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Wanted: First aid for mental health

Jaideep Hardikar | Updated on August 06, 2020 Published on August 06, 2020

Meltdown: Months into the pandemic, clinical mental health issues are ripping apart individuals   -  ISTOCK.COM

A new Covid-19 lab at the University of Mumbai is helping people grapple with the angst of social disruptions and the fear of the unknown

* The disruption of life during Covid-19 is precipitating a major mental health crisis in our society, the scale of which we do not really know. What will be the new normal? People don’t know how to cope.

* The University of Mumbai has started among the first free of cost web-based mental health counselling labs at a university

The voice of the young man on the phone is feeble. He answers the question — how does he feel — with considerable unease. “I am home,” he replies after a nervous pause. “I don’t feel safe.”

But the brief confession is like an outlet, giving vent to pent-up emotions. The ice broken, what begins thereafter is a series of counselling sessions, an actual meeting over two- and-a-half months of two minds on a web-based platform, as a trained psychotherapist calms the unsettled, imploding young mind trapped in a seemingly inescapable quagmire.

“For many, the pandemic drove home the bitter reality of home,” says Ayesha Baig, a psychologist at the department of applied psychology at the University of Mumbai. “(For them), home is not a comforting space, but a toxic trapping from where there is no escape.”

The client she was dealing with was from a sexual minority group. With the lockdown following the Covid-19 pandemic, college — his only private space — was no longer accessible to him. He was petrified at home, living with his abusive family questioning his sexual orientation.

This was just one of the hundreds of conversations that brought insightful learning to a team of eight professors and researchers at the department over the last four months at what is among the first web-based mental health counselling labs to start at a university amidst the raging pandemic.

Shelter in the storm: Clients feel less intimidated undergoing mental health counselling over audio and not video interface   -  ISTOCK.COM

 

Months into the global health emergency, clinical mental health issues are ripping apart individuals, the lab’s counselling sessions and research show. People — young and old, men and women — have been snowed under by worries over social and economic uncertainties and the fear of the unknown.

And this, the experts warn, is only the tip of the iceberg.

“The pandemic is more than what we know it is,” says Vivek Belhekar, an associate professor and trained psychotherapist who set up the Covid-19 research and counselling lab in late March to enable researchers and students to better understand concerns that have been escalating during the pandemic. “The disruption of life is precipitating a major mental health crisis in our society, the scale of which we do not really know. What will be the new normal? People don’t know how to cope.”

Every day, the team confronts shattered individuals: Professionals losing jobs and entering a financial abyss; young parents harried by their children and demanding schedules; young students having to deal with aggressive or even abusive parents and the growing stress of working from home. People fear that Covid-19 will consume their families; vulnerable and marginal groups have been pushed to a dark, often suicidal, corner; and there is the angst of social and emotional disruptions caused by long separations from loved ones.

“It’s like a clogging of emotions, a torrent of uncertainties,” Wilbur Gonsalves, a specialist in web-based counselling at the department, says.

As the country hurtled towards a complete lockdown late March, Belhekar and his colleagues set up this facility to offer free counselling and psychotherapy to people through the online platform in Hindi, Marathi and English. The professors and students work online from home. Students doing their master’s create handouts for different problems in multiple languages.

“We are not a helpline,” Belhekar clarifies. “It’s a psychotherapy centre, so the number of people we deal with is relatively low, but instructive of what they are going through in these turbulent times.”

The purpose behind the lab was to help faculty and students go beyond the routine — teaching, exams, administration or academic work. “Our idea was to learn, understand, reflect and plan our approach to tackling serious clinical socio-psychological cases,” says Belhekar, who has years of research in psychology.

The department has developed a robust protocol to screen patients or clients and send them to in-house experts. Participants have to fill up a form, agreeing to join the counselling service, allowing the experts to get a peep into an applicant’s emotional state, perceptions, cognition, level of anxiety or depression, and the gravity of the problem.

A psychometric test follows, leading the counsellors to generate a psychological profile of a person. The cases are then allotted to a specialist. For instance, problems emerging out of job losses go to the industrial psychologist. Each patient gets full counselling — 8-12 sessions, each lasting for 45-60 minutes, with a gap of 4-7 days between two sessions.

“Web-based platforms have a natural advantage. Clients feel safe and less intimidated because we use an audio and not video interface,” Gonsalves says.

By the third session the team reassesses the problem and assigns a particular therapist.

“We devised an eclectic approach to use a combination of therapies to address different problems,” Gonsalves says. “Our internal review meetings helped us incorporate our constant team-based learnings to better our approach over these four or five months.”

The team has observed that a mix of social and financial pangs has turned into clinical mental health problems. “The problems of poor people are different from that of the middle classes; the poor are the first to suffer and first to start coping,” Belhekar says.

The clients come from disparate backgrounds. Among them are a techie couple in the US, staring at job loss and cancellation of their visas — disruption of a planned trajectory that is leading to stress, anger outbursts and despair. Also undergoing severe stress is a 38-year-old man from Uttar Pradesh whose investments in a new business crashed with the lockdown, triggering panic attacks and emotional turbulence.

A recently married woman called up, saying she was trapped at home with abusive in-laws and a helpless husband. A married man said he was being torn apart by the stress of working from home round the clock in an unhealthy family environment, fearing for his job, and having to deal with an abusive father.

“Work-from-home precipitated mental health issues among many of my clients,” says Aishe Debnath, a faculty member specialising in industrial psychology. “It’s not easy to separate work-life boundaries.”

Many feel that they are always in office, just as they are available to the family all the time, and that there is no boundary between the two lives, she points out. For many, this unstable environment leads to high levels of frustration and stress that boil into unmanageable mental health crises.

Gonsalves points out that because people are now spending more time with each other in the same place, they are also being exposed to aspects of behaviour in their close relations that they were earlier unaware of. Some found out about the dominating nature of spouses. “Working couples (earlier) spent a lot of time apart, but are now spending more time at home with each other,” he says. “This leads to coping problems.”

Over 300 people had registered for the service. So far, more than 100 — men and women in equal numbers, but from diverse social and economic strata and from all over India and abroad — had opted for counselling. More men than women had registered for the programme, but not all had gone in for therapy, says Radhika Bhargava, a psychologist handling the service’s data and processes.

A large number of clients were in their 20s and 30s, either in final year of college or early- to mid-career professionals. Young people may also be showing up in larger numbers because they are more tech-savvy than older people, she says.

Most patients suffered from neuroticism — emotional instability, loneliness and depression and needed emotional support despite being home with family. They demonstrated negative emotions: Anger, frustration, fear, disappointment and suicidal thoughts.

“The initial data helped us predict patterns of depression,” Bhargava says. “Most of them expected a level of certainty in life, but here was a disruption that removed any semblance of that, leading to a psychological breakdown, sowing suicidal thoughts in some of them.”

The disruption is so massive, Belhekar adds, that people do not have the strength to deal with the uncertainties it poses. “People are feeling incapacitated.”

Apart from financial uncertainties and disruptions, there are massive social and psychological uncertainties that need to be factored in, adds Umesh Bharte, who specialises in social psychology.

There is, for instance, the dominant fear of separation from loved ones. “We can’t replace everything real with the virtual — like long-distance chatting and so on,” he says. “Social stimulation has been severely lacking in times like these, causing psychological problems among many individuals.”

The team has found that both over-exposure and under-exposure to social interactions are leading to problems.

Belhekar stresses that one way to resolve such problems is by including mental health education early on in formal education.

“Our society is moving towards an individualistic living pattern, but not an individualistic mental frame,” he says. Educating parents, teachers and children about mental health is necessary. He stresses the need to evolve a community counsellor model, like a first aid manual in the mental health services.

In the current context, counselling psychologist Raosaheb Raut argues, a rapid psychometric test should be conducted at the community level — just like a rapid antibody test for Covid-19. This will reveal the scale and intensity of the problem, he says.

“As a society, we have failed to comprehend the magnitude of the pandemic. Most people can’t estimate the outcome in a larger context,” Belhekar says.

In the next few months, the professors will come out with a book on pandemic counselling and make the lab a permanent feature of their department.

The team has two other mega plans. It hopes to map psychological processes over large landscapes and provide artificial intelligence-based prescriptive online feedback to its clients. It also wants to train mental health professionals in post-pandemic counselling.

The feedback from clients, Belhekar said, has been encouraging. He cites the example of a young man in UP who had relationship issues. At the end of counselling, he was able to deal with his bitter childhood experiences and torn emotions.

“We have got to mentally prepare people from all walks of life for large-scale disruptions in their lives — schools won’t reopen soon, examinations will be postponed and at least a year of academic or work life could be lost. Jobs won’t be easy to come by, aspirations will fall apart, while economic, social, political and cultural activities will be hampered for a long time. We would need to adjust to massive changes around us,” Belhekar says. And that, he adds, will not be an easy task.

(The University of Mumbai’s Covid-19 lab provides free online counselling and can be reached on: https://mu.ac.in/online-counseling-for-covid-19-english)

Jaideep Hardikar is a Nagpur-based independent journalist

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Published on August 06, 2020
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