Mental health series Part-1 | Sushant Singh Rajput’s death: Depression and role of COVID-19 in increasing psychological problems

Manisha*, a 34-year-old homemaker, attempted suicide by consuming mouthwash in April. She was saved, as she was hospitalised on time. She was later referred to a psychiatrist for further treatment and counselling. She was diagnosed with anxiety and depression.

She is now on anti-depressant pills and counselling. People who knew her for years were stunned and couldn't believe that she tried to kill herself. Her family life is stable, with a 5-year-old child and hardly any signs of financial difficulties.

In this case, Manisha is lucky to survive and to get proper medical attention. But many are not so lucky.

The death of Bollywood's rising star Sushant Singh Rajput by suicide has brought to the fore the lurking mental health problem that never got the attention it deserved.

According to National Crime Record Bureau (NCRB), about 1,34,516 suicides were reported in the country during 2018, showing an increase of 3.6 percent in comparison to 2017. The data for 2019 is not yet released. Experts say the figures could be higher as many cases go unreported.

Suicide is an extreme manifestation of mental health problem and is considered as a grey area medically. Even psychiatrists find it difficult to identify a suicidal person beforehand.

"Suicide is a fluctuating state, the number of people who have suicidal thoughts versus the number of people who die is very small. There are 20 people who have suicidal thoughts, maybe two or three of them attempt, and less than one of the 20 may die of suicide," says Dr Soumitra Pathare, one of India's leading psychiatrists and Director at Pune-based Centre for Mental Health Law and Policy.

Mental health during pandemic

Pathare says there is a lot of anecdotal evidence or media reports that suggest suicide numbers have gone up during COVID-19 pandemic, but no hard data.

"In the initial phase of the lockdown there were media reports about alchohol-related suicides, there were suicides committed on suspicion of acquiring COVID-19 infection and there were also reports about people ending their lives in quarantine; these are unusual and suicides directly linked to COVID-19," Pathare said.

Pathare finds fault with the whole communication of COVID-19. He says it created panic around the disease.

"The whole COVID-19 communication is based on fear. If you make people afraid they will stay at home, this has unintended consequences on mental health," he said.

Problem gets complicated

With almost three months into the COVID-19 pandemic, fears, worries and uncertainty about health, financial matters and job losses have only exacerbated. The isolation during the countrywide lockdown to contain the COVID-19 pandemic just made matters worse for many.

For instance, Tanuja Sable, whose livelihood depends on a clothing store in Mumbai, suffered a series of panic attacks triggered by a payment default by a vendor, had to approach a therapist for the first time in her life.

The number of first-timers like Sable seeking professional help for their mental health problems during the COVID-19 pandemic is rising exponentially.

The online doctor consultation platform Lybrate said it witnessed over 110 percent rise in online patient consults around mental health conditions on its platform. Women who seek help saw 150 percent jump in online consultations, compared to 85 percent growth in males. Lybrate came up with the insights after analysing data gathered in the period between March 1, 2020, and May 25, 2020. The platform has more than 3,000 psychiatrists, psychologists and counsellors from across the country.

The queries mainly revolved around stress, isolation, claustrophobia, being unproductive, anger, irritation, loneliness, mood swings, not being able to cope with family members around, rifts between spouses, coping mechanisms, uncertainty and helplessness. Of late, there has been a substantial rise in queries from working people around job losses and related stress, fear and worry on resuming offices at a time when COVID-19 cases are rising in the country.

The online consults are going up possibly because people are unable to physically go to psychiatrists and counsellers during the lockdown due to risk of infection and social distancing. But psychiatrists say that more people are seeking help now.

Samir Parikh, psychiatrist and head of Department of Mental Health and Behavioural Sciences, Fortis Healthcare, told Moneycontrol that there is also an added mental health concern around the pandemic.

"There is fear, anxiety, uncertainty, there is also an economic impact," he said.

"It is not just affecting first-timers; people with pre-existing mental health issues are seeing their  condition relapsing," said Dr Alpes Panchal, a Mumbai-based consultant psychiatrist and de-addiction specialist.

According to US Center for Disease Control (USCDC), mental health conditions such as depression, anxiety, bipolar disorder and schizophrenia affect a person’s thinking, feeling, mood or behaviour in a way that influences their ability to relate to others and function each day.

These conditions may be situational (short-term) or long-lasting (chronic).

The agency suggests that people with pre-existing mental health conditions should continue with their treatment and be aware of new or worsening symptoms. While the situation has eased in terms of availability of medicines, in the initial month during lockdown, due to supply chain disruption people couldn't continue with their medications.

Identifying mental health issues

Panchal says whenever one feels that they have any primary symptoms of loss of sleep, loss of appetite, not able to concentrate, repetitive thoughts and suicidal ideation, they need some sort of help.

"I would say talk to people around you before taking the help of a mental health professional. It could be your friend, colleague, psychologist, psychiatrist, family doctor, or even your boss, please talk to someone," Panchal says.

Panchal warns that anyone could be at risk of suicide.

"Somebody who by societal norm should be happy can have depression, this is due to internal chemical changes," he said.

One can't help but think of many pictures of a smiling Sushant Singh Rajput.

If you or someone you know needs help for mental health issues, call any of these helplines: NIMHANS toll-free number 0804611000, Mpower and BMC joint helpine 1800-120-820050, Vandrevala Foundation 1860-2662-345 or Aasra 9820466726

*Name changed to protect identity.

This the first in a three-part series on the seriousness of mental health, as underlined by the death of Sushant Singh Rajput. Tomorrow's part will look at how accessible and affordable is medication for mental health.