This is also a mental health pandemic, say Mumbai's psychiatrists

The first week of the lockdown was like a vacation for us just like everyone else While others were enjoying the idea of working from home we were on a break as hospitals were strategising about which OPDs to keep operational says Dr John Senthilnathan consultant psychiatrist at Powais Dr LH Hiranandani Hospital and Holy Spirit Hospital in Andheri East But this they would realise was the lull before the stormAcross Mumbai psychiatrists psychologists and other professionals working in the mental health sector attest to a sharp increase in patient load by the end of AprilNidhi Jain clinical psychologistpsychotherapist volunteered as telecounsellorThere was a big surge in the number of patients I was seeing online vis a vis in person PreCOVID I didnt have an online practice at all My schedule was five days a week 9 am to 230 pm These were the hours I chose for myself as I am a mother of two sons whose day is full of activities But with the pandemic and the national lockdown Dr Senthilnathans schedule went for a toss With patients not coming to the hospital to renew prescriptions shed be on the computer writing fresh notes This entailed more work Calling up chemists and ensuring that the prescriptions were honoured because patients cant miss a day of medication In the later months with isolation and being cooped up at home there was a surge in depression and anxiety There were also new patients and I was working extended hoursInterestingly a new lot had been added to her patient groupmdashthe nurses at the hospitals I started going to the hospital in April and here wed offer counselling to workers Every day Id see around five nurses Wed debrief them and try to boost their morale They were surrounded by death and trauma And while earlier patients would have their relatives around them now they were being admitted alone the responsibility of the nurses was greater Between the online and offline sessions a sevendayaweek job Dr Senthilnathan admits to experiencing exhaustion By June I was fatigued I recognised this as I was getting irritable at home But I didnt know what I could do as the need of the hour was to step up and see more patientsClinical psychologist and psychotherapist Nidhi Jain volunteered as a telecounsellor for Project Mumbais helpline and has been able to take a break only a few months ago since the pandemic broke PicSameer MarkandeEven as the Coronavirus pandemic thats a year old now has affected over 25 lakh people in Mumbai and nearly one crore in India its impact has been greater on mental than physical health emphasises Oshiwarabased clinical psychologist and psychotherapist Nidhi Jain This is also a mental pandemic The number of people the virus has infected or those showing symptoms is a sizeable amount no doubt but we can count that number Mentally however everyone has been affected regardless of economic status or community The toll is heavy We are social beings and the first few months were terrible We had people of all ages calling in expressing anxiety panic symptoms difficulty in breathing or just fear says Jain who volunteered as a telecounsellor for Project Mumbais helpline which kicked off in the early weeks of the lockdownShishir Joshi is the founder of Project Mumbai a nonprofit that had in the prepandemic era worked in environment healthcare and even set up mental healthcare programmes for BMC and Thane municipal schools Even as the NGO worked towards procuring groceries for senior citizens while restrictions on movement were severe Joshi soon realised that thered be a mental health crisis at hand too He asked a volunteer network if anybody would be interested in signing up for a telehelpline Within three hours we had a show of 90 hands says Joshi After a check of experience and credentials the helpline started with 70 counsellors speaking across eight languages Then we realised that thered be people with special needs those with autism the elderly and so we set up a separate helpline for them as well The volunteers were available in shifts between 8 am and 8 pm Joshi says adding that the helpline 18001024040 went viral It was also available for senior citizens and those lonely in quarantine There were that many people that needed help At the peak the helpline would get 350 calls a day Calls came in from across the country People didnt know whom to talk to Theyd be anxious about where to get food from or how to access pension funds And while we couldnt help them with these logistics we gave them numbers of local officials who couldBhavana Issar of Caregiver Saathi which set up a helpline for caregivers of patients has been clocking 1820 hours of daily work They also have a grief helpline for those who have lost loved ones in the pandemic PicSatej ShindeBy June the country had begun to unlock ever so slightly But the unlocking didnt ease all tensionThe worries transformed says Jain People then became worried about stepping out and how safe that would be We could spend only 1520 minutes per patient and that wasnt always enough Wed encourage them to call in regularly Those who required more handholding were referred to senior therapists who were not associated with us but had agreed to treat patients at little or no costJain hasnt been able to take on any new patients during this period With the helpline the existing patients and raising two children who are homebound has been an ongoing challenge We were almost like frontline workers Its only in the last couple of months that I could take a call to step backDr Sheryl John Senthilnathan consultant psychiatrist at Powairsquos Dr LH Hiranandani Hospital turned to mindfullness meditation and exercise to cope with the increased workload this year PicSameer MarkandeWorld over psychiatrists and psychologists are at risk of suffering a burnout this year In India the matter is only worse due to the statistics Pandemic or not one in five Indians suffers from a mental health problem says Dr Milan Balakrishnan secretary of the Bombay Psychiatry Society a voluntary organisation that serves as both an awareness and advocacy platform However accessibility to mental health is low Only 20 per cent of the Indian population can access mental healthcare The understanding of illness is lower and only those who are very seriously mentally ill reach the system Add to this the stigma attached to reaching out to a psychiatrist or psychologist and you have far fewer numbers reaching for an appointment than they should Of course if they did they may not have enough doctors to help themDr Alpes L Panchal a consultant psychiatrist at several Mumbai hospitals points out when he was a student 10 years ago medical colleges had a maximum of two psychiatry seats per year and two diploma seats With there being four medical colleges in the state every year eight doctors become psychiatrists from the state Of these not everyone will be from Maharashtra some will go back to their states Compare that to the population How is this number enoughDr Panchal has been battling the numbers this yearDr Milan Balakrishnan Dr Alpes L Panchal and Dr Zirak MarkerWith a 20 per cent increase in patient load he admits to having faced some amount of burn out All of us have been working through the pandemic But there arent enough to take on the load he says adding that a small percentage of increase in patients has also been due to the inability of older psychiatrists to make the shift to online counselling due to difficulty in adjusting to technology We are dealing with the same problem over and over again which is leading to repetitive loss of empathy Before the pandemic I would see four to five patients suffering from depression over a week Now over the phone I counsel that number in a single day And so by the time I am on the fifth call I have noted that my ability to empathise is much lesser Its a normal reaction and is bound to happen My ability to empathise degrades with over burdeningDr Zirak Marker child and adolescent psychiatrist Mpower and medical director The Aditya Birla Integrated School says work from home for psychiatrists like the rest of the working population has blurred the boundary of work hours with people calling in late in the evening or night and the odd panic call coming in even at 3 am Statistics indicate that a lot of people do feel suicidal or anxious in the eveningmdasha time when the mind is possibly less occupied with the hustle and bustle of the daymdashand this is when they reach out Then there are irate clients who argue but youre at home onlyAnd yet if the mental healthcare practitioner is not okay their health and subsequently their quality of care will suffer Dr Marker tries to take physical breaks conducting some calls standing up and switching to voice calls instead of video when its a patient they have known for long At Mpower we meet every Monday to discuss our cases and share experiences Counsellors need counselling themselves through supervision and mentoring he says While he does tell patients to message instead of call he admits to checking his phone even if it buzzes at 130 am Perhaps the mind is heightened to respond to sound at that hour also with age one sleeps lighter However I check the message and respond Only if its an emergency do I call the patient else I call the next day While he says that he has seen an increase in the number of new patients many have been careful of expenditure as they dont want to spend money on a psychologists fees during a period of income loss Many dont have privacy they have said that theyd come for sessions when things reopen Later people found innovative ways calling while in the car or when out for a walkFor Bhavana Issar founder of the nearly twoyearold Caregiver Saathi there has been no more an urgent time than now to establish a system where the caregiver is given care tooThe objective of Caregiver Saathi is to address the mental health needs of the family caregiversmdashwho often take care of patients with terminal illness chronic conditions or anything that is incurable The family caregiver goes through secondary trauma and the world doesnt see them Our culture is such that we expect the family to provide care but those doing it are often underappreciated and underserved says Issar whose organisation has reached out to 1700 caregivers with 100 being registered with them While they had online support groups Issar says many were uncomfortable joining as the person under their care would be around at home In addition to isolation and anxiety about the health of the personmdashthey would naturally fall in groups deemed at high risk from the Coronavirus and thus itd be more difficult for them to step outmdashcaregivers were also fearful of their own health One woman who was taking care of an elderly mother and a young child was anxious that if something happened to her whod take care of them For a husband taking care of his wife the evening walk was his only break But with the lockdown and the fear of him catching COVID19 he now has no recreation and is cooped up at home facing social isolationBoth Issar and Joshi have set up bereavement helplines for those who have lost loved ones during this period without being able to access the social support that our culture traditionally allows us People are not getting closure says Joshi speaking about a woman who lost her husband to COVID19 while she her daughter and soninlaw were in isolation in separate rooms of the same house Neither could they attend the funeral nor could they comfort each other The wife saw her husbands funeral on WhatsApp he addsIssar who has been clocking 18 to 20 hours daily says The burden on mental health professionals has increased also because we dehumanise them We make them into angels and gods This doesnt allow people to see the challenge of the infectious and heart breaking circumstances they work in Everybody needs a therapist and that includes therapists and caregivers She recalls a call with a caregiver She called me and said I appreciate what you are doing and the mantras you give And I said I was delighted to hear that because her appreciation replenished me I am human I dont have an infinite source of compassionIn the week of the interview Dr Panchal had got a COVID19 test done which fortunately was negative But in a sense his isolation has not had a real break since March Since the unlocking he has only gone out for a drive with his wife met a group of four friends in an open area like the beach front for half an hour I havent gone to someones home with the AC running and sat there for more than 30 minutes There have been no mall or restaurant outings either WhyBecause we are the danger not the other people We see so many people daily we are a risk to othersWhen will their isolation endIts simple to say till when the vaccine comes but we dont know how effective it will be A more realistic target will be when the number of cases in Mumbai has been 100 or below for three weeks at least8Number of psychiatrists that graduate from Maharashtra every yearKeep scrolling to read more newsCatch up on all the latest Mumbai news crime news current affairs and a complete guide from food to things to do and events across Mumbai Also download the new midday Android and iOS apps to get latest updates MidDay is now on Telegram Click here to join our channel middayinfomedialtd and stay updated with the latest news