Steps India’s healthcare systems should take to prepare for the mental health pandemic

On World Mental Health Day, Ritika Aggarwal, consultant psychologist, Jaslok Hospital & Research Centre believes that during the pandemic, we should consider having a psychologist trained in management of psychological crisis post traumatic events on board the COVID-19 task force as mental health concerns may not be immediate, but can cause long term effects lasting for 1-3 years

The first onslaught of the pandemic was the physical concerns, but now we need to brace for the tidal wave of mental health concerns across all segments of our population that are expected to continue increasing for the next few months at least. By May, we had already seen a 20 per cent rise in cases of mental health. The mental health concerns due to the pandemic may not just be immediate, but can also cause long term effects lasting for 1-3 years.

For the same, our healthcare systems needs to not only work on raising awareness regarding the importance of mental health concerns but also on increasing the mental health infrastructure, workforce, and access to mental health services: all of which we are severely lacking in.

At last count, India had only 0.3 psychiatrists, 0.12 psychiatric nurses, 0.07 psychologists and 0.07 social workers for every one lakh population. This significant gap between what is needed and what is available only seems to have increased during the pandemic. Due to the stigma associated with mental health, a lack of awareness, and limited access to professional help, only 10-12 per cent of people with mental health disorders seek help leading to another significant gap, i.e. the treatment gap. In addition, India’s 2017-2018 allocation to the National Programme for Mental Health was 0.07 per cent of the health budget, which is already a meager percentage of the GDP.

While the Mental Healthcare Act 2017 mandated that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness”, there is still little clarity on the implementation and provision of services. The healthcare system coming together to work on these issues and acknowledging that certain mental health disorders do have a biological basis could help in working through these obstacles. This would make mental health more accessible to the population at large.

As a healthcare system, we need to first understand the importance of mental health for ourselves and then work on integrating it into the existing healthcare system. I remember when I initially started working as a psychologist I had to first raise awareness among the healthcare workers regarding the importance of integrating therapy and counselling into the traditional treatment process. Now, I have clients across all departments and we can see the difference it makes to the patient’s recovery. To truly work towards a holistic form of treatment, we need to see the person as they are, their dreams, hopes, fears, and anxieties, and not just as their illness.

Primary healthcare workers, such as general practitioners, are in a better position to identify mental health concerns at an early stage. Patients trust their primary doctors and when a mental health referral comes from a trusted source, they are more inclined to take the referral seriously. This allows for better access as well as mental health education to reduce the barriers to availing of mental health services. An inter-disciplinary approach would improve the doctor-patient and therapist-client relationship, reduce stigma towards mental health, and allow for a seamless transition.

Integrating mental health into our existing system

How do we start the process of integrating mental health into our existing system? We need to first identify the challenges and lacunae that exist in the mental healthcare system and in providing good mental health services and start working through those. This would include unifying the education systems, creating more seats in colleges, creating more opportunities for mental health providers, and investing more in mental healthcare.

Next, we need to educate and train primary care providers and frontline healthcare workers with psychological first aid strategies so that they can triage patients from a mental health perspective and refer those that seem to be at risk for developing mental health concerns to mental health practitioners. This is especially necessary for patients in COVID wards and ICUs and those under quarantine as the only people they interact with are the frontline staff who have the ability to make a difference to the mental health of the individual.

While the pandemic has focused the spotlight on mental health, generating greater investment and access to the mental healthcare system must be a continuous process. During the pandemic, we should also consider having a psychologist trained in management of psychological crisis post traumatic events on board the COVID-19 task force to evaluate and create policies, guidelines, provide guidance from a psychological perspective, and provide psychological crisis intervention.

To summarise, we need to be aware of the impact of the healthcare system within which we work and join forces to prepare for the looming mental health pandemic.