by Charmi Saujani
In addition to the adverse effects on physical health, the pandemic has the potential to cause chronic psychological manifestations like depression, anxiety, panic disorder, and psychosomatic manifestations. The government’s National Mental Health Survey reported that about 10 percent of adults meet diagnostic criteria for a mental health condition (ranging from mood and anxiety disorders to severe mental illness). 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. Research conducted by the Suicide Prevention in India Foundation (SPIF) in May found that nearly 65% of 159 mental health professionals surveyed reported an increase in self-harm among their patients. More than 85% of therapists surveyed said they were experiencing caregiver fatigue, and over 75% said fatigue had impacted their work. One of the most vulnerable, but neglected, an occupational community of internal migrant workers has been prone to development of psychological ill-effects due to double whammy impact of COVID-19 crisis and concomitant adverse occupational scenario.
Rural to urban migrant workers are predisposed to experience adverse psychological consequences of multiple stresses, generated through interactions of various factors, not limited to chronic poverty, malnutrition, cultural bereavement, loss of religious practices and social protection systems, lack of alignment with a new culture, coping with language difficulties, changes in identity, substance abuse and poor access to healthcare in addition to the poor living conditions and financial constraints. On the backdrop of COVID-19 other factors are -> absence of family support and caretaker during crisis, limitations to follow the rules and regulations of personal safety due to lack of resources, barriers to assess the psychiatric consultation, economic constraints due to loss of work, absence of effective laws for unorganised sector workers. Recent flee of stranded internal migrant labourers to railway stations and bus stations or by feet, making desperate attempts to go back to their home states ignoring lockdown rules is an example of socially irresponsible behaviour due to high levels of anxiety. Moreover, reports suggest that the rate of suicide among female workers is on the rise and the irregularity of their immigration status is directly proportionate to the amount of abuse they suffer.
With increasing media coverage, the mental health issue of migrant workers escalated to the extent of Public Interest Litigation (PIL) filed at The Supreme Court of India which responded, saying, ‘trained counsellors and/or community group leaders belonging to all faiths will visit the relief camps/shelter homes and deal with any consternation that the migrants might be going through’.
Nearly 14,000 migrant labourers who returned to their natives places in Bihar from other states during the COVID-19 lockdown sought counselling and psychological help from mental health professionals from April to mid-July, shows the data of the Bihar State Health Society (BSHS). Nearly 4,500 labourers and their families — who took refuge in makeshift shelters in the national capital — were detected with mental health issues and required professional counselling during the lockdown period from April to June. Their anxieties stemmed from loss of livelihood and concerns about family members back home even as they stared at an uncertain future. An assessment by Delhi-based Institute of Human Behaviour and Allied Sciences (IHBAS) put the prevalence rate of mental health concerns among migrants at 10-15% after its teams visited the shelters housing over 53,548 migrants from April 2 to June 18.
A mental health outreach exercise by civil society organisation, Manas Foundation, claimed that as autorickshaw drivers slowly resume their business after a slump of almost 2 months, a study capturing their struggles post the anti - coronavirus lockdown shows that many of them are facing severe mental stress due to the rising financial distress. 75% of the 1200 odd drivers who they spoke to indicated signs of anxiety and panic. A substantial number also reported sleeping disorders. Follow-ups with many have shown that the distress has only grown. During the intense 35-45 minute long calls, counsellors from Manas Foundation spoke to over 1200 drivers who shared their concerns over threats from landlords regarding delay in payment of rentals and how school administrations were asking them to pay fees when there was no money left. A number of drivers were also anxious about not having any savings left in their bank accounts. Another concern for the was expenses incurred on buying sanitisers, gloves, caps and masks.
In 2013, the National Health Mission (NHM) launched Direct Intervention System For Health Awareness (DISHA), a 24/7 tele-health helpline in Kerala. The mission was to provide a reliable healthcare response to its citizens. From the beginning of the pandemic, electronic media and social media carried out mass advertising campaigns on how people can contact this toll-free helpline. DISHA is a guild of social workers and health professionals. Kerala has 14 districts. An effective District Mental Health Program (DMHP) functions in all districts in Kerala. In every district, DMHP consists of psychologists, clinical psychologists, psychiatrists, social workers and nurses. When DISHA receives an inquiry, they direct it to the DMHP in the relevant district. According to Akhila V Nair, Floor Manager at DISHA, they received over 4,000 calls per day in March and April, most relating to mental health. Now the calls have reduced to 2,000 per day. This centralized COVID-19 helpline is completely free of charge. “Many Keralites work in Gulf countries and Europe. Now back home, they constantly stress over the future of their employment status,” said a Clinical Psychologist at DMHP. DMHP contacts every person who is in government quarantine facilities or home quarantine to inquire whether they experience any psychological disturbances. As per the guidelines issued by Kerala’s communist government, everyone gets a follow-up call to reassure their well being.Treating substance abuse issues is also part of the DMHP. Professional believes that there’s a clear decline of stigma surrounding mental health now. People approach DISHA and DMHPs, and are aware of psychotherapy more than ever before. While he states that the state needs more manpower in clinical psychology, governments elsewhere can learn from Kerala’s approach to tackle long term mental health issues piling up due to the pandemic.
Another example of response can be from Bengaluru where The National Institute of Mental Health and Neurosciences (NIMHANS), was directed to assist the State government (of Karnataka) in addressing mental health concerns of migrants who were sheltered at relief camps and shelter homes across the city of Bengaluru. NIMHANS, in coordination with the Bruhat Bengaluru Mahanagara Palike (BBMP) and the Health and Family Welfare Department of Government of Karnataka then prepared a Mental Health Professionals team comprising Psychiatrists, Clinical Psychologists and Psychiatric Social Workers. This multidisciplinary team joined hands with 11 Mobile Medical Units (MMU) of BBMP and visited all migrant camps in the city. The role of the MMU was to screen the migrants for physical and mental health concerns in general as well as to screen for any mental disorders and provide further necessary care. The teams approached each visit with the following intervention agenda - Step 1: Understanding the migrants’ psychological distress as a group. Step 2: Validating their concerns and assuring that their needs would be addressed by appropriate authorities. Emphasis on recent Government notification on assuring job security and income by their employers, and communication of future decision on public transport availability were made. Step 3: Reinforcement on continuing precautions during their stay at these camps. Step 4: Screened positive subjects for mental disorders were dealt with brief interventions. Step 5: Following brief interventions, they were linked to nearby District Mental Health Programme team for pharmacological interventions. Those who required psychological interventions were linked with the National COVID Psychosocial Helpline number for individual psychotherapy.
Mental health is a critical aspect that needs to be addressed everywhere, making it imperative to initiate steps against the psychological ill effects due to pandemic through generating awareness and psychological preparedness among the internal migrants. Though some states and organisations have taken considerable initiatives to combat this issue there are still many workers who need care and support to pass through this phase. This is also a historic opportunity for us to completely reimagine what mental healthcare means. To acknowledge and embrace the plural ways in which mental health problems are experienced, we must go beyond the narrow, disease-based models of mental healthcare and embrace the diversity and the pluralism of mental health in our communities.