Pragya Lodha remembers the hours after Prime Minister Narendra Modi announced a nationwide lockdown to contain the spread of coronavirus. It was the middle of the night. A patient was calling her phone. The patient had suffered “a breakdown” and was having suicidal thoughts. “They said, ‘I cannot stay in my house [anymore],’” recounted Lodha. “‘I’ve managed for the last three days, but [the days ahead] look scary.’”
Lodha is a clinical psychologist and the programme director of the Mumbai chapter of MINDS Foundation, a nonprofit that expands mental health services to rural India. The days since the outbreak of Covid-19, she says, have been hard. There is heightened anxiety among the public, which is causing reactions ranging from “general distress to severe anxiety and sense of isolation,” said Lodha.
Recognition of these mental health ramifications of Covid-19 had come relatively early. On March 18, the World Health Organisation released advice on protecting mental health. Among its recommendations: “avoid watching, reading or listening to news that could cause you to feel anxious or distressed”; “find opportunities to amplify positive and hopeful stories”; “protect yourself and be supportive to others”.
But general guidelines go only so far. To fill the vacuum caused by the lockdown, mental health service providers have been taking to the internet, offering counselling sessions over video calls and staying connected via webinars and social media.
Rashi Vidyasagar is a co-founder of The Alternative Story, a mental health startup that has always conducted 80% of its counselling sessions online. Since the lockdown began, The Alternative Story has been “training other professionals and organisations in the skill sets [required for online therapies]”, said Vidyasagar.
Pratiksha Tewari, a therapist at the Hank Nunn Institute in Delhi, said working from home brings its own set of challenges. “There are articles on how people need to keep themselves occupied [during the lockdown], but what we don’t realise is that people with mental health difficulties often depend very heavily on routine to cope with distress. Going to work or meeting friends is a coping mechanism for many.”
The internet hasn’t helped – and can’t help – everyone, though. “The language of mental health, the way [the] services are run, [and] the costs isolate a large section of the population – it is a problem that existed even before Covid-19,” said Divya Kandukuri, the founder of Blue Dawn. Blue Dawn is a support group that facilitates mental health services for Bahujans (Scheduled Castes, Scheduled Tribes, Other Backward Classes, Nomadic Tribes, Decriminalised Notified Tribes).
While it is conducting workshops online, Blue Dawn has had to halt its field work in remote areas. “It’s not like we conducted therapy sessions [in the field], but sitting with [people] and talking about mental health for eight to 10 days made a difference. That has stopped,” said Kandukuri. “The marginalised section, which is already more affected due to Covid-19, is not getting mental health services.”
For those living in urban areas, online therapy is circumscribed by lack of space and privacy. Tanisha Singh, a 29-year-old counselling psychologist from Mumbai, has been in therapy for two years and has had one online session since the lockdown. “A major issue I faced was lack of space,” she said. “Since my sister has been working from home and my family is visiting, I was very aware of the fact that there were people in the next room. This affected my openness in the session.”
Home is not always a safe space, especially for those dealing with familial conflicts or coming to terms with their sexuality, said experts. On the one hand, said Vidyasagar, “people are increasing the frequency of therapy [sessions] because they are staying at home with families or people that might be their triggers”. On the other hand, “a lot of people who are queer can’t openly be themselves. Their coping mechanism has been taken away.”
Neela Chakravarthy, a 25-year-old freelance writer from Hyderabad, said online therapy was not as effective for her as in-person sessions. “There was some miscommunication over video with respect to what I was trying to say and what my therapist understood. I think I was also more distracted and less open in the video session due to lack of privacy at home.”
In addition to logistical problems, such as unpredictable connectivity, there are other limitations to the internet. Tewari said, “We are still doing intakes, but I have had patients choose to not begin therapy and wait till we move back to in-person sessions. They were not comfortable with the idea that they have never met me.”
Despite its shortcomings, the internet has been helpful for many, providing some solace amid solitude and paranoia. “Long ago, I had read this poster that said ‘when you have obsessive compulsive disorder, you think if I don’t wash my hands, my father will die.’ In this case, that’s actually true. If I don’t wash my hands, my father might die,” said Vidyasagar, summing up the bizarreness of our times.