World Mental Health Day is marked on October 10th, every year. This is a day intended to raise awareness about mental health, advocate the right to mental health for all, and to organize resources to support persons with mental illnesses.
The World Federation for Mental Health, along with the World Health Organization (WHO) has announced the theme for this year – Make mental health & well-being for all a global priority. Yet, what do this day and this theme mean to a world about four years into the COVID-19 pandemic?
Considering that mental health is an ever-broadening and increasingly nebulous concept. The WHO has classically defined mental health as a state of well-being in which the individual realizes his or her own abilities can cope with the normal stresses of life can work productively and fruitfully, and is able to make a contribution to his or her community.
It is unlikely that there is anyone whose mental health has not been adversely affected by the pandemic. Socioeconomic stressors, increasing sociocultural inequities, political strife, and a looming recession have all taken a heavy toll on the mental health of people across the globe.
A study in 2021 examined 221,970 participants across 5 Asian countries (including India) and estimated the prevalence of depression, anxiety, distress, and insomnia to be 31.4%, 31.9%, 41.1% and 37.9% respectively. Another study in 2021 examined 398,771 participants across 32 countries (also including India) and estimated the prevalence of depression, anxiety, post-traumatic stress symptoms, stress, psychological distress and sleep problems to be 28.0%, 26.9%, 24.1%, 36.5%, 50.0%, and 27.6% respectively. A study in the Lancet estimated an increase in the prevalence of major depressive disorder by 27.6% and anxiety disorders by 25.6%
In the Indian context, a study in 2020 by the Indian Psychiatric Society examined 1871 participants to find the prevalence of anxiety and depression to be 38.2% and 10.5% respectively. Closer to home, another study in 2021 conducted in Kerala examined 640 participants to find 56.9% reported depressive symptoms.
As is evident, not all people are affected to the same extent. Women, children and adolescents, older people, persons of colour, persons with pre-existing physical illnesses and persons with pre-existing mental illnesses are more likely to have poor mental health due to their physical and social vulnerabilities.
There are three points to be made here. The first is, while the sheer weight of statistics is overwhelming, it is expected that a world in which 1 in 8 people lived with a mental illness even before the pandemic, would be further adversely affected by the chronic crisis caused by COVID-19. Further, with no clear end to the pandemic in sight at present, stressors are likely to continue and perhaps even intensify. Thus the prevalence of mental illnesses is likely to remain high and perhaps rise even further.
The second is that, while the WHO and the WFMH emphasize the mobilization of resources to support people with mental illnesses, resources are scarce and mental health was underfunded before the pandemic. The redirection of health and social resources to address COVID-19 and subsequent outbreaks of infectious diseases amplified this scarcity. The associated economic crises and political instability across the world served to amplify this scarcity even further.
The third is, mental health exists within a context. The current distress that we see in our communities is occurring in the context of the adverse social conditions experienced. That said, it is unfair to attribute all suffering to mental illness and place it in the domain of mental health. There may be limited use for prescribing an anti-depressant or psychotherapy to a person whose depression is linked to unemployment or unfavourable living conditions. A diagnosis also carries the implication that the management of mental illness is the responsibility of the individual and their family.
There are some potential solutions available. There has been an increase in the deployment of telehealth services to overcome barriers to health care. The mobilization of grass root workers and delivery of health services in the community also helps improve the reach of mental healthcare services. Increased dialogue also helps address the stigma and myths that we have held about mental health and make seeking help easier. The WHO has recommended an increased focus on mental health at the workplace as we embrace newer working models.
However, it is important to be mindful of the fact that we are addressing an ever-increasing problem with continually depleting resources.
(Dr Migita M D'cruz is Associate Consultant, Psychiatry and Behavioral Medicine, KIMSHEALTH)
