Saturday, March 28, 2020

Coronavirus Outbreak: As mental health experts respond to crisis

A recent article published by the Harvard Business Review about the psychological toll of the coronavirus outbreak was titled 'That Discomfort You’re Feeling Is Grief'. It addressed how the various measures in place all over the world to deal with the pandemic — social distancing, self-isolation, quarantine, curfews both full and partial, lockdowns — had led to a loss of routine, cut people adrift from many of their vital day-to-day moorings. There is fear surrounding the wellbeing of loved ones, uncertainty about financial futures and what a post-pandemic world might even look like. Pre-existing mental health conditions may also have been exacerbated by the crisis.

 Coronavirus Outbreak: As mental health experts respond to crisis, filling gaps in service delivery needs govt accountability
Mental health is intrinsically linked to social, political and environmental factors and hence it comes as no surprise that the coronavirus pandemic and its consequences are not in the least conducive to mental well-being. Image for representation only. AP Photo

Mental health is intrinsically linked to social, political and environmental factors and hence it comes as no surprise that the pandemic and its consequences are not in the least conducive to mental well-being. The World Health Organisation (WHO) recently released a resource addressing psychosocial considerations during the coronavirus outbreak, urging people to be kind, empathetic and support each other through these tough times.
Mental health organisations and professionals have recognised the severity of the impact on people's mental health and are responding to the crisis by optimising digital modalities of communication, through hosting webinars, Instagram lives, and curating pro-bono counselling helplines.
One such example of an intervention is the ‘Counsellors on Call’ helpline initiated by Project Mumbai, a not-for-profit which works to create social transformation through initiatives of scale, in collaboration with Prafulta, another organisation that works  in the psychological well-being space. Explaining the ‘Counsellors on Call’ concept, CEO and founder Shishir Joshi, and project coordinator Malvika Fernandes, state that the team curated a list of counsellors across the country, with varied language fluency, including in Hindi, Punjabi, Malayalam, Telugu. The counsellors who came on board underwent virtual training, and were equipped with legitimate health resources and articles from the WHO/UNICEF.

For professionals and organisations in urban locales, use of virtual platforms has not been completely novel as many say that Skype and telephonic sessions are time effective, and offer a viable option to avoid city traffic. However, moving all case-load online is challenging (even for a tech-friendly millennial population) as being cooped up at home with family members fails to provide a space that is quiet and ethically-safe for therapy.  ‘The Alternative Story’ (also known as ‘thealtstory’), a Bengaluru/Mumbai based organisation that works at the intersection of technology and mental health recently conducted a webinar to address the lack of community healing present in times of social distancing. Its director Rashi Vidyasagar says that while the organisation has always upheld values of the psychosocial model of mental health, their webinar was aimed at creating a mutual realisation that “depression and anxiety are normative responses/reactions to an abnormal situation, it’s not something that we call pathological”.
In light of the 21-day lockdown, mental health professionals are also feeling the need to address specific themes — for instance, psychotherapists Lamia Bagaraswala and Anjali Nair’s attempt to merge webinars and support groups through their initiative ‘An Online Safe Space’. Another of their initiatives is titled ‘A Shared Learning Space’ which is aimed at co-creating a virtual group for adults to pool in tools and resources for mutual support to work their way through their work from home routines, address possible stressors and guide them through boundary-setting.
While these online spaces are open to all, every individual might choose to participate differently. Bagaraswala says, “As facilitators, we try our best to be mindful of the heterogeneity of the group and allow for participants to respond to each other while moderating the space…and using the chat option really helps especially for those who can listen but not talk from their home spaces. We also ensure that we take feedback in writing from every participant to take into account their experiences of the session”.
While there is a steady discourse on mental health and service delivery for persons with mental health concerns in the virtual space, mental health practice in institutions that need clients to come in for timely, direct contact with practitioners are severely impacted.  For instance, Sadaf Vidha, senior counselor at Sukoon, a TISS field action project that works in courts in the area of psycho-social stress in matrimonial litigations, says that with courts working at 5 percent capacity, check-ins and follow-ups of cases are being done over phone. A complete transition to digital communication would be impossible, given that they are bound to legal jurisdiction and specific guidelines of operation.
Mental health professionals continue to be concerned about how barriers to accessing mental health care will continue to prevail among the most marginalised sections of society. Rashi Vidyasagar (from ‘thealtstory’) adds that “women with the load of responding to partners, elderly parents/in laws’ demands, children and persons with disabilities, queers persons, freelancers and daily wage workers will be at a higher disadvantage”. A response to these very unique life stressors of particularly vulnerable communities is therefore vital.
Anushree Dirangane’s Free psychotherapy project, for instance, aims to address psychological distress and trauma of health professionals owing to possible exposure to the novel coronavirus, resources limitations, and prejudice and discrimination from the public for the possibility that they might have treated a patient with the virus. Besides one-on-one and group therapy, advocacy resources creating awareness are also essential. An easy to follow resource for LGBTQ persons is one such guide created by independent activists in Sri Lanka (including the  Collective for Feminist Conversations) to address psychosocial well-being and how ‘home’ might not be safe spaces for many people who identify as queer or gender non-conforming.
While mental health in India confronts this very novel crisis that has changed the course of our routine lives, mental health professionals and organisations question the concerns that have pervaded the sector in India even before the COVID-19 crisis. The already worrying mental health burden, large resource gap, and the alarming scarcity of barefoot mental health professionals to provide psychological first aid at the rural and grassroots level continue to be pressing concerns even as this health crisis is upon us. The Central Government’s responsibility and accountability to address the mental health care of citizens is therefore crucial as we grapple with health inequities of this global health crisis.
Lorelle completed an MA in Social Work in Mental Health from TISS (Mumbai) in 2017, and has been working in the education space since. Her research interests include mental health, culture and gender studies.

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