To address the mental health challenges of children and women, schools must reopen: Vikram Patel

Vikram Patel, professor, Department of Global Health and Population, Harvard TH Chan School of Public Health. Image source - Harvard University

Social restrictions, closure of schools and businesses, loss of livelihood, and  fall in economic activity following COVID-19 and resultant lockdowns have taken a toll on the mental health of the population. The highly reputed medical journal Lancet, in a recent write up, estimated that an additional 53·2 million cases of major depressive disorder were reported globally in 2020 because of COVID-19. The rise in cases was higher among females than among males--at 35·5 million and 17·7 million respectively.

Vikram Harshad Patel is one of the best-known psychiatrists and researchers, renowned for his work on child development and mental disability in low-resource settings. He is a professor at Department of Global Health and Population, Harvard TH Chan School of Public Health, and co-founder and member of managing committee, Sangath, a Goa-based NGO that focusses on child health. Patel talked to Moneycontrol about the less-visible but deep-running toll the pandemic has taken.

In one of your essays, you have said that the impact of the pandemic can be seen in two phases—the first is the acute phase, which coincided with the lockdown—the period when the pandemic surged through the country. The second phase will unfold in the months ahead, as the virus begins to get contained, but the economic fallout of the pandemic begins to bite deeper. Do you believe we are in the second phase?

The second phase has now passed, and the country is recovering from the trauma that swept it during the wave, which led to unprecedented loss of life and livelihoods, particularly affecting the poor.

An internet-based survey conducted between March-May 2020 show high rates of depression and anxiety in the general population. For example, the ‘FEEL-COVID’ survey conducted in February-March 2020 with 1,106 people across 64 cities reported that a third of respondents faced significant ‘psychological impact’ because of COVID-19. Could you expand on this?

The rise in population level psychological distress has been observed in all countries, as documented in a paper published in the Lancet this week. This is not surprising given the high and enduring levels of uncertainty and loss, both of which are recognised risk factors for poor mental health, which have affected populations globally over the past two years. It is important to note that this increase in distress particularly affects the young, the poor and women, and will likely fuel an increase in clinically significant mental health problems in all countries.

The pandemic is affecting different groups in specific ways. Women are suffering from anxiety and depression due to increased household responsibilities and higher incidence of domestic violence during the lockdown. A survey said that more than 50 percent of children had experienced agitation and anxiety during the lockdown. Now the vaccination of children has been proposed. Will that help in improving the situation as schools begin to open?

The single most important policy action to address the mental health challenges faced by both children and women is to reopen schools without any further delay, irrespective of the vaccination of children. Schools play a fundamental role in shaping the mental health and well-being of children (and adolescents) and their closure is feared to have a profound negative effect on learning and mental health for years to come.

According to another survey, 37 percent felt that their mental health had been ‘strongly impacted’. This is not surprising. According to the Centre for Monitoring Indian Economy, over 10 million or 1 crore people lost their jobs in India because of the second wave of Coronavirus this year. This is in addition to a decline of 97 per cent of households' incomes since the beginning of the pandemic last year.

This is one major example of loss experienced during the pandemic, i.e. the loss of livelihoods.

A survey of 152 doctors found that more than a third of them are experiencing depression and anxiety due to the pandemic. Frontline workers were reportedly burdened by over-work, and anxious about contracting the virus.

The pandemic has brought into sharp relief the existing poor working conditions of frontline workers, in particular ASHA (Accredited Social Health Activists) who are not even counted as ‘workers’ in the formal sense. It is imperative to formalise their roles with full worker rights such as salaries and leave entitlements.

What has been the response of governments, non-profit organisations, NGOs, and universities to these cases?

There have been many initiatives to address mental health taken by all these sectors, mostly through supporting telephone or tele-counselling.

In your essay, you have mentioned that even before the pandemic struck, the Global Burden of Disease study estimated that nearly 200 million people in India have experienced a mental disorder, nearly half of whom suffer from depressive or anxiety disorders. India accounts for more than a third of the female suicides globally, nearly a fourth of all male suicides, and suicide has been the leading cause of death in young Indians. Yet, the government has spent very little on mental healthcare, estimated at less than one percent of the health budget. What is your take?

That mental health care is dominated by a biomedical, doctor-centric approach, which is not only unlikely to address the massive unmet needs for mental health care in India, but also not acceptable to the population. Community based delivery of mental health care by appropriately supported and supervised frontline workers (like ASHA), following the model pioneered by Sangath, is the solution.

Does this pandemic present an opportunity to improve things, push up infrastructure and take a more sensitive view of the situation?

Absolutely, the pandemic is a historic opportunity to reimagine our health care system in general and the mental health care system in particular. This means more than just greatly increasing public investment in health care, but also using these funds wisely, with much of the funding supporting the scale up of primary care and community health workers.