Mental health promotion needed to reduce suicides

 The World Health Organisation estimates 800,000 suicides occur every year worldwide. The data in India as per the National Crime Records Bureau from 2021 finds around 164,000 deaths by suicide which makes up about 20 per cent of the world’s figure. This number could be more because there may be several unreported or ‘unsure’ verdicts. The states of Maharashtra and Tamil Nadu consistently recorded the highest number for three years.

For every suicide, there are 25 attempts in young and four attempts among elderly people. Every suicide or attempt brings distress to the family members in addition to facing soci- etal stigma. Suicides are common across all age groups. They occur in rich or poor, in high or low-income countries. The majority of likely causes are family related problems, illness, addiction to drugs or alcohol, marital problems, and love affairs.

Stressful events directly hamper mental health. Difficulties in childhood due to marital problems in parents, bad experiences in school such as being bullied, being unable to attain academic standards or meet expectations of the family, or repeated humiliation due to poor academic performance can all contribute to mental health problems. Many children may be without siblings and both parents may work, which may mean they miss out on sharing their worries, and feelings. This can continue to build up. There is a need to provide life-skills training, and resilience building in all secondary school students. Stress, mental health, coping, meditation, and concepts of mindfulness may also be taught as part of the school curriculum.

Adolescents have unique sets of issues. This is also the age where long term chronic mental illness could begin. They strive for novelty and action and many want to do something to make them stand out from their peers. They swing between being a child and an adult. There is a fear of missing the teenage period. They may do risk-taking activities and experiment with new things including smoking, alcohol, or drug use, especially in groups.

Though many have some control, a few may become dependent on these. Relationship breakdowns can lead to feelings of low self confidence or loneliness and have lead to pessimistic thoughts, suicide attempts, and suicides. Parents must develop trust to make them come to them for any problems and open up to them to make them feel listened to or reassured.
There is another set of adolescents who are busy preparing to crack IIT, NEET, or State Entrance tests. There is no doubt that some profes- sional courses can be the gateway to lucrative employment. How to choose a professional course is not structured or in other words would not undergo the right evaluation. Many do not know their strengths or weaknesses, their skills or lack of particular skills, for them to choose the right career path. Competitive exam preparation not only requires subject preparation, but also preparing the mind to be calm, and confident throughout. Avoid comparison with peers, be realistic, and understand that competition is only against your previous best. If there are any negative thoughts or thoughts of death, dying, or suicide, immediately seek professional help.

There could be unidentified anxiety or depression which is treatable. This if not treated, can hamper the concentration and consequently the exam performance. Many of these mental health issues build up slowly, therefore with anyone coming with mental distress, or severe anxiety closer to exams, the best thing is damage limitation. Students must realise there is so much competition and always have plan B and plan C. Some students decide to drop another year in a rush, and this decision-making may also be done in discussion with men- tors, parents, and teachers. Practicing mindfulness-based meditation may help some to keep their emotions and thoughts under control, thereby improving their concentration levels. Coaching Centres must be mindful of the stress on their students and have emergency helpline numbers and access to local psychiatry clinics.

Relationship difficulties, separation, waiting for a legal hearing for divorce, and subsequent divorce can make the person feel lonely. An unemployed, separated man who is drink- ing alcohol excessively is at higher risk of suicide. Workplace stress is common, as superior authorities could also be under stress, expectations to compete with the market, and striving to improve. Initially, it is only you who has to identify if the workload is excessive, the work environment is inspiring, and this job is something you are passionate about. There are only two ways forward if you don’t like your job, either adapt soon, start to say you like the job, make peace with it, or find a new job. Ambivalence and procrastination lead to severe stress and can lead to not only mental health issues such as anxiety, depression, addiction to alcohol, changes to personality, loneliness, and sleepless- ness but also contribute to diabetes, hypertension, heart disease, and frequent infections due to low immunity.

There can be ripple effects on relationships around you too. There is a need to spend time with friends and family, on hobbies, going on tours, exercise, walking, yoga, meditation, diet, and practice good sleeping habits. If work is stressful, discuss it with your partner or friend, seek counselling, or see a nearby psychiatrist at the earliest.

Depression and anxiety are also common in older people in addition to chronic physical ailments, needing regular health care. These need to be identified early and treated. Express- ing the desire to go far away should also be considered a suicidal gesture. Sometimes, without families noticing, they could be skipping their regular pills to make their physical illness worse, thus wanting to die.

Women during adolescent age, around pregnancy, and menopause are at higher risk of developing mental health issues. Social support could help reduce this. There are reports of a mother having killed her new-born baby and then herself. Depression and so-called psychosis can occur in this period. So, identify and treat the mental health symptoms at the earliest.

The person suffering from chronic illness with pain, and disability can contemplate suicide. Caregivers of persons with prolonged illnesses such as cancer and dementia know these can be stressful. Survivors of suicide attempts must be followed up for mental health issues and treated appropriately. Someone expressing thoughts of suicide must be taken seriously until proven otherwise. Engaging them, giving them time and making them feel they are important, can prevent some. There is a need to provide first-aid gatekeeper training to many.

Many suicides are preventable. Change in behaviour in your friend or relative should not be ignored. They can be offered support. Everyone must understand the concept as well as the skills of problem-solving. Suicide is not a solution to any problem. There could be underlying depression, anxiety, or other mental health issues that can be treated, so see a psychia- trist soon. India has its own national suicide prevention strategy unveiled in November 2022. There is also a national telemanas helpline 14416 for free counselling for the public.

VIJAYKUMAR HARBISHETTAR

Source: The Statesman, 10/04/23

Enemy within: Editorial on concerns over mental health of armed forces

 The assurance of care and accountability could work wonders for armed personnel battling demons within

A chain is only as strong as its weakest link, or so goes the adage. It is thus vital to ensure that the ‘links’ — personnel — that make up the valiant chain that is the army remain robust, physically and mentally. Unfortunately, it seems that the mental health of security men — they have one of the most stressful jobs — is being neglected if the alarmingly frequent reports of fratricide — the killing of a fellow soldier by a serviceman — and suicides in the armed forces are anything to go by. The recent killing of four jawans by their colleague at Bathinda military station is only the latest in a long line of incidents of self-inflicted violence within the armed forces. Now, a report prepared by the Union home ministry has informed Parliament that 29 cases of fratricide took place in the paramilitary forces between 2018 and 2022. Eighteen such incidents had been recorded in the army between 2014 and March 2021. The causal factors are revealing — bullying and harassment are two principal contributing elements even though the junior home minister, Nityanand Rai, stated that "personal and domestic problems" led to such incidents. It is worrying that the aspect of harassment remains unaddressed. It points to the existence of embedded power hierarchies that can have a deleterious effect on fraternity and solidarity that are crucial to the efficacy of and the discipline within the armed forces. The other issue that must be revisited is the aspect of leave. Armed personnel, who dedicate their lives to the service of the nation, often have to go without leave for long periods, adding to their stress. This brings to light a related issue: there must be greater numbers of counsellors and therapists made available for soldiers. The latter must also be encouraged to seek therapy as prevailing institutional and cultural notions of masculinity and aggression can discourage servicemen from approaching therapists.

The minister of state for defence, Ajay Bhatt, has claimed in the Lok Sabha that the government has taken numerous steps towards "stress amelioration" among soldiers, including encouraging a buddy system and providing recreational facilities. The data on fratricide reveal that much more needs to be done. There is also the case for the military top brass to be more transparent about fratricide and suicide. The assurance of care and accountability could work wonders for armed personnel battling demons within. 

Source: The Telegraph India, 26/04/23

Mind matters: Editorial on the mental healthcare problem

 A National Mental Health Survey conducted four years before the pandemic had revealed that almost 80% of Indians with mental disorders had no access to care.

People with mental ailments have been subjected to discrimination throughout history. A clear example of this embedded prejudice is institutional apathy. Systemic measures implemented by the State can, in effect, reinforce social stigma against those battling mental illnesses. For instance, the asylums of 18th-century Britain served as penal centres owing to the then perception that those suffering from mental disorders are criminals. Even advancements in medical sciences, which led to the changes in terminology over the years — the colonial ‘lunatic asylum’ transitioned to ‘mental hospital’ and, eventually, to today’s ‘mental healthcare institution’ — have failed to root out the deeper biases against patients. A classic manifestation of this is the neglect of the mentally ill inside India’s psychiatric institutions. In fact, a 1982 report on the Central Institute of Psychiatry, Ranchi, had revealed shocking human rights violations committed against the inmates — patients were denied basic facilities,  offered badly cooked meals, and were made to inhabit poorly ventilated and ill-lit cells and so on. Dishearteningly, not a lot seems to have changed. Recent findings by the National Human Rights Commission show that the old malaises remain intact. According to the NHRC, all 46 government mental healthcare institutions in the country present an ambience that is expressly inimical to the well-being and the dignity of inmates. This is just the tip of the iceberg. The ratio of mental healthcare professionals to citizens is very poor. The staff in care institutions often lack basic training, leading to ill-treatment of patients. The scope of societal rehabilitation is limited as a result of persistent stigma. As a result, even those who are medically fit to be released from care facilities end up leading incarcerated lives. A National Mental Health Survey conducted four years before the pandemic had revealed that almost 80% of Indians with mental disorders had no access to care. This is only to be expected in a country which, according to one survey, has 0.8 psychiatric hospital beds per 100,000 people.

 All this is especially alarming in the light of the fact that India, experts believe, is expected to face an avalanche of mental ailments in the near future. Yet, the implementation of the provisions of the Mental Healthcare Act, 2017 has not been uniform across states. Budgetary allocation for mental health remains abysmal — of the meagre 0.8% spent on mental healthcare, only 3% is allocated for mental institutions. Will the upcoming budget rectify this glaring gap?

Source: The Telegraph, 30/01/23

Why the link between mental health and death penalty deserves greater attention

 

Vikram Patel writes: Courts need to ensure a more searching inquiry into the lives of death row prisoners, particularly the mitigating factors which help humanise the perpetrator, creating the possibility of compassion in passing judgement.

There are many reasons why the death penalty should have no place in any society, not least because it violates the fundamental right to life. The argument that it may deter violent crime is countered by the observations that murder rates declined in ten out of eleven countries which had abolished capital punishment in recent years. The most egregious aspect of the death penalty is the widespread evidence of miscarriage of justice which occurs even in the most robust judicial systems, leading to the real threat of an irreversible punishment being inflicted on an innocent person.

India has a chequered history with the death penalty. For many years, until the execution of Dhananjoy Chatterjee in 2004 for the rape and murder of a minor girl, the country was a de facto abolitionist state. Since then, nearly 500 prisoners have been sentenced to death row, nine individuals have been executed since 2014, and there has been a legislative expansion of the death penalty, in particular for crimes of sexual violence.

Against this background, the release of the Deathworthy report last month on the relationship between being sentenced to death and mental health, calls upon our society to revisit its ambivalent stance on the death penalty. The report is the result of NLU Delhi’s Project 39A, under the guidance of mental health professionals from NIMHANS, Bangalore. The study involved the interview of 88 death row prisoners and their families. Its findings can be summarised in two broad ways: First, what are the origins of the violent behaviours which led to the criminal acts and second, how might living on death row affect the mental health of the prisoner.

Adverse childhood experiences are the most important determinants of poor educational attainment, violent behaviours and mental health problems. This association has been demonstrated in diverse contexts and has a clearly defined biological mechanism. The lack of nurturing environments and the exposure to toxic stress, that is, when a child experiences intense, frequent or prolonged adversity such as emotional abuse or neglect, directly impacts the development of a healthy brain architecture which is most sensitive to environmental influences in the early years of life. These influences lead to a range of psychological difficulties in young adulthood, such as impulsivity and low frustration tolerance, which are precursors to violent behaviour and antisocial acts.

The Deathworthy report provides empirical evidence that a high proportion of death row prisoners have been exposed to adverse childhood experiences. More than half the prisoners had experienced verbal and physical abuse as children, and the vast majority had experienced parental neglect and grown up in a “disturbed family environment”. Seventy-three prisoners had experienced at least three adverse childhood experiences and 56 prisoners had experienced at least three traumatic experiences, such as a serious accident or a life-threatening injury. In short, this was an extremely vulnerable group of persons who had been exposed to many risk factors which could explain the increased likelihood of poor mental health and violent behaviour.

The second observation is, perhaps, less surprising: Two-thirds of the prisoners were diagnosed with a current episode of mental illness, in particular depression. About half were assessed to be at “risk” of suicide. Undoubtedly, this suffering is the direct consequence of living with the fear of an imminent, violent death. More shockingly, a significant number of prisoners had evidence of cognitive impairment, often due to head injuries. Nine of these individuals were found to have an intellectual disability. This implies that these individuals had deficits in mental functioning which are well-recognised for influencing the capabilities to make responsible decisions and observe social norms. Yet, in none of their cases was their disability brought to the attention of the courts.

From a narrow legal lens, the report indicates the need for courts to ensure a more searching inquiry into the lives of death row prisoners, particularly the mitigating factors which help humanise the perpetrator, generating empathy and understanding for what is undeniably a horrific act of violence, and creating the possibility of compassion in passing judgement. Even if trauma, cognitive impairment and adverse childhood experiences have not found their rightful place in our legal lexicon, they do hold relevance in determining whether a person is so blameworthy as to be sentenced to death. The report also raises the question of whether the harrowing mental suffering consequent to the death penalty is in itself a violation of the rights of even the most despised members of our society. In the case of intellectual disability, the choice of action is even more stark: The imposition of the death sentence on persons with intellectual disability is prohibited under international law, and jurisprudence in India must align at least with this basic principle.

Ultimately, the Deathworthy report provides a sobering, if not entirely unsurprising picture of the devastating disadvantages experienced by death row prisoners which may have played a critical role in mediating their violent acts and the mental health-related pain and suffering consequent to living on death row. Together, these two observations provide compelling evidence to drive the final nail into the coffin of this form of punishment, by far the cruellest act a state can inflict on a citizen. Indeed, the death penalty is counter to the judgement of the Supreme Court which, in 2014, declared mental illness grounds for commuting a sentence of death. If there is an indictment to be made, then it has to be of our society which causes so many children to be exposed to toxic levels of deprivation and the failures of child and adolescent mental health services to detect and intervene early in the trajectory of mental health problems.

Written by Vikram Patel

The writer is the Pershing Square Professor of Global Health at Harvard Medical School, and a member of the Lancet Citizen’s Commission on Re-imagining India’s Health System

Source: Indian Express, 26/11/21

The dark side to daydreaming

 

Excessive and persistent daydreaming hampers productivity and can interfere with relationships

As you log out of online classes, a pile of assignments awaits. After catching up with Zoom-fatigued friends, you decide to tackle your readings. You sprawl on your bed with your weighty economics textbook. As you wade through the chapter on supply curves, you wonder whether your sister’s wedding will end up being a small, intimate affair, thanks to the pandemic. Before long, you conjure an image of yourself in a resplendent lehenga with gold trimming. Shoving aside COVID-19 restrictions, you envision dancing with your friends during the sangeet. Suddenly, your phone pings and you glance at the time. You have spent 45 minutes and barely read two pages. Even worse, you haven’t registered a word.

Many individuals daydream, especially when alone. While daydreaming has been linked to stress-release and creativity, it also has a detrimental side. Excessive and persistent daydreaming not only hampers your productivity but can also interfere with your mental health and relationships. Though maladaptive daydreaming is not listed as a disorder in the Diagnostic & Statistical Manual (DSM-V), it may morph into a “clinically significant condition”, according to psychologists Eli Somer and Nirit Soffer-Dudek (as cited in a British Psychological Society blog post by Emma Young).

Watch out

Healthline.com provides a list of symptoms that indicate when your reveries may jeopardise your well being. If you have an irresistible urge to continue daydreaming even when it begins to interfere with your daily activities, then you should watch out for other at-risk signs. If your daydreams are replete with vivid sensorial images, continue for extended periods, are sparked by real-life events and accompanied by troubled sleep, you may need to seek help.

However, getting help for this condition may not be straightforward, as it is not a recognised clinical disorder. In a letter published in The Psychologist, Maria Tapu bemoans that maladaptive daydreaming is either mistaken as psychosis or dismissed as a fertile imagination. While schizophrenics and manic depressives have difficulty differentiating between their fantasies and reality, Somer argues that maladaptive daydreamers are aware that their daydreams aren’t real. Young writes that cognitive behaviour therapy may be used to help individuals tackle their compulsion to daydream. Online support groups may also provide succour.

Counsellor Trudi Griffin offers some coping tips on wikiHow.com. Certain triggers tend to evoke daydreaming, and you must try and recognise these. It could be boredom or a specific room in the house, for example. In that case, try to stay engaged and avoid that room, especially when alone. As impaired sleep is also linked to more daydreaming, establish healthy sleep routines like sleeping and waking up at the same times. Avoid caffeine and alcohol in the evenings.

Griffin also urges one to stay active. If you feel the urge to enter la-la land, practice yoga, cook a meal, or call a friend. She also suggests journalling, as writing down your dreams may help calm your racing mind and release stress.

Aruna Sankaranarayanan

The writer blogs at www.arunasankaranaryanan.com and her book, Zero Limits: Things Every 20 Something Should Know, will be released by Rupa Publications.

Source: The Hindu, 31/10/20

A humane classroom is what universities must prioritise post Covid

 

Perhaps even more important than transacting the prescribed syllabus is the holding and containing presence of peers and teachers who can listen, empathise and offer themselves as a reliable non-competitive circle of care.

The suicide of Aishwarya Reddy, an undergraduate student at Lady Shri Ram College, has once again foregrounded issues of mental health care of students. The tragic irony remains that it takes the loss of a life for us to momentarily acknowledge the enormous and long-standing neglect of provisions for psychological support in our country. According to the WHO, on an average there are over two lakh suicides in India annually. More than half of these are by young people aged 18-30 years.

2020 has been an exceptionally difficult year. While the economic fallout of COVID-19 has received extensive attention, its psychological impact has been sidelined. A steep rise in depression, anxiety, panic attacks, claustrophobia, loneliness, death anxiety, paranoid symptoms, insomnia, suicides and psychotic breakdowns has been noted. The targeting of minorities and socio-economically marginalised groups, escalation of domestic violence, sexual abuse of women and intensification of familial discord during the lockdown period have considerably impacted the already vulnerable. In particular, students from deprived backgrounds have suffered a form of intense alienation. I wish to focus on college and university students, while thinking of preventive provisions of emotional care that institutions of higher education need to prioritise.

The demands of higher education are experienced as challenging by most students. However, for women students and first-generation learners, the challenges are intensified manifold. In India, women’s education is still largely undervalued. Apart from some belonging to the aspiring middle and upper classes, most young women have to fight fierce battles with tradition and patriarchy in their families to set their feet outside home.Male or female, most first-generation learners enter the university feeling lost. The sense of confusion is enhanced as they experience being at the receiving end of the rural-urban and caste spectrum. Differences in class-related mannerisms are enhanced with the English language acting as a huge divider. With some exceptions, friendship circles among students remain within the nThat the classroom is a space rife with histories embodied in the subjectivities of students is a fact lost to most teachers. Only a few are able to acknowledge that the silent, absent, disruptive or problematic student is the one who is actually feeling isolated and left out. In a recent conversation, a Dalit student said, “So far I have lived my life in hiding, I shudder to think that my classmates will find out about my caste.” Another student from an economically deprived background said, “It is so difficult to speak about my address, my home, the place I go back to each day….” Educators need to remember that access to education is just the first step in the struggle against social injustice. It has to be accompanied by compassionate engagement on the part of teachers and the institutional system.

An education that strives to make its students into questioning subjects runs the risk of challenging traditional norms. It hopes to impart a critical perspective — a lens through which traditional values and familial-cultural aspects are relooked at, at times even critiqued. While most students grapple with a destabilising phase of creative confusion, for some it can turn into a painfully difficult experience akin to an identity crisis. As an inner churning is offset through classroom discussions, students need the comforting and nurturing care of their teachers. Perhaps even more important than transacting the prescribed syllabus is the holding and containing presence of peers and teachers who can listen, empathise and offer themselves as a reliable non-competitive circle of care. The first link in the chain of psychological care is thus a humane classroom, where intellectual discourses on transformative politics are accompanied by an authentic reception of the subjective life of each student.

The second link is an institutional administration that keenly receives and values students as growing adults with valid positions, even when they sometimes challenge the established institutional positions. An administration that is not afraid of students or of “going beyond the letter of the rule” in exceptional circumstances, and one which encourages dialogue across difficult issues, goes a long way in fostering self-confidence in its students.

The third and final link in putting a nurturing culture in place is the vital presence of a space where professional psychological care is available to students. A psychotherapy clinic undoubtedly offers devoted attention to those going through a state of breakdown where one’s emotional life feels unbearably heavy. Instead of solely reading emotional problems as manifestations of mental illness, a psychologist listens to psychic distress as being integral to life.

As an illustration, let me briefly cite the work done by Ehsaas, the psychotherapy clinic at Ambedkar University Delhi. At the time of its creation, this university believed that the pursuit of intellectual knowledge had to be in sync with provisions of emotional holding. A Centre of Psychotherapy and Clinical Research (CPCR) was created with the above mandate. In the last seven years, CPCR, through its Ehsaas clinic, has offered over 23,000 hours of psychotherapeutic support to students, staff, faculty and community. Hundreds of students have walked into the psychotherapy clinic, many from deprived and disprivileged backgrounds, with acute despair, accompanied by fears of ending their life. The Ehsaas clinic has functioned as a space where pressing symptoms have gradually been transformed, through a revitalising emotional journey, into seeds birthing a renewed self-process in the student. At Ehsaas, psychic concerns are understood within the larger framework of social justice.

As I think of Aishwarya, I recall the words of a student with a history of severe neglect whom I met for a long time in psychotherapy, “That I can call you when I feel defeated by my deafening voices prevents me from taking my life. Even if you do not say anything, just to know that you are there on the other side of the phone, holding the receiver and believing that we will together survive this moment reaffirms my will to live.” If at the time when despair was overtaking her, Aishwarya too could have had access to supportive sources she trusted, perhaps a tragedy could have been prevented.

 Honey Oberoi Vahali 

This article first appeared in the print edition on November 19, 2020 under the title ‘A listening classroom’. The writer is a psychoanalyst and professor of psychology at Ambedkar University Delhi

Source: Indian Express, 19/11/20

arrow confines of who is acceptable and who is not.

Keep a positive attitude, it will help boost your memory: Study

 

Science gives you another reason to have a happy outlook towards life; find out!

Even the most positive and optimistic of people have struggled with their outlook this year, because of the strange global situation brought about by the pandemic. But, even if you have had no reason to be in a celebratory mood this year, you need to consciously maintain a positive attitude towards life, because it can help you immensely with your mental well-being and your memory.

A recent study, carried out by Northwestern University in Illinois, has revealed that people who are positive and generally enthusiastic about life, are less likely to experience memory loss when they become old. Weakening of memory is a natural thing to happen to a person as they age, but their mental outlook can slow down this process.

Published in the journal Psychological Science, the research was done with 1,000 adults in the US, and was carried out over a period of time, as the participants got older.

For the study, between 1995 and 1996, 2004 and 2006, and 2013 and 2014, the participants were asked to describe the emotions they felt over 30 days leading up to the study, before being asked to take a memory test. The test had them recall words directly after hearing them, and again 15 minutes later.

The participants’ age, gender, education and history of depression was taken into consideration, and the researchers were able to find a link between “positive affect” — how a person experiences positive emotions — and memory loss.

In other words, while all participants for the study showed a natural decline in memory with age, those with “higher rates of positive affect, had a better ability to recall information”.

“Individuals with higher levels of positive affect had a less steep memory decline over the course of almost a decade,” Emily Hittner, lead author of the study, was quoted as saying.

Source: Indian Express, 5/11/20

Confront the mental health challenge

 

There are several ways to reach out to women at risk in this time, and this is a time when they need the most support

The ongoing pandemic has exacerbated several problems for women, one of them is mental health. The loss of income and mobility have compounded this.

Social and physical distancing are not an option for many women in India. They are not in positions of power within the household, they have no access to finances and, therefore, they are at greater risk of falling into poverty. They are increasingly trapped at home and have had to take on more unpaid responsibilities with schools being closed and family members requiring care. This has meant that women are more burdened than ever before. In rural areas, women are often heading single households as the men are in cities. They are unable to take care of themselves properly, and the idea of taking a day off is alien.

The loss of income and mobility, where these existed in the first place, have also resulted in women having to face situations of domestic violence, which has added to mental health challenges. In every way, the pandemic has reduced their ability to make decisions, and decreased their social power within the family structure. This has left them vulnerable to neglect, abuse and harm, all of which have contributed to lack of mental well being.

The loss of mobility has also led to women not being able to report instances of abuse or to seek medical help. They suffer from lack of community support at the best of times, the pandemic has made things worse for them. The networks which could have helped in the form of small non-governmental organisations (NGOs) are few and far between and, therefore, largely unavailable to women during this time. This increases the distress they suffer.

In such a situation of tension, women are bound to suffer a variety of mental challenges, ranging from depression to anxiety to a feeling of worthlessness. This, once internalised, worsens the situation. This increase in their trauma decreases their ability to take care of both themselves and their families.

For many women, the trauma can take the form of increased feelings of negativity, mood swings, attention deficit problems and physical conditions such as loss of appetite, fatigue, and suicidal thoughts.

The pandemic has diverted health care which should be routinely available for women. This has led to a decrease in reproductive health services which means that women have less access to contraception, abortion and pre- and post-natal care.

Fortunately, we have robust grassroots organisations in the form of panchayati raj, which has a fair representation of women. These should be activated to look into the mental health needs of women, apart from, of course, their physical well being.

The government must think of including the services of mental health experts in the panchayati raj system in a much greater way to ensure women’s safety. For a start, the government can work to use panchayati raj institutions to set up shelters for women suffering from domestic abuse. There must be more online services for women to report mental health problems, on condition of anonymity. The government can work with NGOs to increase awareness and look to deploy specialised care workers in mental health. There are several ways to reach out to women at risk in this time, and this is a time when they need the most support.

Lalita Panicker

Source: Hindustan Times, 17/10/20

Dealing with the human condition

Uncertainty is giving rise to anxiety, guilt, shame, panic. Respond better

The suicide of a young man, who was admitted to Delhi’s Safdarjung Hospital after flying in from Sydney, even as test results to ascertain whether he had the coronavirus disease (Covid-19) were awaited, is a wake-up call. There has been commentary on safety measures required to deal with the outbreak and the individual, social and institutional actions required. But not enough attention has been paid to the toll the disease — and the messaging around it — is taking on mental health.

Covid-19 is new. Rarely, if ever, in recent history have human beings across the world — be in Boston or Bengaluru, Wuhan or Doha, Rome or Seoul — experienced a common set of concerns, driven by a single factor. From its roots to its symptoms, from its treatment protocol to a possible cure, uncertainty is rife. This uncertainty is causing fear, anxiety, panic among people — about themselves, about their loved ones, about their future. This is coupled with a sense of shame among those who are either suspected or have the infection, because of the stigmatisation of Covid-19 patients. Yes, there are people who could have been more careful; yes, there has been a streak of irresponsibility in those should have followed treatment protocols. But it must be emphasised that a patient who gets infected is not guilty, but is actually a victim. Targeting individuals or families with traces of the case is wrong. Unacceptable racial attacks — be it against Chinese-origin Americans in the United States or against people from the Northeast in India — is only adding to this sense of vulnerability. Misinformation is not helping.

The government must weave in the mental health dimension in the way it approaches Covid-19. There has to be sustained counselling and therapy for patients and suspected cases. There has to be better messaging, which battles the sense of shame associated with Covid-19 and emphasises that social distancing is a temporary measure and patients are not criminals. There has to be kindness and empathy in the way families, neighbours, and communities engage with each other. Only a humane response can help deal with the deeply vulnerable human condition of these times.

Source: Hindustan Times, 19/03/2020

Anxious at work? Here’s how you can manage that anxiety

While you’re trying to do your best at work, don’t ignore your mental health and tame that anxiety

You’re at work, playing a certain role, attempting to achieve targets, doing your best to contribute to the organization and its growth while also trying to derive the maximum for yourself as an individual professional. Nonetheless certain factors at work can make you anxious.

A system where clear communication is not maintained, expectations are not clearly stated, processes are not followed in an organized format, or challenging situations keep continuously emerging is usually stress-inducing. It can trigger anxiety in its employees, regardless of the roles they have or the compensation they receive.

If you don’t have a clearly defined role or targets, leaving space for ambiguity in what is expected of you, you may feel rudderless and unsure which can leave you feeling anxious. Not having the skills to fulfil your responsibilities is another reason why people often feel anxious at work.

Simultaneously, if you feel like you cannot communicate with your peers, juniors or the leadership team it can contribute to your lack of satisfaction at work. Having interpersonal relationships is a critical aspect contributing to workplace well-being and its lack thereof can certainly contribute to the anxiety.

Here are some things that you can do to take care of this anxiety:

Build connections and relationships
Work to connect to those around you by getting to know them, where they come from and how they operate. Ask simple questions and be mindful of their presence on a daily basis. Remember to connect and reach out to them when there is a problem.

Also be careful to ensure you do not enter into situations where you talk about someone behind their back. Have a one-on-one conversation instead. And try to have fun moments at the office and if possible then intermittently outside the workplace too.

Seek clarity
Don’t hesitate to ask questions or seek additional information when you are unsure about things. Be it your role, the expectations that the organization has of you, or the responsibilities you hold towards your colleagues—all of these are important and you must be clear on what your contribution must be. Don’t assume it to be a reflection of your incompetence or lack of knowledge.

Set realistic deadlines for yourself
Often people place immense pressure on themselves by keeping rather strict deadlines that tend to border on the unrealistic. As a one-off, work can demand that something be done rather urgently. However, this cannot and should not be a matter of routine.

Creating and following a balanced approach is critical to well-being and the management of anxiety. This also translates into ensuring that you go out, do the things you like to do, spend time on your hobbies, and focus on your health and lifestyle.

Note: If you do continue to experience significant anxiety which is becoming difficult to manage, impacting your relationships or your work, taking away from your health and well-being, disturbing your sleep or appetite, then don’t hesitate to reach out to an expert to find more solutions for managing it.

Source: Hindustan Times, 7/08/2019

How to deal with depression among youth?

Close to 15 million individuals are battling with some form of mental health related illness in India. 10% of all children suffer from some form of mental health issue and more than 50% of these go untreated and many more undetected (Medindia, 2010)

There is no doubt that depression one of the most common mental health related illnesses. The past few years have witnessed an unprecedented increase in the prevalence of depression across various age groups and other demographic sections of the population, including children, pre-teens and adolescents as well.

Understanding Depression in the Youth

The manifestations of the symptoms of depression in children and adolescents can be very different from that observed in adults. As a characteristic of their developmental phase, they may end up keeping their emotional struggle to themselves. As a consequence, they may end up becoming irritable or angry, display a social withdrawal, have a consequent decline in academic performance, and indulge in aggressive or risk taking behavior,, along with an increase in somatic complaints like headaches and stomach aches.

Facts and Figures

The existing statistics indicate a growing prevalence of mental illnesses, especially amongst the children and adolescents. Close to 15 million individuals are battling with some form of mental health related illness in India. 10% of all children suffer from some form of mental health issue and more than 50% of these go untreated and many more undetected (Medindia, 2010). Specifically depression is found in people of all ages including children and adolescents with prevalence rates estimated to be 1% in the younger population (Kaplan and Saddock, 2007). According to the WHO, depression affects 121 million people worldwide (2011).

It is extremely common for pre-teens and teenagers to experience difficult emotions such as loneliness or extremely stressful situations which could have an adverse impact on their self-esteem and self-concept. Considering the physical and emotional changes that occur in the emerging years of adolescence, it is natural for these emotions and feelings to be experienced very intensely, thereby making such a population also susceptible to ramifications in terms of their mental health.

In addition, the lifestyle adopted by today’s youth is an additional factor to be kept in mind! Such unhealthy lifestyle choices as well as erratic routines further influences both their physical as well as mental health in the long-term, influencing their personal, social, academic as well as occupational functioning.

The following are some of the points which could be kept in mind when helping pre-teens and teens in dealing with depression:

1. Provide them with a strong system of social support. Such social support could include family, friends, peers, teachers, or even seniors. Building an effective support system is very important to help the pre-teens alleviate their emotional distress as well as improve their social and psychological well-being.

2. Be calm and supportive. As a parent or a guardian, as stressful as it might be, it is important for you not to get anxious or distressed. Be calm, and provide your support by

being there for the child. Provide support, be empathetic and a listening ear, genuinely. Give him or her a chance to express him/herself. Do not interrogate or form judgements.

3. Assess the risks. Especially in cases of severe depression, it is vital for the family, friends or caregivers to be on the alert for signs of suicidal ideation. All dangerous items that are potentially harmful including sharp objects, pills, and poisonous substances need to be removed from the reach of the teenager.

4. Encourage them to reach out for help. Do not discourage them to seek help. It is important to encourage the depressed person to seek the support of mental health experts to ensure adequate interventions and prevent adverse outcomes.

5. Remember that professional help is irreplaceable. Depression is a diagnosable and treatable illness. It is not caused due to a character weakness or laziness, which can be overcome by will-power, or can pass out over time. It is an illness with requires adequate and timely medical and psychological interventions. Professional help including psychiatric medications and psychological counselling is irreplaceable.

6. Let’s talk! We should not hesitate to initiate the conversation with the affected children, pre-teens or teenagers, as it is important to give a chance to express their feelings and release their pent-up emotions. It is the need of the hour to encourage widespread awareness about such issues, while maintaining a sensitivity as well as openness to talk about it.

(The author is is a Consultant Psychiatrist with Fortis Healthcare)

Source: Hindustan Times, 7/08/2019

Why Americans are the world’s most stressed-out people

Americans are among the most stressed people in the world, according to a new survey. And that is just the start of it. Last year, Americans reported feeling stress, anger and worry at the highest levels in a decade, according to the survey, part of an annual Gallup poll of more than 1,50,000 people around the world, released on Thursday. “What really stood out for the US is the increase in the negative experiences,” said Julie Ray, Gallup’s managing editor for world news. For the annual poll, started in 2005, Gallup asks individuals about whether they have experienced a handful of positive or negative feelings the day before being interviewed. The data on Americans is based on responses from more than 1,000 adults. In the US, about 55% of adults said they had experienced stress during “a lot of the day” prior, compared with just 35% globally. Statistically, that put the country on par with Greece, which had led the rankings on stress since 2012. About 45% of the Americans surveyed said they had felt “a lot” of worry the day before, compared with a global average of 39%. Meanwhile, the share of Americans who reported feeling “a lot” of anger the day before being interviewed was the same as the global average: 22%. Gallup found that being under 50, earning a low income and having a dim view of President Donald Trump’s job performance were correlated with negative experiences among adults in the United States. “We are seeing patterns that would point to a political explanation, or a polarisation explanation, with the US data, but can we say that definitively? No,” Ray said. The findings were not all bleak for the US. Despite having widespread negative experiences, Americans also generally reported more positive experiences, on average, than the rest of the world did. Globally, just 49% of those interviewed said they had learned or had done something interesting the day before. In the US, however, 64% of adults said the same. The two sets of questions about negative and positive experiences, are unconnected, says Ray. An individual can feel both stressed and wellrested in a given day. NYT NEWS SERVICE

Source: Times of India, 26/04/2019

What India must do to solve its mental health crisis

There is a desperate need for mental health literacy. An ecosystem of care, empathy and inclusion requires involvement of politicians, celebrities, activists, scholars and citizens. Only then can we change the way we address mental illnesses. The conversation must start.

We just don’t know what she went through,” a friend told me when we lost a close friend – who struggled with poor mental health for years – to suicide. This remains one of India’s biggest challenges in addressing mental illness: a general lack of mental health literacy. Mental illnesses – anxiety, depression, Post-traumatic Stress Disorder, Obsessive Compulsive Disorder, bipolar disorder, schizophrenia among many others – are neglected in India.

Today, April 7, marks World Health Day, on which the World Health Organization (WHO) in 2019 is focusing on universal health coverage. India has taken a step in the right direction, specifically towards mental health insurance and through the Mental Health Act, 2017. But why does India rank poorly in treating mental illnesses?

In April 2018, a study titled How India Perceives Mental Health across eight cities with 3,556 respondents provides an insight. It revealed that although 87% of the respondents were aware of mental illnesses, 71% used terms associated with stigma - “stupid”, “mad”, “crazy” and even “retard” – to describe mental illnesses. Recently, politician Akhilesh Yadav was criticised for calling the BJP “schizophrenic”.

In a comprehensive piece titled “Generation Stress” in Foreign Affairs, Sylvia Mathews Burwell looked at three factors behind the mental health crisis on American college campuses. These factors intersect in a country with a complex socio-cultural setup like ours. They are: safety, economics and technology.

Examining the factors:

Safety: In India there are two cohorts which greatly lack safety: gender and certain castes. While India is making strides towards inclusion, it is time to push the boundaries. It should start with the recognition that depression is more common in women than in men (World Mental Health report, WHO). But gender isn’t just about women. India celebrated the historic Supreme Court verdict decriminalising homosexuality. But questions of equal opportunity and social inclusion remained. The civil rights of the LGBTQ+ community continue to be limited. Caste further exacerbates the problem. “The pervasive socioeconomic exclusion faced by the LGBTIQA+ community in intersection with caste, class and gender sets up a structural baseline of insecurity. Social exclusion, shaming and abuse can constitute serious blows to one’s mental health”, said Karthik Bittu Kondaiah, a trans-activist and scientist. Gender and caste determine access and opportunity, and therefore, one’s place in society. Lower castes face intergenerational trauma through social exclusion, oppression and negative stereotyping, leading to poor mental health and stigma.

Economics: In many low-to-middle income countries, there are many hurdles in the way of upward mobility. This is especially true for India, with a vast rural-urban divide, a growing unorganised sector and little to no dignity of labour. Writing for The Hindu in October 2018, Jacob Koshy and Bindu Shajan Perapaddan observe that the rural youth’s mental health is most neglected. Interestingly, since villages are more community-oriented than cities, the environment is more conducive to address such issues. However, India’s dismal ratio of one psychiatrist per every 100,000 persons (National Mental Health Survey, 2015-16) proves that even if there is access, options for professional intervention are severely limited and unaffordable. Dr Purnima Nagaraja, a therapist and psychiatrist, believes that people need to move away from an “anti-psychiatry” attitude and seek help. “But due to entrenched patriarchy, vulnerable groups, such as women and children, are often deemed to be overreacting or seeking attention. There is no support system for women since it involves time and money, causing them to believe that they’re a burden on the family.”

Technology: Over-dependence on technology has been shown to be harmful to the mind. A study by Amy L Gonzales (Cornell University) proves technology helps social diversification. It pushes disadvantaged communities to virtual conversations which they would otherwise prefer not to have. Technology can push people into categories of haves and have-nots, but can serve as a problem and a solution. Dr Rajneesh Choubisa, an assistant professor at BITS Pilani, who works on technology and wellbeing believes that “technical and digital literacy” can help spread awareness. “We can solve issues through carefully-crafted interventions to rationalise and control the problem.” For instance, since viral content registers and plays up in one’s psyche, positive content on mental health can trigger a change in attitudes.

India’s Mental Healthcare Act (2017) provides, protects, promotes and fulfils the rights of persons with mental illnesses. The Mariwala Health Initiative, Bridge the Care Gap wants to prioritise mental health in policymaking. “As political parties are currently working on their manifestos, this is the right time to intervene and make a difference in the lives of millions of people affected by psychosocial disabilities”, Harsh Mariwala, chairman of Marico says on their website. While this move is welcome, policy alone won’t work. There is a need for mental health literacy. An ecosystem of care, empathy and inclusion requires involvement of politicians, celebrities, activists, scholars and citizens. Only then can we change the way we address mental illnesses. The conversation must start. “The conversation is slowly beginning, both in rural and urban India. But once help-seeking behaviours change, that is, when people start to look at mental illnesses the way they would their physical health and destigmatise it by asking for help, we can move from conversation to treatment”, Dr Purnima adds.

As the first director-general of the WHO, Brock Chisholm declared in 1954, “Without mental health there can be no true physical health.” So, even though Mental Health awareness has its own day (October 10), it’s important to keep the two together.

Source: Hindustan Times, 7/04/2019

The right to mental health

A new report shows how rising mental ill health is causing mounting disabilities, early deaths and fuelling cycles of poverty.

The term “mental health” has become a euphemism for “mental illness”. This is in stark contrast to what it should be, for mental health is the most valued asset we have, the most treasured aspect of our humanity. This is precisely why, when people are asked to compare different health conditions, mental health problems are ranked as the ones they fear the most. This is not surprising, for we rely on the diverse capabilities our mental health underpins to successfully learn and master the skills that make our lives meaningful and worthwhile. So, one would expect that mental health would be the most prioritised of all issues facing the world. Sadly, that is quite far from reality.

Today, the medical journal, Lancet, publishes a report by its Commission on Global Mental Health. The report was launched on Tuesday at the first ministerial on global mental health, hosted by the UK government in London. It not only documents that mental ill health is on the rise worldwide, but that this increase is causing massive amount of disability, early deaths and fuelling cycles of poverty. Most people with mental health problems do not receive care, which prolongs suffering and leads to colossal societal and economic losses. Even worse, they are often subjected to human rights abuses and discrimination. Perhaps no other cause of suffering has been so profoundly neglected.

The situation in India is on par with amongst the worst country-level mental health indicators in the world. In India, suicide is now the leading cause of death of young people, alcohol use is blatantly promoted by commercial interests and its abuse has been relegated to a moral issue to be addressed by primitive, punitive policies rather than through a public health approach, tens of thousands of people with severe mental health problems languish in horrific conditions in mental hospitals or on the streets and appalling deprivations — from under-nutrition to neglect — that affect the development of the brain in childhood remain unchecked. There are virtually no community-based mental health services in the country.

The Sustainable Development Goals (SDGs) represent an exponential advance from the Millennium Development Goals, with a substantially broader agenda that affects all nations and requires co-ordinated global actions. The specific references to mental health and substance use as targets within the health goal reflects this transformative vision.

To help achieve these targets and, indeed, the SDGs themselves, the Commission outlines a comprehensive blueprint for action. It has three unique guiding principles. One, our approach to mental health must cover its full spectrum, from day-to-day wellness to long-term, disabling conditions. We know how to promote mental health, prevent mental disorders and enable recovery. It’s time to use this knowledge to benefit entire populations. Two, mental health is the product of psychosocial, environmental, biological and genetic factors interacting with neurodevelopmental processes, especially in the first two decades of our lives. Because our experiences in childhood and adolescence shape our mental health for life, it is crucial that these years unfold in nurturing environments, which promote mental health and prevent mental disorders. Three, mental health should be respected as a fundamental right by putting people living with mental health problems at the centre of planning services. Everyone is entitled to dignity, autonomy, care in the community and freedom from discrimination.

Achieving these aspirations will require several actions. First, mental health services must be scaled up as an essential component of universal health coverage. Second, barriers and threats to mental health, such as the pervasive impact of stigma, must be assertively addressed. Third, mental health must be protected by public policies and developmental efforts led by the country’s top leadership. This endeavour should involve a wide range of stakeholders within and beyond health. Fourth, new opportunities must be enthusiastically embraced, in particular those offered by the innovative use of community health workers and digital technologies to deliver a range of mental health interventions. Fifth, substantial additional investments must be urgently made as the economic and health case for increased investments in mental health is strong. There is also an immediate opportunity for more efficient use of existing resources, for example, through the redistribution of budgets from large hospitals to district hospitals and community-based local services. Finally, investments in research and innovation must harness diverse disciplines to advance understanding of the causes of mental disorders and develop more effective interventions to prevent and treat them.

Mental health is a global public good. Our reframing of mental health is aligned with the central principle to “leave no one behind” and to the contemporary notions of human capabilities and capital. We believe both in the inherent right of every person to mental health, and that mental health is a means of facilitating sustainable socio-economic development, more complete health, and a more equitable world.

Urgent action to fully implement our recommendations will not only hasten the attainment of the health SDG, but indeed many of the other SDGs as well. While diverse legislation and programmes, from the Rashtriya Bal Swasthya Karyakram to the Mental Health Care Act, provide a robust policy foundation for realising these aspirations in India, we need to ensure that these are implemented. For this, we will need a genuine partnership of a diverse range of groups — from the mental health and development communities to policy makers and civil society — coming together to transform mental health across the country.

Source: Indian Express, 10/10/2018