A whopping 68.6 per cent of the therapists reported an increase in the number of clients and in the hours they spend counselling after the pandemic hit. A few others reported a possible increase.
Nelson said, “This might be a good time for the government to more seriously implement the Mental Health Care Act, 2017 that promises mental healthcare for all with a rights-based approach. It is time to mainstream the mental health conversation so that there’s awareness, increase in help-seeking and shedding of stigma. It is time for a mental health movement that normalises these conversations and leads to a focus on mental well-being right from a young age”.
The increased anonymity, accessibility and ease of use that comes with online counselling might have helped people overcome their resistance towards therapy. Additionally, the fact that a large number of therapists have considerately offered their services for free at this trying time, may have also made the choice of seeking help easier, by making it financially accessible to many more.
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