“This assault on my mind. Please help me.”
Many experience ‘long COVID-19’, wherein they struggle with symptoms long after initial infection. While it is important to discuss the physical aftermath of battling COVID-19, it is also of great importance to discuss the mental health effects. An article published recently in The Wire draws attention to post-traumatic stress disorder (PTSD) and COVID-19 with some patients wracked with fear they will contract the disease once more.
The article by Dr Alok Vinod Kulkarni, a senior psychiatrist at the Manas Institute of Mental Health in Hubli, Karnataka, centres around the story of forty-year-old Bengaluru businessman Mahesh whose first visit to a psychiatric hospital came following his earlier experience with COVID-19. Kulkarni cites Mahesh’s remarks during a clinical examination, in which he expressed “the nightmares just won’t stop. I wake up every night shaking with this intense fear that I will contract COVID-19 once again. I wake up drenched in sweat. Worse still, I am unable to function and have stopped working.
“Any mundane discussion remotely related to the virus sets off a series of alarming responses within me. Anything and everything can be a cue to further my anxiety. I have started drinking to cope with this assault on my mind.
“Please help me.”
Kulkarni identified what Mahesh expressed as PTSD. In the COVID-19 context, it is a crucial area to explore.
Why we need to pay attention to mental health, PTSD and COVID-19
In 2013, the World Health Organization (WHO) estimated 3.6 percent of the world’s population to be affected by PTSD in the preceding year. PTSD, a 2017 study explains, results from “trauma exposure” which “is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognised.” Kulkarni delves into many of the specifics of PTSD at length in their article, which adds to the growing concern over mental health during this health crisis – one felt globally and painfully intimately.
As previously noted by Health Issues India, the COVID-19 pandemic has taken a toll on Indians’ mental health. In May of last year, my colleague Nicholas Parry noted how “mental health issues and suicide rates have seen a notable increase in India since the beginning of the coronavirus pandemic.” The Indian Psychiatry Society at the time said a recent study showed a twenty percent rise in mental health disorder cases, affecting at least one in five Indians.
It is understandable why this is the case. In the earlier stages of the pandemic, India entered a strict lockdown for an extended period of time. Individuals coped with loss at a virtually unprecedented scale across multiple fronts: loss of employment and so loss of income, loss of social contact and, of course, loss of loved ones. There is then, of course, the anxiety. Fear of such losses and of becoming infected oneself can provoke anxiety. Even when one ostensibly recovers from COVID-19, there is the potential for reinfection. Even if reinfection does not occur, there is still the potential for lasting physical health effects. As Mahesh’s story shows, there is the very real potential for lasting mental trauma.
Other countries have identified interrelation between PTSD and COVID-19 as a concern. In the United Kingdom, for example, the Royal College of General Practitioners (RCGP) wrote in June 2020 that general practitioners were “adapting the techniques they use to diagnose and care for veterans with Post Traumatic Stress Disorder in readiness for a ‘huge surge’ in patients with the condition as a result of COVID-19…[general practitioners] are already anecdotally reporting a rise in the number of patients with anxiety, depression and trauma symptoms, particularly in those who have pre-existing physical and mental health conditions – and they predict that this will escalate rapidly as lockdown restrictions are lifted and patients try to deal with their experiences.”
PTSD: The mental health dimension of ‘long COVID’
For those who have had COVID-19, the prospect of PTSD is a spectre which may loom large. Kulkarni writes, “at the beginning of the COVID-19 pandemic, I was half-expecting people to present with PTSD symptoms following recovery from COVID-19, and I wasn’t wrong. I have observed a steep increase in the number of patients presenting with PTSD in the last six months.”
Kulkarni writes that “stories such as that of Mahesh tell us that a range of mental health problems are in the offing thanks to the ongoing pandemic. COVID-19 can verily affect the brain, and produce distressing neuropsychiatric symptoms. Early diagnosis and evidence-based treatments will help sufferers reintegrate themselves into society at the earliest.”
Yet India faces a major challenge. The Government, acknowledging the pandemic’s likelihood of inducing mental distress among citizens, launched a helpline early on to help people cope and subsequently unveiled guidelines for mental healthcare during the pandemic. Nonetheless, it is worth remembering that India’s mental healthcare infrastructure has long languished from underfunding, underresourcing, and understaffing. Concerningly, during the pandemic, this has remained the case.
In December last year, Parry wrote “for those affected by mental health issues [in India], treatment is a practical impossibility.” The vicious circle of mental health issues among the population being amplified while treatment remains a distant prospect (if not more so compared to the pre-pandemic world) is one that portends to engender elevated rates of substance misuse, self-harm, and suicide unless the relevant authorities act. Addressing the mental health concerns of those affected by COVID-19 in tandem with any lasting physical effects is an imperative at all stages of the healthcare delivery system.
As Parry noted, “even under normal circumstances, these individuals would be unlikely to avail treatment. Mental healthcare accounts for just 0.16 percent of the government budget for health. In addition, there is an acute shortage of psychiatric professionals in the country. Data indicates that there are 0.3 psychiatrists, 0.12 psychologists and 0.07 social workers for every 100,000 Indians.” While there has been legislative progress and meaningful steps in the right direction, more needs to be accomplished.
The pandemic has underscored the vulnerability of health systems everywhere and India has lessons to learn. Mental health is among those lessons – and addressing the very mental trauma of those who contract diseases such as COVID-19 in the aftermath must be incorporated into treatment.
Contact details for mental health support in India can be accessed here.
If you are suicidal or experiencing suicidal thoughts, visit your nearest hospital or contact AASRA on 91-22-27546669 or Sneha India on 91 44 24640050 helpline. A list of other suicide helplines can be accessed here.