Some time back the World Health Organisation (WHO) had announced that a mental health pandemic would overtake the whole world as a result of the lockdown that has imposed restrictions on movement of people all over the world. India also, according to mental health experts is to be a major country which will be visited by this crisis and going by that prediction Manipur too is included in the regions where a long spell of mental problems is expected to be encountered by the population. The alarm bell seems to have been sounded in good time and in earnest as sooner than expected people in Manipur have begun streaming into mental health clinics and hospitals for advice and treatment.
According to Dr. Senjam Gojendra, who is the honorary state secretary of the Indian Psychiatric Society, under whose purview all the psychiatrists and psychologists in the state come and who is also an Associate Professor at the Department of Psychiatry at the Regional Institute of Medical Sciences (RIMS), the new term now for the emergent situation is not ‘mental health disease’ but ‘Covid-related anxiety’ and it includes sleeplessness, anxiety, fright, restless mind, reacting with a start, a feeling of what if I get Covid, lots of social stigmatisation, compounding of anxiety because of quarantine stay or having to get tested again after 14 days of quarantine, feeling low to the point of contemplating death, thinking of the fact the virus has no treatment and getting suicidal thoughts, the last symptom having increased manifold among the public in general in the preceding months. “Yes its true, the pandemic is manifesting and stress related symptoms are noticeable in large numbers of people,” says Dr. Gojendra.
Though there’s considerable increase in the number of patients, both patients and doctors are feeling more comfortable without one-to-one physical consultation due to the fear of proximity and chances of infection. Instead scores of calls are coming in each day. The scare is real now and tele-consultation is being increasingly taken advantage of by the patients. The facility was started by the government three to four months back and it’s not for mental health patients only but for all illnesses. The government has provided the phone numbers of the doctors to the patients and also according to government rules doctors are allowed to prescribe certain kind of medicines by telephonic consultation. For instance Dr. Gojendra says the number of people with depression has risen considerably and he prescribes anti-depressants to at least four to five patients each day during such sessions via phone. The doctor says this way both parties can stay safe from the community spread which is on in the state. Otherwise there is no problem for availability of medicines and the cost; both are manageable. The only apprehension remains in having to be physically present as transmission of the virus has transpired from those with travel history or foreign return to the spread within the community.
The government orders are for social and physical distancing because of which people cannot spend time with each other, not just with friends but with family too. One-to-one relationships are not possible these days and except for the phone there is no scope for conversation, restaurant outings, or other entertainment, due to which mental problems are increasing, says the doctor adding that when this problem gets severe people get suicidal thoughts. There’s a remedy though. Dr. Gojendra advices, in case of suicidal thoughts one should immediately call a mental health professional, which includes a psychologist, psychiatrist or a counsellor, and speak for some time to him or her. During and post Covid, anxiety and depression has increased and will do so many times over and suicidal thoughts will also increase proportionately. “If someone talks to a suicidal person for some time the person’s pent up emotions will get a vent; suicide cases can be kept under control if emotional support comes at the right time,” says the doctor.
When asked if mental illness is curable or life long, Dr. Gojendra says, “Let’s not look at it like that but take the WHO’s definition of health, which says it is not just physical well-being; it is also mental or psychological well-being and spiritual well-being.” Complete health means one should not have physical ailments like diabetes, liver problem, or kidney and stomach ailments; in addition one should be mentally sound, able to control anger and ward off bad thoughts; and along with this one should inculcate spiritual values and practice.
For mental illness the term ‘controllable’ is used rather than ‘curable’. “Many mentally ill persons whose illness has been controlled by medicines now work in banks, and as doctors, engineers and school teachers,” the doctor says explaining that the earlier cases of people behaving like mad men and coming out on the streets cannot be seen these days as medicines can control the illness. Mental health today means not total madness but anxiety, depression and post traumatic disorder – for instance trauma arising from rape, seeing a bomb blast or a suicide or a plane crash like the 9/11 WTO crashes, which instances are all defined as Post Traumatic Stress Disorder or PTSD, the doctor tells in further detail.
To keep to protocol the doctor did not want to comment on what all the state government is doing to take on the mental health pandemic but said at the same time that it is trying its best. Regarding the availability of rehabilitation centres, Dr. Gojendra says there are two kinds of rehabs; one is purely for mentally ill persons and the other kind for drug users. In fact, he says drugs rehabilitation is a component of mental illness rehab also. The drugs intake of mentally ill persons increases many times and vice versa drug users also get mentally ill.
The rehabs are called half-way homes and in Manipur there are one to two rehabs purely for mentally ill persons who have Schizophrenia, Bi-polar disorder or mania, whereas for drugs there are many rehabs both government and private sector. There are many drugs related cases also, the doctor cites, where the drug user gets mentally ill and indulges in violence with arms over property disputes. Moreover people also get ill with anxiety and depression after losing money in Marup or chasing after their Marup amounts. In the recent case of a financial company going bankrupt in the state many people suffered from symptoms like anxiety, sleeplessness and depression as they lost their interest money and capital, the doctor informs.
To a question whether the long break from school will affect the social identity and mental health of the children, Dr. Gojendra says, “Definitely. But the effect will be both good and bad.” He explains that at one time children were expected to be at school from 7-8 am in the morning to 4-5 pm in the evening. That concept has changed and the Covid pandemic has taught that school hours don’t have to be so long; plus students can go online also, saving a lot of time for play and extra-curricular activities. However, according to him there’s one minus point also that the children’s social development and personality development will be affected as they are not getting a chance to mix with or meet anybody. “There’s a fear psychosis in them which is expected to have an adverse effect on their physical and mental development,” the doctor says.
As for the most vulnerable category of the elderly, those above 65 years, they are already lonely, some with spouses no more or with children who can’t give them time as they are busy with their work. Without their daily walks, which most of them don’t get now, their physical fitness level is come down. Their emotional support is also missing as they are confined and can’t sit or spend time with their friends. The low fitness and lack of emotional support has increased their anxiety and depression levels.
One of the best ways to develop good mental health is humour, says Dr. Gojendra. “Life should be lived practically; one should have a positive mind. Now everything should be taken as positive. If we think too much about the pandemic depression will arise. Don’t think too much about it. When there’s a problem we have new hope; it brings a new development,” he says advising not to overly think of future consequences. “Be bindaas, humorous, jolly and have an easy going life,” he says but at the same time ends on a note of caution for the people generally not to mistake the advice to enjoy as a sanction for taking to gambling, drinking or smoking. “Don’t fall for that,” he repeats; an advice one should take to heart in these bleak times.