Twenty-three-year-old Rashi*, a working professional from Kolkata, has mixed feelings about 2020. For her, the year of the coronavirus pandemic has not just been about the disease -- in 2020, Rashi came to terms with her own mental health illness.
"I have battled anxiety since I was a child. But 2020 made me realise that I needed to speak to someone. This year has been horrible for my mental health. Worrying about my job, financial stress, constantly stressed about my parents and their health - one day, I just could not take it anymore. I snapped. For two days, I could not get out of bed. I felt physically ill although I knew there was not technically anything wrong with me. That's when I knew I needed help," said Rashi.
However, seeking help was easier said than done. The world was in the middle of a pandemic and everything had moved online. Even therapy.
"I was never very keen on speaking on phone. How was I to do therapy online?" Rashi said, as she explained how exasperated the whole process made her feel. "Not just the inconvenience, I backed out after many therapists I had contacted online told me that they charged over Rs 1,000 per session. That's expensive," Rashi said.
Megha*, 31, an IT professional, had similar qualms. Megha had been diagnosed with bipolar disorder when she was 22. "For someone with a specific problem like mine, you need a specialized treatment and a psychiatrist. But those are for the rich, how will I afford four sessions a month when each session would cost me Rs 1,500?" Megha said.
But that is not surprising, since India barely has one psychiatrist for 100,000 citizens. When asked about what she wants different in 2021, Megha said, "Mental healthcare needs to become more affordable. It is still a privilege when it should be counted as one of the bare necessities."
In India, over 30 million people suffer from mental health problems. But only a fraction seek help. Most of those who do, belong to urban areas. In rural areas, mental health continues to remain an alien concept. According to a report by Business Standard, in rural areas, the only place for mental disorders is a district hospital. According to the 2015-16 National Mental Health Survey, there are only 0.05 psychiatrists for every 100,000 in central India. The number increases to 1.2 in southern parts of India.
A leading psychiatrist in the UK has said that the coronavirus pandemic poses the greatest threat to mental health since the second world war.
According to a study, the coronavirus pandemic (which can be classified as a traumatic event) can lead to "mental morbidity symptoms" among anyone while simultaneously exacerbating the symptoms of those who are already living with mental health disorders.
Some of the factors that could affect mental health, especially in the middle of the pandemic, are obvious - the rapidly evolving nature of the event, the threat to oneself and loved ones, the overall impact on the economy, jobs and so on.
"The pandemic is not ending anytime soon. There has been so much grief this year, and no time to even cry about it. It is necessary to do something different in 2021," said Ruchita Chandrasekhar, a trauma therapist.
But the question arises, was the healthcare system in India not prepared for such a crisis?
In April, when the coronavirus pandemic was at its peak, News18 had reported about a surge in calls to suicide helplines owing to the pandemic. Ten months on, India's healthcare system is still ill-equipped to deal with the mental health epidemic that has hit India, silently but surely, along with the pandemic.
While pandemics and lockdowns may have become synonymous with 2020, they are certainly not new as concepts. This is not the first time the world has faced a pandemic, or a subsequent mental health epidemic - nor will it be the last.
The influenza pandemic of 1918-1919 should have served as an example, urging countries like India to pay equal attention to mental health during a pandemic. According to research, survivors of Spanish flu reported an increase in mental disorders in the years following the pandemic. They reported sleep disturbances, depression, mental distraction, dizziness, and difficulties coping at work.
But despite existing research, mental health in India took a backseat during the pandemic.
In 2017, the Indian government passed the Mental Healthcare Bill which took into consideration multiple aspects, including decriminalising suicide and acknowledging the rights of persons with mental illness. But it does not include a directive or SOPs to be followed in the event of a traumatic situation like a pandemic.
"A generalised mental healthcare bill is not sufficient," explained Chandrasekhar. She said that the need of the hour is "culturally congruent intervention strategies in a deeply stigmatised society."
"If a person is constantly worried about losing his job, which has been the case for so many amid the pandemic, not even therapy will be sufficient to help him. If the problems persist, there's only so much therapy can do," she said.
The therapist explained that most of the mental health problems in India are related to socio-economic problems. Without basic amenities to help people survive the pandemic, stressors are aplenty which can lead to mental disorders. These stressors can be reduced if the problems are taken care of. This, according to her, would come under preventive strategies.
"Many fail to understand that mental disorders can have somatic implications. They can even lead to symptoms like fever and headache and chronic stress can adversely affect immunity too. Both the government and private organisations need to come up with emergency care policies for such situations. For instance, better severance packages for those losing jobs. Taking care of these aspects may go a long way in reducing mental health problems," Chandrasekhar said.
She also hopes that in 2021, language around mental health will improve and that education about this will become more accessible. "It is unlikely that a person will go to a therapist and say they have anxiety. They are more likely to say they aren't feeling okay, or that they have been feeling restless. There needs to be awareness campaigns funded by the government," she said.
Telecounselling, or remote therapy, was a rather obscure concept before the pandemic. While a handful practiced it, most forms of therapy took place face-to-face. However, that changed when the pandemic struck. The shift was paradigm, but fruitful.
"It has worked out well for me. I think this has made therapy more accessible. People can talk to me from the comfort of their homes and schedule appointments by working around their schedules," Chandrasekhar explained.
India's mental healthcare needs to be more wholesome and all-encompassing in 2021. While the bill is indeed a step towards normalising and destigmatising mental health problems, it does not account for the threats posed by natural disasters and traumatic events like pandemics. Awareness campaigns, for instance, need to be prioritised. Healing needs to be made more accessible.
2020 is nearly over. A new year, with possibly newer challenges, awaits. But if anything, 2020 has left behind significant lessons. For one, India's mental healthcare system needs to be prioritised and revamped to accommodate pandemics and similar traumatic crises in the future.
*Names have been changed to protect identities.