Fear of the pandemic, social distancing, isolation and economic impact has certainly overwhelmed people causing stress and anxiety. This, in turn, has given more impetus to mental health and psychosocial considerations. Dr Radhika Bapat, Clinical Psychotherapist in conversation with Raelene Kambli speaks volumes on a whole new world post-COVID and the growing significance of mental health apps
COVID-19 pandemic has suddenly created more emphasis on mental health and wellbeing? Do you agree?
Human beings have endured flu pandemics before, but with an ease of access to information, luckily, mental health needs are being more openly addressed in 2020 than what they might have been in 1918. Mental health needs include the risks posed by intimate partner violence, the emotional by-products of isolation, financial hardships, the effects of school closures on families, the stigma of actually contracting the virus, emotional contagion and mass panic, and most importantly burn-out and stress amongst the front-line medical workers. Since we are dealing with a highly infectious disease, doctors and nurses also double-up as sources of emotional and mental health support for isolated patients. Cases of compassion fatigue have been reported in addition to the workload, sleep deprivation and separation of doctors from their own families. All in all, mental health is being actively addressed this time.
You talk about a brave new world which is physically distanced yet socially connected. What is your rationale behind this concept? Are you hinting at a tech-infused world?
An event of this proportion leaves a pronounced mental health footprint behind. Evolution does not simply mean survival. It entails the transformation of internal remodelling of our belief systems and habits. Day one of the lockdown looked different from Day 15 – with people starting to innovate and indulge in miscellaneous yet distinct coping mechanisms. Others followed suit and a menu of choices was shared over social media. Soon, we had more platforms available to hold meetings, virtually consult with doctors, attend school, have dinners with family, play games, share information and take virtual tours around the world without moving. So yes, this is a brave new world and we are using all the resources available to weather this storm and stay connected.
How do you think people can positively survive isolation?
If you look at past data, you see that people with the highest exposure to media coverage of the 2013 Boston marathon bombings had even more acute stress than people who were directly exposed to the bombings. We need to first and foremost limit ourselves to a fixed 15 minutes daily for media coverage of COVID-19 and also trust only authoritative sources.
Most mental health publications have already touched upon the customary importance of following a routine, of self-care and grooming, and of staying socially connected. In addition to these, I would like to add routinely indulging in aesthetic experiences made freely available to you – such as the google immersive virtual tours of national parks, museums and historical sites. Accommodate time after a hard day of household chores and childcare to connect with friends or family via game or movie nights. It is now possible for many people to watch the same Netflix movie together by downloading the application – Netflix party. It helps to “give” and not just focus on “getting.” Surprising people via deep and meaningful acts, however tiny — such as giving a thank-you note, gifting a movie or a kindle book, presenting a photograph of a hand-written note – add a positive element to any tense environment, reducing general familial stress.
How do you think healthcare providers should react to this new world?
Healthcare providers need to be open to novel models of mental health delivery. In India, unlike other countries, family doctors are the gatekeepers or “First in, Last out” points of entry to any problems that a family faces. Currently, several clients of mine consult with them via online consultations in order to get a preliminary diagnosis so as to avoid going to a hospital. They then refer clients to psychiatrists or psychologists. It is important to bring “family doctors” into the fold in order to reduce the mental health impact a pandemic of this proportion would have on hospital systems. In that sense, certain flexibility on the part of the entire system, especially specialists and super-specialists becomes very important.
How do people broadly see mental health app and telehealth services? Are they good enough?
When it comes to psychology, up until recently we were not in a space where there was any requirement with seeking serious help online. Necessity is not only the mother of invention but forces flexibility and change. Suddenly, we find ourselves dependent on apps and telehealth services. Already, we were quite familiar with relaxation and habit tracking applications such as Headspace, Sanvello and Calm – but these cater to an English-speaking audience. As we are forced into getting familiar with online modalities, we too have overcome our inhibitions. More and more, my long-distance clients who travel weekly from Mumbai to see me, are finding their comfort thresholds change! This is quite a revolution. We save time and money. I, too, am much more open to offering help to Indian students living abroad and seeking online help! This model, naturally, will not work with psychiatrists who need to examine their patients physically, nor will it work with children and adults with rehabilitation requirements. It is, however, an advantage for people seeking help for stress or less serious mental health conditions such as loneliness.
I admire how the British Medical Association has set up stress counselling services online that are confidential, run 24/7 and offer peer support to all doctors and medical students. In India, the situation is slightly more complex. Language, for one, is a huge concern apart from accessibility to helplines and pathways to address the more serious cases. The National Academy of Psychology (NAOP) is one major organisation of Indian psychologists who are vetted thoroughly and they boast of recognition by bodies such as the International Union of Psychological Sciences, a sort of United Nations for psychologists over the world. It is important that the government collaborate with such bodies to set up channels to address psychological issues. This apart, we cannot exclude the role of cultural belief systems In India, which makes it important to join forces and train faith-based practitioners while empowering ordinary people or ‘lay counsellors’ to deliver psychosocial interventions as espoused by the astute psychiatrist Dr Vikram Patel from the NGO Sangath. He is a true hero, and Sangath has already piloted a model that should be adopted by us all.
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