Grief, fear, anger in covid country9 min read . Updated: 26 Apr 2021, 06:10 AM IST
The unprecedented toll on mental health has become a parallel pandemic that deserves urgent attention.
The unprecedented toll on mental health has become a parallel pandemic that deserves urgent attention.
Ahmed had voluntarily moved to Bengaluru to work as a partner for a popular food delivery app two years ago. He returned to his family’s one-room tenement in Mumbai earlier this month after his sister and brother-in-law were detected with covid-19. “I used to be out working all day, maybe I too will get sick. If I cough, I’m scared. I can’t sleep or eat," he told Mint.
He hears his colleagues taking ill every day, some of them seriously so. Much-in-demand e-commerce companies saw a number of their delivery personnel call in sick last week or two, forcing a round of fresh recruitments.
Earlier this month, the rush of patients in need of a hospital bed or oxygen apparatus at Mumbai’s Lilavati Hospital prompted the management to put up beds in the elevator lobby of the premier hospital. The makeshift beds soon filled up but patient registrations would not stop. Doctors on covid-duty, some of whom had beaten back the virus, felt “overwhelmed, extremely helpless and angry", said a senior doctor of his younger colleagues.
These are words not expected from doctors.
As covid-19 rampages across India in the second wave clocking the world’s highest daily caseloads of over 300,000 and 2,300 deaths, turning the health emergency into a massive humanitarian crisis, mental health issues are wreaking havoc with lives in a way that psychiatrists and therapists had not seen last year.
Feelings of stress, fear, anxiety and depression related to the pandemic emerged last year, subsided a wee bit early this year, only to return with a vengeance this March. From erratic behaviour and anger on social media to frantic calls for help and support, the signs of this malaise are all around us. While there is a glimmer of reversal in Mumbai, the recent, tragic images from Delhi in particular have cast a pall of gloom on the nation’s collective psyche. Mental health practitioners are calling it a parallel and silent pandemic that deserves urgent attention once the crisis for oxygen and ICU beds tapers off. Those who have the bandwidth to address it—formal workplaces, corporate offices, better-off schools and colleges—have begun to take note, but just about. Workplaces are introducing new measures to deal with the deepening mental health fallout among employees in the second wave of the pandemic. But for informal sectors, mental health issues are not even on the table yet.
“What we are going through now, after what we went through last year, is leaving deep emotional and mental scars on people, even on those directly unaffected by the virus. We will collectively carry them for a long time. No doubt at all that it’s a parallel pandemic," Dr Rajesh Parikh, noted psychiatrist and medical director of Mumbai’s Jaslok Hospital told Mint.
India’s frontline healthcare workers are at high risk. Dr Kersi Chavda, noted psychiatrist and consultant at Hinduja Hospital said, “Those who are out there have been soaking up unbelievable stress for a year. A doctor friend called me the other day to have me counsel his son, around 24 years old, who’s been a resident doctor at a covid-19 centre since last year. He’s burnt out."
There was a three- to five-fold rise in the number of mental health cases last year from the pre-pandemic norm. Mental health practitioners say they are seeing many times more patients now. In a survey that the Indian Journal of Psychiatry conducted last year, nearly 48% respondents showed anxiety or depression and 74% showed moderate stress; these must have spiked in the second wave, practitioners reckon.
All psychiatrists, psychologists and counsellors Mint spoke to said their appointment calendars are full despite working longer hours. “I’m seeing at least 50 patients a day which is huge for a hospital in Bhopal, and I’m feeling the strain now," said Dr Rajni Chatterji, psychiatrist at Bhopal Memorial Hospital.
The range of mental illnesses has expanded in the second wave of covid, so has the type of people calling in. Anxiety, fear and depression were the three most commonly seen disorders last year, say psychiatrists. The brutal second wave has added a layer of direct or complicated grief, anger born out of helplessness, despair and intense hopelessness. “Women have another layer of abuse or violence, so do children. We aren’t even talking about that," remarked Dr Chatterji.
Clinics and online consultations are recording three distinct categories of patients in the second wave: many with history of mental illnesses are seeing recurrences or relapses of ailments, those with mild forms of mental illnesses have experienced an exacerbation of their conditions, and there are large new sets of people without previous mental health issues.
That a pandemic has mental health ramifications is known. “Whether it was the Influenza epidemic of 1918-19 or the Calcutta plague, there are references to depression in the records," Chinmay Tumbe, economist and author of Age of Pandemics told Mint. “There used to be collective or community solidarity practices such as bhajans at crematoriums to address the emotional fallout."
Grief is complicated by covid death protocols. “The most difficult part was to conduct final rites of my mother all alone and not even touch her one last time," said Chennai-based Meera Gurunath who lost her mother last week and is nursing her husband through covid complications. Her children fear she will “crumble" any day now.
Depression, which psychologists say was more typically seen in 20-year-olds and 50-year-olds, is now across all demographics. OCD behaviours have spiked, especially because covid-19 protocols demand repeated hand-washing and sanitisation. “People are working with new protocols of distancing, Work from Home types feel isolated, older people feel cut-off within their homes. The isolation-cum-depression has escalated," said a renowned Delhi-based psychiatrist on condition of anonymity.
Additionally, women are exhibiting a burnout and fatigue after a year of juggling professional work and housework, younger children are confused and unable to process the world around them—a four-year-old believed that school meant tiny windows on his mother’s laptop while young adults are exhibiting a range of anxiety disorders emanating from the uncertainties that lie ahead of them. Of course, senior citizens are experiencing acute vulnerability and thought spirals of their mortality.
“The scale and enormity of what we are grappling will unfold as a crisis. We aren’t prepared for that," remarked Dr Chavda.
India Inc’s human resources departments are witnessing a marked change from the behaviour of last year: employees are breaking down and asking for more me-time; the freedom and flexibility that came with WFH last year has been replaced with loneliness and disconnectedness; the ‘doomscrolling’ of dismal news is dominating official meetings; and downscaling of organisations has meant either job losses or pay cuts which exacerbate uncertainty.
“We thought last year was challenging enough but we find that the second wave has cracked our employees who coasted last year," said a senior HR manager of a FMCG multinational on the condition of anonymity. More than in the first wave, executives across hierarchies have seen covid-19 complications or death up close this year in their families or among friends and colleagues.
Counselling and, particularly grief counselling, is the latest practice that a few organisations have taken to since working through shock and grief, even indirectly, became a challenge. The constantly changing protocols of restrictions and quasi-lockdowns that each state is enforcing in the second wave have added to the weariness.
“Employee wellness which was a low-level activity has become a central piece of the workplace," remarked organisational development expert Dr Shalini Lal. “Wellness doesn’t only mean programmes on mindfulness anymore but transactional things like leadership taking the time out to do non-work meetings, offering covid-support to employees, and so on. Company leaders are learning from best practices of one another," she added.
Corporates do not want to come across as insensitive. Among the concepts and practices that organisations have embraced in the second wave are covid leave, vaccination leave, care-giving leave, softening of KRAs, moving beyond productivity benchmarks, and asynchronous work. “Empathy is now acceptable in our corridors. There has been a fundamental shift in work culture," said Dr Lal.
While some organisations have stepped up their HR practices, a few have gone through down-sizing staff without warning, increasing the stress and depression levels among those who suddenly find themselves without jobs.
Two-thirds of the migrant workers who left cities last year had returned or planned to return to their work but were in no better emotional or mental health than last year, showed a pan-India survey conducted in January this year by the Rapid Community Response to Covid (RCRC), a coalition of 43 organisations in rural India.
This survey, of 11,766 respondents across 12 states, showed a staggering 78% stressed or highly stressed, nearly a third of them with sleep disturbances: another third irritable, and nearly 45% tense all the time.
Moreover, the asymmetry in medical facilities between large cities and rest of India is mirrored in mental health care too. “There’s hardly any mental health care in small towns or rural areas. People still fall back on community networks," said Dr Chatterji.
The next steps
Psychiatrists and therapists offer a range of “psychological first-aid" tools to get through this time. The most important aspect is for people to square off their fear and anxiety of covid, especially because recovery rates are good with nearly nine out of every ten recovering. “It’s important to find this balance amidst the doomscrolling. It does help to keep a positive mindset," said Dr Parikh.
Other important alleviation measures include accepting that some degree of anxiety and depression is par for the course now, cutting family members and friends slack for their emotional ups and downs; accessing professional help given that mental health care is now available online; practising meditation and other calming techniques, forming online support groups; and not discussing covid-19 statistics all the time.
These measures work well if organisations have professional mental care facilities to fall back on. The better endowed schools and colleges brought trained psychologists on board and offered counselling sessions for students.
When a cohort of post-graduate media students of a premier institute wrote to their department head asking for an unprecedented two-week leave and suspension of all deadlines because “the pandemic (was) taking a toll on us", their request was not only honoured but the college also organised one-to-one therapy sessions for those interested at no cost to students.
Corporates worked with mental health professionals to offer similar sessions to employees. The helpline run by MPower, Aditya Birla Education Trust, saw a staggering 75,000 calls last year (they do not yet have numbers for the second wave).
“This wave is bigger. We are getting more calls now even from people whose test report is positive and need hand-holding," said Dr Ambrish Dharmadhikari, head of psychiatry at MPower, to Mint. The organisation proactively worked with Mumbai’s frontline workers in civic services and police since the pandemic began. “Hundreds of them have died, their colleagues are stressed out and their trauma unbelievable. I believe we made some difference," he added.
For all the gains, the discipline of mental health does not have all the tools to comprehensively address this unprecedented parallel pandemic. But we live in hope.
The last word goes to a journalist, Parth MN, who has reported on the pandemic for national and international publications from across India since March last year. “It’s excruciating, one breaks down seeing all the misery and mismanagement. I’ve lost sleep but I cope somehow."
Smruti Koppikar is a senior journalist and urban chronicler.
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