This post has been self-published on Youth Ki Awaaz by Gayatri Kotbagi. Just like them, anyone can publish on Youth Ki Awaaz.

Will COVID-19 Push Us To Recognize Mental Health Care As A Right For All?

More from Gayatri Kotbagi

By Gayatri Kotbagi and Aatish Shinde

In 1919, Science magazine published a paper on lessons from the Spanish Flu pandemic. The paper argued that three main factors stood in the way of prevention:

(i) public indifference: people do not appreciate the risks they run,

(ii) it goes against human nature for people to shut themselves up in rigid isolation as a means of protecting others: it does not lie in human nature for a man who thinks he has only a slight cold to shut himself up in rigid isolation as a means of protecting others on the bare chance that his cold may turn out to be a really dangerous infection, and

(iii) the highly infectious nature of the respiratory infections adds to the difficulty of their control. As the period of incubation varies considerably, the disease may be transmissible before the patient himself is aware that he is attacked. Thus, people often unconsciously act as a continuing danger to themselves and others.

These factors are still very much a barrier in the way of preventing COVID-19, especially in a country like India. A lot of things that we have been taking for granted have been all of a sudden thrown under the bus due to the COVID-19 pandemic. Not just the outbreak of the virus, but the way the governments, and subsequently, the media, have handled the pandemic has made mental health a serious concern worldwide.

Woman on street corona
Image for representational purposes only

The unpreparedness of the nations, even with the advanced medical sciences and resources, has failed to address the mental health aspect amongst its public. Six months since the Indian government announced its first lockdown, as of 7th of October 2020, India reports a staggering 67,57,13 total cases and 1,04,555 deaths.

The Indian government’s expenditure on health as a percentage of GDP still hovers around 1·5%, one of the lowest in the world. As for mental illnesses, a recent survey by the Indian Psychiatric Society shows a 20% increase in mental illnesses since the coronavirus outbreak in India. There have also been reports pointing to the increase in domestic violence, self-harm, and suicides in India.

Through this brief commentary, we wish to look at the impact of the COVID-19 pandemic on mental health and make a case for an opportunity to build a strong mental health care system based on human rights. We would like to reflect upon the various emotional responses to the pandemic, risk communication (the lack of), and the role of social stigma in order to defend the idea for a rights-based mental health care approach.

Emotional Responses

Fear: Fear has been the central emotional response to the COVID-19 pandemic. In order to combat ecological threats, humans, just like all other animals, have a defensive system. At the beginning of the outbreak, the fear was more related to getting infected by the virus and the uncertain end date of the lockdowns. However, as the lockdown got extended, over the past few months, individuals have been afraid of the economic and social consequences (loss of livelihood, uncertain future) of having had to stay at home.

Anger: Worldwide, strong negative sentiments of fear were detected in the early phases of a pandemic. But these emotions seem to have gradually been replaced by anger. It is evident that the government responses to the pandemic were insufficient. Decisions have been made without taking people into account. The government’s unplanned approach has given rise to rage amongst different sections of the society (migrants, frontline workers, patients, teachers, students, etc.). It is also evident that it is the socially disadvantaged individuals who have borne the brunt of this pandemic. They are the first ones to lose their jobs or see their businesses flounder and lack access to healthcare.

Grief: Another emotional response to the pandemic has been that of grief. Individuals having patients or family with severe complications of COVID-19 may have experienced what is called anticipatory grief. The huge surge in deaths for frontline workers is distressing. They too, have been experiencing anticipatory grief.

As the situation has intensified, getting little time for mourning and venting out has added to their grief. Many families experience anticipatory grief because knowing their loved ones suffering and missing out on the final moment are poignant. Also, the absence of ritual, such as a funeral, often results in disenfranchised grief and also impairs support resources that help the grieving process.

Communication

Misinfodemics (spread of the epidemic through misinformation): Risk communication is one of the eight core principles of pandemic preparedness by International health regulations, which is essential to prepare for, respond to and recover from serious public health hazards like emerging infectious diseases.

The goal of risk communication is not just to disseminate information but also to raise awareness, encourage protective behavior, and to promote acceptance of risks and management measures. The debunking of misinformation is a collective responsibility, and authentication of facts is a necessity for the sake of one’s sanity. During times of crisis, the government has to over-communicate. It, however, chose to under-communicate on the pandemic. Poorly communicated or insufficient information from the government seems to have impacted disease control in India.

Persuasion through positive communication: India has paid scant regard to these principles and has communicated to the public about the disease in a way that raises more questions than it answers. The way India responds to COVID-19 has immense implications for the rest of the world.

Another aspect the government seems to have poorly managed is behavior change through persuasion (action-based approach in communication). Clear and concise messaging with transparency, regular press conferences, scientific accuracy with respect to preventive and curative measures, tailoring these messages for target audiences, delivering them consistently through multiple channels were some of the things that the government has clearly lacked upon.

Stigma

Research across the globe has convincingly demonstrated that stigmatization due to infectious diseases leads to adverse outcomes both for the person stigmatized as well as society as a whole. Social stigma and discrimination (the consequence of it) can pose serious significant challenges to the health of people in general and those in particular who are most vulnerable.

Persons affected and recovering from COVID-19, healthcare and frontline workers who are at a higher risk of exposure to the virus, individuals from marginalised socio-economic groups as well as members of a particular race or religion (the Muslims in India for example) have been discriminated against. They were shunned from the housing societies, named and shamed publicly, were refused shelter, and ostracised significantly.

COVID-19 has led to the reinforcement of pre-existing stereotypes against various groups. We know that such stigma and social isolation have negatively impacted HIV prevention in the past, and we seem not to have learned from that. Those who are already targeted for their identities may find it difficult to come forward and seek support with their mental health problems due to social stigma.

Challenges Ahead: Is There A Light At The End Of This Tunnel?

The ill effect of the spread of disease, the need for isolation and social distancing, economic recession, unemployment, poverty are all responsible for the surge in mental distress. This distress is then exacerbated by misinformation, fake news, and lack of effective risk communication on behalf of the government.

mental health
Image for representational purposes only

This, in turn, implies that it is necessary to look at mental health and mental illnesses through the biopsychosocial lens. The biopsychosocial approach posits that biological, psychological, and social factors play a significant role in disease causation and treatment. This lens is not only limited to understanding mental health but can also be applied to understand suicides (which increased significantly).

This brings our attention to the fact that in order to strengthen the mental health care system, one needs to look not only within but also beyond the field of mental health. Within the field of mental health, governments must increase investment in mental health and bring it under health coverage.

The pandemic is also an excellent opportunity to go beyond the pharmaceutical approach to mental illnesses and develop and implement new forms of support and care. The challenge here remains how to deliver these services remotely, especially in a country like India, where digital literacy and lack of sustained internet, as well as electricity, are still significant barriers.

On the other hand, looking beyond the field of mental health implies that human rights must be implemented and strengthened. The primary societal factors that threaten mental health and well-being are inequalities, injustice, discrimination on any grounds (casteism, sexism, racism, etc.), and violence. Many governments have been suppressing human rights even before the outbreak of Covid-19. However, the pandemic seems to have given an added opportunity for these governments to undermine human rights principles further.

The best ‘cure’ for mental ill-health is where the government invests in giving a protective environment to its citizens by ensuring that they get government support packages, basic housing and that their civil and social rights are protected and upheld at all times—during and after the pandemic. In other words, we need to adopt a human rights-based approach for policies within and beyond the field of mental health.

You must be to comment.

More from Gayatri Kotbagi

Similar Posts

By Aditee

By Karun Lama

By InnerHour Mental Health Platform

Wondering what to write about?

Here are some topics to get you started

Share your details to download the report.









We promise not to spam or send irrelevant information.

Share your details to download the report.









We promise not to spam or send irrelevant information.

An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

Share your details to download the report.









We promise not to spam or send irrelevant information.

A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

Sign up for the Youth Ki Awaaz Prime Ministerial Brief below