While in many other countries, COVID-19 restrictions are being reimposed after a second wave of infections, India’s first wave has yet to reach a definitive peak. For the world’s second-most populous country, gaining control of the outbreak has proven to be an insurmountable task for its overburdened healthcare system. 

An unemployment rate of 7%, an exodus of migrant workers away from cities and students endangering their lives to continue their education has further amplified the underlying sense of distress. Research by the Observer Research Foundation revealed that 41% of Indians between the ages of 18-25 felt that their mental well-being had been strongly affected during this period. Furthermore, an early study by the Institute of Liver and Biliary Science concluded that nearly one-third of the participants in India felt some psychological impact due to the pandemic, thus, the question remains — is India prepared to deal with a growing mental health crisis, snowballed by COVID-19?

Indians are stressed out and afraid

A study conducted by the Suicide Prevention India Foundation (SPIF) surveyed 159 therapists during the ongoing lockdown. 65% of them observed an increase in self-harm while 57% noted that individuals who were making progress had relapsed. It was found that the most common issues that grew during this period were anxiety, fear of job loss, and stress. 

71% of therapists said that more people had expressed suicidal ideation post the outbreak, according to the SPIF survey. Fear of contracting the virus, along with the social, personal, and occupational impact, has had a dramatic effect on people’s lives and by extension, their will to continue living. 

In order to abate this, if an Indian were to seek out a mental health professional for help, would they be able to find one?

“Almost 150 million people [in India experience] some form of mental illness yet 80-85% of them have little or no access to the required care and treatment,” Jasmine Kalha, Program Manager & Research Fellow at the Centre for Mental Health Law and Policy, Indian Law Society, Pune told Re:Set. This is due to supply and demand-related factors, creating a large gap in mental health care, which gets further exacerbated in rural areas, she added. Mental health is socially determined and is a development issue, she commented, thus, addressing access to social elements like disability benefits, unemployment benefits is a key part of the centre’s mental health intervention model in rural communities. 

A cry for help

According to the survey by SPIF, after the onset of COVID-19, 68.6% of therapists reported an increase in the number of people they see and the time spent taking sessions. With such a limited number of professionals available, the mental health care ecosystem in the country is straining against the growing weight of those seeking help.

Apart from availability, the affordability of mental health resources is a challenge for a country that is still reeling from massive layoffs across sectors and a shrinking GDP. With restrictions in place, many are turning to virtual therapy. 

Estimated on the basis of open-sourced nationwide lists of therapists, the cost of a single therapy session in large cities like Mumbai and New Delhi averages between 800-1,500 INR, which can be steep given that the average monthly salary in these cities ranges between 32,000 to 35,000 INR. With the magnitude of the crisis rapidly increasing, several mental health practitioners are also offering a sliding scale rate or sessions on a “pay what you want” basis.

Initiatives like Atmiyata by the Centre for Mental Health Law & Policy, ILS, Pune are also working at the grassroots level to improve access to mental health care in rural India by training community volunteers to provide counseling and support.

A 2011 study noted that the District Mental Health program, an initiative of the National Mental Health Program, was only operational in 125 out of India’s 626 districts with further research adding that its implementation has been poor in mostly rural areas. 2005 data cited in the study revealed that access to mental health services in rural regions was severely limited as there were only 0.2 psychiatrists, 0.05 psychiatric nurses and 0.03 psychologists per 100,000 people.

The unbalanced availability and cost of seeking mental health help have resulted in only a very minute portion of the population having the means to access it. “Mental health systems have always been very scanty in India and during this time, the gap between what is needed and what is available has widened markedly,” Shekar Saxena, former director of the WHO’s mental health division, told The Hindu.

“To reduce the mental health care gap, mental health services need to be co-designed with the communities, need to be affordable, accessible, acceptable to the communities being served, and provide quality care,” Kalha reiterated.