The Covid-19 pandemic brought with it grief, a sense of helplessness, disconnect and instability. With every wave and the slew of lockdowns and restrictions, stories and data from across the country indicated high levels of psychological distress as well as gaps in accessing mental health services.
The pandemic has worsened the social determinants that influence mental health: unemployment, food insecurity, social exclusion, poverty, reverse migration and domestic violence among them. While the pandemic aggravated life for those already living with mental health issues, a high rate of people developing mental health concerns for the first time was also reported.
Responding to this emerging mental health crisis, Finance Minister Nirmala Sitharaman said in Parliament while presenting the Union Budget, “To better the access to quality mental health counselling and care services, a National Tele Mental Health Programme will be launched.”
Perhaps our experiences and challenges at Sangath since we launched our virtual Well-Being Centre in June 2021 offering free phone-based mental health services by its team of trained counsellors and psychologists may be useful for others attempting similar projects.
As of March 2022, our centre had received 2,174 unique callers. Common concerns for those seeking help include anxiety, depression, and obstacles related to social/interpersonal relationships. The service provided six free one-on-one counselling sessions for mental health support to people from the privacy of their homes.
Most of the callers are young (mean age 26 years), came from an urban background largely from major cities within Maharashtra, Goa, Delhi, and Uttar Pradesh, and had technical familiarity, easing their process to seek help.
Stigma, women’s concerns
Our experience showed that the stigma around mental health negatively affected help-seeking behaviour. Common issues of stress, especially among women, often go unnoticed due to a lack of understanding of their relationship with mental health services. Further, myths perpetuate the stigma that seeking help to manage stress and difficult emotions indicates a lack of emotional strength.
While the intervention has proven helpful for a segment of the aware and urban populace, the majority of the country’s population is based in rural areas where network connectivity is low and unstable, and there is minimal awareness.
India is known for its linguistic diversity and it is a challenge for helpline services to provide quality, standardised and accessible support to all.
The accessibility and quality of service are further greatly affected by unavoidable and frequent call drops. These interruptions do not only break the flow of conversation and rapport established by the counsellor, but also affect the timeliness of the intervention, particularly in high-risk cases.
Additionally, limited access to safe spaces to engage in call-based therapy is a reality of life in India. If phones are shared in the household, privacy and private access to devices could be a gendered experience with a male member usually controlling access to the phone.
Wider reach, behaviour change
In the paucity of outreach programmes to raise awareness, helplines continue to cater only to those who have been exposed to information that advocates seeking help. Under such circumstances, the challenges faced by senior citizens and those who are not accustomed to using technology are going unnoticed.
There is a need for extensive behaviour change campaigns to prepare the ground for enhanced uptake of mental health interventions. There is documented evidence of government programmes on raising awareness on HIV/AIDS, polio, tuberculosis, and reproductive, maternal, newborn and child health interventions. Similarly, a comprehensive mental health awareness programme is strongly needed in the country if interventions are to succeed on scale.
Beneficiaries who gain support through the helpline may find it easier to access support through traditional means in the future. However, it falls upon the strength of the system to provide for sustained support by creating infrastructure that backs the first line of response.
While it is important to recognise that mental health issues are on the rise and there is a definite need for mental health first aid interventions, they continue to remain an entry point. Without the assurance of a sustained backing of systemic changes, we run the risk of a high prevalence of disability. The World Health Organization estimates that India will lose close to $1.03 trillion due to mental health conditions between 2012 and 2030.
The value of disability-adjusted life years among the projected instances in India could potentially outweigh the budgets currently allocated for the services. For the creation of an equitable health system, availability, accessibility and acceptability continue to remain the three most important factors for the assessment of large-scale interventions.
Currently, there are governmental and non-governmental mental health helplines running in the country. These include several helplines that cater to the needs of various segments of the population. What is lacking, however, is a consolidated effort to align projects through inter-linkages and combining accountability mechanisms and domain expertise for efficacy in providing population-based solutions at scale.
If you or anyone you know would like to talk to someone and receive some mental health support, our wellbeing center offers free telephone based counselling, community support, and self-management resources. Call 011-41198666 between 10am and 6pm
Abhijit Nadkarni, Pooja Nair, Ila Patil and Rhea Sharma contributed to the writing of this piece.