SHALINI SAKSENA speaks with experts who say that the rising numbers need to be tackled on a war-footing as a 2019 report by the World Health Organisation revealed that 7.5 per cent of Indian population suffers from some form of mental disorder, which constitutes one-sixth of all health-related disorders and accounts for nearly 15% of the global mental, neurological and substance abuse burden

A15-year-old student has allegedly died by suicide because she could not cope with online classes. The Class X student, Subiksha, from Sivaganga district, Tamil Nadu allegedly ended her life on September 15, 2020 since she couldn’t understand the lessons taught through the online sessions. Subiksha was depressed as she was not able to follow the lessons and feared that she would not be able to score high marks in her exams if she was to study via online classes.

On August 14, 2020, a decomposing body of a 40-year-old doctor working at AIIMS was recovered from his residence in South Delhi. Mohit Singhla was found hanging in a room on the second floor, which was locked from inside. The doctor worked with Department of Paediatrics at AIIMS. A suicide note was recovered that said: ‘It was his life, his choice and he didn't want to live till 60-70 years. The letter also said he couldn’t hide his mental state anymore’.

On August 10 2020, a 22-year-old medical student, Vikas, had allegedly committed suicide at AIIMS. He was a second-year MBBS student from Bengaluru, and had been seeking treatment at the institute for depression.

On July 11, 2020 Dr Anurag Kumar (25), a junior resident with the psychiatry department, allegedly committed suicide at AIIMS.

Depression is a term we often throw around without realising the depth of the disease. “It is a mental health condition that affects people of all ages in the form of one or recurrent major depressive episodes that can be mild, moderate, or severe. There is no single cause of depression; it is a disorder of the brain that occurs due to a combination of genetic and environmental factors working together. It is a frequent mood disorder that is severely disabling and has a significant impact on everyday life of an individual as well as society at large, including a substantial economic burden on society,” Dr Prakriti Poddar, director Poddar Wellness Ltd explains.

According to The Lancet, mental disorders are among the leading causes of non-fatal disease burden in India and 197.3 million people had mental disorders in India in 2017, which includes 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders. It goes onto state that mental disorders comprised 2.5 per cent of the total disability-adjusted life-years in 1990 that increased to 4.7 per cent in2017.  Among non-communicable diseases mental health is the largest contributor to economic loss in India.

“It is time we shun this one at a time approach towards depression and other mental health conditions and take up the cudgels to support them. Depression is a risk factor for suicidal thinking and good mental health care can reduce the risk, there are several ways to ensure the affected person can access these. Suicide prevention programmes and hotlines can provide support and can withhold the tendency for some time. However, the focus   and its prevention draws attention away from the fact that in worst case situations depression and resultant suicidal thinking/suicide attempts/suicide can be compelling,” Dr Poddar says.

The COVID-19 pandemic has added to the stress and disrupted not only just businesses but also our consumption patterns and the way we live. The pandemic induced forced work from home and online education has become the new normal. Screen time has gone up exponentially and a lack of physical activity has significantly impacted mental and physical health. Established routines are completely unsettled. Within a week of the lockdown, reported cases of mental health went up 20 per cent.

A Tata Salt Lite survey has indicated that for Delhiites, work related issues and technology related issues were the top reasons forgetting angry and stressed. Every three out of five (61%) respondents admitted that they would feel extremely angry, make errors or even argue with their boss if they were assigned work on their holidays or if they were asked to work longer on Fridays for some urgent work.

According to Dr Raj Kumar Shrivastava, senior consultant and head, Department of Mental Health and Behavioral Science, Max Super Speciality Hospital, Patparganj, depression is the most common form of psychiatric problem. “It has always been there. Today, people have started talking about it more. People are more open and reporting is on the rise. The role of social media and the celebrities also talking about their mental health, people have become courageous. The pandemic has not helped matters. Fear of infection, losing jobs and negativity around the Coronavirus has added to the burden. There is a change in the lifestyle of people as well. The uncertainty has made people anxious. Glorifying suicide of a celebrity by the media is to be blamed.One has to understand that the person who commits suicide, that person is not mentally strong. Even the smallest things in one’s life can be a trigger leading to mental illness,” Shrivastava says.

The good is that stigma around mental illness is getting diluted, people are willing to talk about their problems. “However, in smaller towns the problem still continues. In the metros the situation is much better.What is more important is to look for signs. There is a term, intent to suicide in psychiatry. It may be a casual phrase which can be a phase that a person is going through. But if the phrase becomes repetitive, that is a red flag,” Dr Shrivastava tells you.

Pallavi Joshi, clinical psychologist at Sri Balaji Action Medical Institute, tells you that people are more aware today and open to talking about mental illnesses. “But there is a need to go through psychometric tests and then diagnose. There are a series of tests that the person is put through. Clinically diagnosed depression is a serious problem. The present generation, if denied certain comforts feels they are depressed; this is not true. The coping mechanism is low for Gen Z now for a few reasons. Lack of physical exercise is one reason. It makes some changes in the brain. Second, the older generation was asked to do certain things like help the mother in the kitchen or offer water to the guest. Kids had household chores to do. They felt needed and had a role to play. Today, they don’t have this and are unable to tackle the pressure. Contributing to the life of others has its benefits, it prevents mood swings, getting bored and falling into depression,” Joshi explains.

Natasha Sharma, counselor, psychotherapist and clinical hypnotherapist opines that the younger generation has lost the art of communication because they have been living in the virtual world of social media and reality is so different.

“Therefore, the lockdown has been so devastating. Humans are social animals. We are meant to be in community. We shrivel up when there is no touch. Isolation is the severest of punishment in jails, there is solitary confinement. This is psychologically the worst thing that one can do, to a human being. Then there is an illusion of being connected due to social media. We don’t pick up our phones anymore. There was a time when one had to wait one's turn to speak over the one phone in the house. Today, even with each one having a phone, we send messages. There is no face-to-face conversation. There is no touch which is a form of communication; there are verbal and non-verbal modes of communication when you are in the same room or in a relationship. What we are seeing is the dark side of technology,” Natasha says.

For a person to commit suicide, research suggests that 90 per cent people who commit suicide have undiagnosed mental disorder. That is not to say that because you have mental disorder, one will commit suicide. There is impulsive suicide as well which doesn’t follow any steps. But suicide does involve a lot of steps and intervention therefore is required which has lot of steps. Skipping a step can result in a loss of life. Essentially, there is no one cause but a bunch of precipitating factors that come together at a particular time or stage.

Pulkit Sharma, Puducherry-based clinical psychologist, says what has changed between then and now is that on an external level. Back then there was a good support system. “People were well-connected. If something bad would happen, society would rally around the person. Face-to-face communication helped and the relationships were deep and meaningful and not superficial like today. Earlier, life was less complicated. Today, the work culture is such that the mind never gets a break. We are doing a lot and have no space to just be yourself. Social media, the virtual world, has added to the problem. One might have 500 friends online, but none whom they can really connect with emotionally,” Sharma tells you.

Though people today may be doing well financially, there is a feeling of lack of accomplishment. “Beyond money, life is empty today. People are working like machines especially for those in the corporate sector. The sources on which one’s self-esteem was based earlier, were deeper and were about value, ethics and work performance. Today, it is superficial; it is all about material things — it is about how much you earn, how you look and what you own. This superficial life can ditch you fast and can lead to depression.‘I have lost my charm’ and I don’t look like I used to’ are common and become triggers,” Sharma explains.

Since there is no or little Government help in order to reach out to people with mental illness, Natasha tells you that it is the people around, the society that needs to step in and lend a hand.

“There are rumblings that there may be something happening at the Government level. We, as a nation,we are under-equipped. We have not Centre of State level policy for suicide prevention. We have no national helpline for suicide prevention, whatever is happening it is due to certain people. There are not enough mental health professionals per capita; there are not enough mental health clinics or hospitals given the population. So, the Government should take up steps. While some head way has been made, a lot more needs to be done,” Natasha says.

Triggers

Stressful events: Personal events like divorce, loss of job, death of a friend or close relative may cause depression.

Family history: Genes have a role to play, so if you have a parent or a sibling with the condition, chances are you will also develop it.

Giving birth: The hormonal and physical changes in a woman's body during pregnancy and after birth, coupled with the added responsibility of a new life, may cause postnatal depression, also known as baby blues'

Substance abuse: Sustained high consumption of alcohol and psychedelic can affects brain.

Illness: Chronic or life-threatening illness like cancer, can cause depression. Other triggers can be poor hormonal balance (hypothyroidism) or head injury.

Gender: Women are more commonly prone to depression than men, mainly due to socio-cultural surroundings.

Prevention

• Take good care of yourself. Get enough sleep, eat nutritious food, and exercise regularly.
• Reach out to family and friends if you are feeling lonely or sad and spend time with them.
• Fight stress with exercise, meditation, and yoga.
• Know yourself better. Find your strengths and pay attention to what makes your symptoms worse. This can help your doctor or therapist.
• Stick with your treatment plan. If you are on medicine, take it as prescribed.
• Do not skip sessions and tell your doctor what is and is not working for you