The psychological and physical consequences of the pandemic have manifested in the lives of people, leading to seismic changes in their engagement with the world. Amid the overnight virtualisation of operations, the increased feelings of social isolation, loneliness, burnout, stress and other mental health complications have been evident among individuals.

Supplementing the anxiety and uncertainty, other factors such as increased screentime, the rise in disinformation, fake news, and the difficult, visual reality mediated by news platforms have also been detrimental for mental health.

Psychiatry services, too, have not been spared by the transitory effects of the pandemic. Alongside the rise is the use of digital platforms in other socioeconomic, professional and educational spheres, the health sector witnessed an increased dependency on the virtual means of consultation and treatment.

The use of telepsychiatry, in the form of videoconferencing or through other digital mediums such as live chats, or phone calls, emerged as a convenient way of communicating with patients. The increased use of virtual mediums to disseminate healthcare services and circulate news has produced various dynamics.

Digital spaces can be used to increase reach and surpass regional barriers to form a social connection. However, caste, gender and class stratifications determine one’s position in the digital economy, restricting access to telepsychiatry, media and forms of mental healthcare treatment.

This essay shares observations from the perspectives offered by psychiatrists, counsellors and mental health experts on the use of digital tools and virtual platforms to provide mental healthcare services and spread awareness across different demographics and social attributes.

This piece will also look at some of the shortcomings associated with the emerging field of telepsychiatry that warrant reflection and further investigation into the increased use of technology as a treatment platform, especially in case of mental health-related issues.

Technology, mental health

Usually deployed during disaster response, telepsychiatry has emerged as a field that makes treatment and consultation accessible across borders. Its development and prevalence as an efficient form of delivery in healthcare systems during the pandemic has been astounding, thus leading to most doctors and patients worldwide digitising their operations.

With an increase in emotions of stress, loneliness, grief, anxiety, boredom and social isolation among first responders and the public, adapting to these systematic changes has been the need of the hour.

Accessibility and efficient, comprehensive models of mental health resources and services can create safe spaces that ensure well-being and help shed the stigma surrounding mental health concerns. Telepsychiatry, in such cases, is essential in helping individuals face and process this ever-changing and challenging reality that the world is collectively facing.

According to a recent survey by the World Health Organization, the pandemic has disrupted or halted critical mental health services in 93% of countries worldwide despite the increased awareness and mental health consultations.

The lack of physical examinations and in-person interactions has also restricted methods of treatment and evaluation that would have been different if consultations were not taking place through virtual means. However, the transition to digital platforms does not come without hurdles and navigating it in the health sector can be difficult.

Through telepsychiatry, patient evaluation takes place by building a rapport that can further lead to a well-rounded diagnosis or a solution to the issues at hand. Dr Payal Chokker, a mental health practitioner based in New Delhi, says that rapport building is the first element determining how future sessions will proceed. In an interview, she said, “Rapport builds trust and comfort with the client, which cannot be fulfilled online.”

Dr Payal Chokker and Swapneela Sethiya speak talk about how technology changed mental health practice.

During sessions, the virtual medium can serve as an obstacle to the efficacy of psychiatry services. Seeking an emotional connection through a purely digital environment can be complex from the patient’s side as the therapist is viewed as an online presence who is otherwise non-existent in physical space. The absence of human touch can lead to a lack of trust and comfort in a client-psychiatrist relationship, which hinders healthy and seamless communication, leading to a strain in diagnosis.

Deviating from traditional in-person practice, telepsychiatry also does not allow a comprehensive assessment due to the clinician’s inability to analyse nonverbal cues, body language and the overall physical presence of the client. These components of examination are integral pieces of information that can supplement comprehensive treatment and diagnosis.

Additionally, in emergency mental healthcare cases, the inability to bridge an understanding of the physical symptoms displayed by the patient can be detrimental. Many of these cues are lost in translation through online consultations. Remote consultations can also affect privacy, which is key to maintain during psychiatry sessions.

According to Dr Chokker, technological errors and scepticism over privacy-related concerns lead to hesitancy in building a relationship of trust with the psychiatrist. A virtual environment does not always provide a secure space. With lockdown restrictions leading families to stay at home, holding private conversations with the fear of being overheard can create obstacles to the ideal circumstance of interaction with a psychiatrist.

“A few of my patients usually had their families in the background of the video call, especially for those from a low socio-economic [strata] cases since they were excited with this form of medical routine.”

— Dr Desiree Saimbi

As a result, patients are more likely to have several undisclosed thoughts that could potentially be essential to their case. Thus, in search of a private setting, many individuals resort to sitting in their cars, a friend’s house, or at a location away from people who would otherwise cause the patient to be uncomfortable to open up and converse freely.

Facilitating a secure environment during telepsychiatry meetings is challenging to implement and beyond one’s control, primarily as social and housing situations differ with each patient. Such barriers are unavoidable in this digital field. To ensure mental wellbeing through a productive psychiatry session, it is essential to learn from the lessons of the pandemic that can potentially lead to better virtual care in due time.

Media, mental health

In times of social isolation, the media – print or television, and social media – mediates news to the comfort of one’s home, serving as either an escape from the grim reality or a window to the world. News articles on the devastation of the pandemic, especially during the deadly second wave in India, were disturbing, and for many, gave rise to remorse and grief.

Dr Desiree Saimbi, a psychiatrist in New Delhi, said the media could have been more sensitive during coverage about Covid-19 deaths and other grim topics. The mention of trigger warnings and the reduced circulation of disturbing images on mainstream media could have potentially reduced mental health complexities.

Even though the media attempted to supplement the general public with ways to cope with this sense of loss, discussions carried forth by mainstream media were inadequate compared to how social media platforms manoeuvred the area of mental health. To maintain mental well-being, several initiatives took to social media to converse about ways to cope with these drastic changes.

Dr Kaustubh Joag and Dr Shruti Khare talk about the lasting effects of the pandemic on mental health.

Implementing wellness programmes, encouraging individuals to prioritise themselves before their work and educational responsibilities, and amplifying personal experiences of grappling with the mental consequences of the pandemic has helped create a platform to spread awareness about mental healthcare.

Additionally, with infographics and articles emphasising measures at personal, educational and professional levels, other avenues of help such as suicide hotline numbers, emergency live chats and websites have circulated throughout the expanse of the internet. These attempts to destigmatise discussing mental health issues in public forums have had positive indications in personal life.

However, many mental health awareness campaigns were short-lived. With trends constantly gaining traction and dying out within weeks on the internet, attempts to facilitate well-rounded conversation about mental health stumbled.

To shed the stigma surrounding mental health concerns and emphasise that every emotional experience is valid enough to seek help, it is essential to keep such conversations from fading out. A multipronged and consistent approach in amplifying the importance of mental well-being in the media can have a lasting effect on the manner in which healthcare is approached, even once the effects of the pandemic wane.

Digital divide, disparities

Equal accessibility of mental healthcare through telepsychiatry has been restricted in case of individuals from to economically and socially marginalised communities. According to a survey by Oxfam India, 63 million people in India have been pushed into poverty annually due to exorbitant healthcare costs. The digitisation of health services has accentuated this inequality for the digitally disadvantaged.

Without smartphones, a stable internet connection and low digital literacy, psychiatric and psychological treatment is inaccessible and costly. Moreover, unemployment has negatively affected millions of workers in the informal sector. Financial burdens, poverty, homelessness, starvation and deprivation are additional psychosocial stressors that increase vulnerability to mental health complications.

Social attributes such as caste and gender are additional factors that contribute to the digital divide and poor mental health in India. Identity-based exclusion from the digital infrastructure is a product of insufficient educational and job opportunities, and social oppression, both of which equally influence each other in reinforcing discrimination against women and individuals from “lower” castes. Indian women are 15% less likely to own a mobile phone and 33% less likely to use mobile internet services than men.

When considering caste-based digital inequality, a study conducted in 2020 shows that only 6% of Scheduled Caste and Scheduled Tribe individuals had a computer at home compared to 20% of those belonging to other social groups. The intersection of inadequate access to mental healthcare and necessary devices is a consequence of prolonged gender and caste-based oppression that has only deepened through the lingering effects of the pandemic and Covid-19 restrictions, making telepsychiatry an unattainable option.

Taking note of the intersection of regional, economic, and social inequalities, telepsychiatry is considered a luxury that is only feasible for the socially and economically privileged. Additionally, the stigma surrounding talking about or reaching out for mental healthcare reinforces the disparities.

To ensure the holistic development of telepsychiatry and the mental health sector, it takes more than re-evaluating linear educational, healthcare, economic and social policy to make an adequate difference.

Implementing policies, programmes, and mental health initiatives that consider the various narratives of marginalised communities is essential to emancipate individuals despite their social and economic standing. The need of the hour is the urgent need to make changes in the several systems that play a role in restricting access to well-rounded mental healthcare.

Summing up

An increased usage of the virtual medium for psychiatry services has transformed approaches to mental health evaluation. Due to the current global health crisis, telepsychiatry bridges the gap of receiving treatment but comes with some costs, which affect its efficacy.

The virtual model, however, also presents itself as a barrier: limitations of rapport building, holistic patient analysis, privacy-related concerns, and equal accessibility for individuals from digitally disadvantaged and marginalised groups have served as significant hurdles that need to be addressed.

With technological advancements initiated to meet changing needs, it is only a matter of time till the health sector gradually adapts to virtual mediums of functioning, possibly leading to seamless evaluation and treatment. To do so, it is essential to ask if virtual correspondence can revolutionise and substitute physical connections and personal communication sought for treatment and care purposes?

This is the second of a two-part series of essays from a recent study undertaken by the Visual Storyboard Team of Centre for New Economics Studies, Jindal School of Liberal Arts and Humanities. More information about the Visual Storyboard Team’s work can be found on their website.

Deepanshu Mohan is Associate Professor of Economics and Director, Centre for New Economics Studies (CNES), Jindal School of Liberal Arts and Humanities, OP Jindal Global University. Ada Nagar is Senior Research Assistant with CNES. Jignesh Mistry is Senior Research Analyst and Visual Storyboard Team Lead, CNES. Vanshika Mittal is Senior Research Analyst and Visual Storyboard Co-Team Lead, CNES. Rajan Mishra is a Video Editor with the Visual Storyboard Team at CNES and works at Amity University, Lucknow. Mohd Rameez is Senior Research Analyst with CNES. Tavleen Kaur, Isha Khurana, Ruhi Nadkarni are Research Assistants with CNES.