India has a sizeable army of helpline counsellors whose job is to listen without prejudice and offer support without judgement
Lounge takes a look at what the reality of working on mental health helplines look like in this country
A little over a month ago, the results of the Telangana intermediate examinations left hundreds of thousands of 17- to 18-year-olds aghast. It appeared that roughly 328,400 students, out of the 970,000 who had taken the exam this year (almost a staggering 33%), had failed. Investigations into the abysmal success rate led to some shocking revelations.
It was found that Globarena Technologies Pvt. Ltd, a private agency that was tasked by the state government to conduct the exam, had made colossal blunders. In its haste to meet the deadline, it had assigned 100 scripts to each teacher for correction every day, when the threshold for this number, as experts pointed out, is usually 30. No wonder errors of evaluation were aplenty. Worse still were the mistakes made in computing the results. In one particularly egregious instance, a student was marked 00 in the Telugu paper when he had reportedly merited 99 out of 100.
In the 10 days that followed the publication of the results on 18 April, mayhem ensued. By the time ministers and bureaucrats stirred into action, fuelled by public outrage, the damage had been done. At least 25 students who had failed the examination had killed themselves—though not all their results had been subject to technical errors.
The scale of this senseless tragedy not only exposed the callous and irresponsible education system in Telangana but also shone a light on the steep premium that is generally put on academic performance in India, often at a dire cost. The proof of such systemic and societal failures, especially their effect on the mental health of young people, is perhaps most palpably felt in the paramedical spheres.
“We receive a high volume of calls from young people during exams and around the time results are published," says Anita Gracias, who works as a volunteer at Sahai, a Bengaluru-based helpline for the suicidal. “I wish our children were taught ways of dealing with stress as part of their school curriculum," she adds.
Gracias is among a sizeable, though mostly invisible, army of helpline counsellors in India whose job it is to be the patient ear and voice of comfort at the other end of a telephone line, offering advice free of judgement and any cost (the caller usually pays only for the cost of the call). While many of these people work as volunteers, some are employed in salaried positions with different platforms.
All of them have to undergo rigorous training, be it in the form of academic courses or workshops offered by different helplines, clocking substantial hours of experience before they are actually put on call. They also have to be mindful of their own self-care and remain in therapy and/or under supervision for the entire duration of their career as counsellors. Last, but not least, they are required to accumulate experience, incrementally, by regularly attending modules and seminars offered by mental health professionals and related organizations.
In a country of 1.3 billion, where there is one psychiatrist for every 37,000 people with mental health concerns, according to an analysis of the latest figures released by the World Health Organization, these helpline workers render an invaluable service to society, though one that remains largely under-appreciated.
A report published last year in the medical journal Lancet Public Health shows that India accounts for a growing share of the world’s suicides (quoted in “Suicides In India: What Data Shows", Mint, 17 October). According to data from 2016, cited in Mint’s report, the leading cause of death for men and women in India between the ages of 15-39 is suicide. Further, all the five southern states, though more economically prosperous, are also more suicide-prone than states in the north. Although suicide was decriminalized in India by the Mental Healthcare Act of 2017, it still invokes a degree of shame and censure in society.
“Most of our callers reach out to us due to interpersonal traumas," says psychiatrist Lakshmi Vijayakumar. “And very often they don’t want to die, but they say they can’t live like this—the way their life is at that moment." In 1986, Dr Vijayakumar and her psychiatrist husband founded Sneha, one of India’s earliest suicide intervention helplines—also a rare one that operates 24x7 across 365 days—in Chennai. Since then, it has played a crucial role in increasing awareness about suicide prevention across Tamil Nadu, one of the most suicide-prone states in the country, running programmes to educate students and young people, trying to remove the stigma that is still attached to seeking help for mental health issues.
Almost all the helpline professionals Lounge spoke to cited relationship problems as being the most common reason for the calls they receive. “Unemployment, or under-employment, is another major trigger," says Patrick Vaz, the coordinator of Sahai, who has been associated with the platform for eight-nine years. “Some years ago, a politician had mentioned Sahai at a rally for farmers in Karnataka," he says. “Soon after, I remember, some farmers started calling us, under the misguided notion that the helpline would offer them financial support." After actor Deepika Padukone’s mental health organization, The Live Love Laugh Foundation, listed Sahai on its website, Vaz says, some people called the helpline hoping to have a word with the actor.
Sahai was founded in 2002 by a Bengalurean, K.K. Rajagopal, with the support of the National Institute of Medical Health and Neurosciences (Nimhans), the Rotary club, and Medico-Pastoral Association (MPA). Currently, it is MPA that takes care of Sahai.
Rajagopal and his wife themselves sought treatment for depression when their daughter died in an accident. Once he managed to cope with his grief, he wanted to help others in distress, a common impulse for many who volunteer their services on helplines. For instance, Gracias, who was one of the first counsellors at Sahai, joined the helpline shortly after she had overcome a phase of depression.
“You don’t get to choose the cards life deals you," she adds. “How you play your hand is up to you." While Sahai, like most helplines, has fixed working hours, Gracias often allows clients to call her on her mobile phone outside those slots. Typically, a call is about half-an-hour long, but, in extreme cases, when the caller is in a precarious state, it could go on for 3-4 hours.
“We very often receive multiple calls at the same time," adds Malini Sridhar, executive director of the Parivarthan Counselling, Training and Research Centre. The 10-year-old Parivarthan Counselling Helpline (PCH) owes its existence to the feedback of its teenage clients. Initially called Youth and Child Helpline, it is now open to, and accessed by, people of all age groups. PCH is currently run by “a team of 15 trained, multilingual, gender-sensitive, professional counsellors," Sridhar says. It is not exclusively a suicide helpline and the service is provided by counsellors who are paid an honorarium.
“Of course, we do receive calls from people who feel suicidal," counsellors say. “We are sensitive to picking up hints about their suicide ideations and once we understand there is a threat of self harm, we have a defined protocol to work towards client safety."
Listen without prejudice
Apart from being free, in a nation where professional mental health services are not only hard to access but also difficult to afford, helplines provide a confidential and non-judgemental platform where callers can speak freely, without having to identify themselves. Counsellors at Parivarthan, who also work face to face with clients, say that the anonymity of a helpline sometimes makes it easier for clients to speak about their vulnerabilities.
“Technology-assisted services like ours can give clients a lot of privacy as well as anonymity," says Tanuja Babre, programme coordinator of iCall, a helpline which has been incubated by the Tata Institute of Social Sciences (Tiss) in Mumbai. “We are a feminist, queer-affirmative safe space with a team of 16 multilingual and full-time salaried professionals, offering their services on phone, email and online chat."
Like most helplines, iCall is a free service, with callers from all over India and even beyond. “We get calls from NRIs (non-resident Indians), who may not have counsellors or therapists that are capable of understanding the sociocultural nuances or realities of the problems they are facing," Babre says. About 54% of people call iCall again and some have been in touch with the counsellors for three-four years.
While most helpline counsellors try their best to replicate the experience of face-to-face therapy by being fully present in the moment and paying close attention to their caller’s speech, there are always cases where telephone counselling isn’t enough. All helpline workers usually have a database with references for doctors and hospitals in different parts of the country, to whom they can refer the caller. But in cases where telephone therapy works, there is usually a distinct shift in the caller’s manner: Their voice modulation calms down, their breathing becomes steadier, and it is then possible to build up their confidence in themselves.
The strain of the job can be overwhelming though. “Even though we have a self-care allowance for our staff to access therapy, we still see burnouts," says Babre.
Sahai has, on an average, 30 people, but the numbers keep dropping and new members are added to the pool every few months. Sneha takes in only 7-8% of those who apply to join it. “Every candidate has to appear for an interview that may run for 3-4 hours. It probes their mental health history, attitude to life, motivation to work, and so on," Dr Vijayakumar says. “Many people who apply to join us often turn out to be in need of help themselves."
“We look for a few specific qualities in a potential volunteer," Gracias adds. “Good problem-solving skills, a capacity for empathy, high levels of tolerance, and so on." The task of a counsellor listening to a caller is not to intervene and offer advice but to be a non-judgemental sounding board. “My job, as I see it, is to walk beside my callers and pick them up when they fall," she adds.
DIAL M FOR MENTAL HEALTH
There are many mental health helplines operating across India—the details are available on the internet. Here is a list of five that offer services free of cost.