Mental Health and Corona: Better Late, Than Never

Professor Braj Bhushan has written perhaps the most significant article from social science perspective that reveals glaring gaps in our Coronavirus preparedness. Hardnews believes that it is important to engage with this issue as the fight with pandemic will be bitter and long

Sanjay Kapoor, Editor

COVID-19 was lurking at our doorsteps since the end of 2019. Within a small window of two months it has engulfed more than 150 countries. While the government of the day apparently started gearing-up in January this year, the country actually started feeling the heat when the Janata Curfew was called followed by a 21-day lockdown. There has been a lot of debate on TV, newspapers and social media platforms; so how did the scientific community of this country respond?

I want to share what one would ideally expect from the social scientists of this country and what we see on the ground. Views of psychologists in the US and Europe did appear in the newspapers. Let me quote a few who were published between February and March this year.

The story of the Chief Medical Officer of Bhopal, Dr Sudhir Dehariya, returning home after 5-days of intense duty and having tea sitting outside his home, maintaining distance from his family members, got limelight in the media. I keep wondering; did the psychologists, psychiatrists, psychiatric social workers, and others in a similar field think what could forced isolation like this result into?

In early February, The New York Times published an article by social psychologist David DeSteno which laid emphasis on fear and unwarranted actions arguing that “…quarantine or monitoring policies can make great sense when the threat is real and the policies are based on accurate data”. Few days later, another psychologist, Paul Slovic, was quoted in the ‘Interpreter’ column of The New York Times with respect to fear incited by “city-scale lockdowns” and similar factors that was skewing our judgment. On February 28, Cass Sunstein wrote an article for Bloomberg Opinion arguing that “excessive fear” in the aftermath of this pandemic was due to “probability neglect”. On March 12, Gerd Gigerenzer wrote, ‘Why What Does Not Kill Us Makes Us Panic’ in Project Syndicate arguing in favour of “risk literacy” so as to “approach situations such as the COVID-19 epidemic with a “cooler head”.

 Remember that Italy and the US are worst hit by COVID-19 and the scientific community of psychologists was responding to the public and policy makers via their professional services and also by appearing through the mainstream media. DeSteno referred to his lab experiments while Sunstein borrowed from behavioural economics. Both or all these articles are open to debate and discussion, but they did appear right when they were needed.

In a critical article published in UnHerd on March 31, 2020, Stuart Ritchie, a psychologist at King’s College, London, wrote that “psychologists are disgracing themselves anew over the coronavirus”. He went on to critically examine Sunstein’s arguments claiming that “lab experiments don’t necessary generalise to other contexts”. Stuart went on to warn that “psychologists should know their limits, and avoid over-stretching results from their small-scale studies to new, dissimilar situations”.

There were views and counterviews, opinion and explanations. Those in teaching and research were responding to the recent pandemic.

MY QUESTION TO fellow psychologists and other social scientists here is simple and fundamental:  Why are we silent?

India has seen unprecedented measures and varied behavioural phenomena. Should the social scientists of this country not take the pain of explaining it — the least that they can do. The response from different scientific organizations has been different. The Indian Council for Medical Research (ICMR) is actively involved. When I checked their website (April 1, 2020), they had put up, ‘Environmental and Social Commitment Plan (ESCP) — India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836)’, as well as a link to the webpage of the Ministry of Health and Family Welfare. This webpage has information about COVID-19.

Similarly, the Science and Engineering Research Board (SERB) has given a call for proposals under IMPRINT-II C.2 (Consortium Mode) and it clearly states 20 identified themes. It challenges the scientific community to work towards solutions to this crisis.

Therefore, where are the social scientists of this country?

I searched the website of the Indian Council of Social Science Research (ICSSR), a body meant to ‘promote research in social sciences in the country’ to see if they did anything during this period of national crisis. To my surprise, there is complete silence.

Similar to SERB’s IMPRINT (Impacting Research Innovation and Technology), ICSSSR also has IMRESS (Impactful Policy Research in Social Sciences). If SERB can quickly decide for a call, why is ICSSSR silent?

There are a whole lot of psycho-social and economic challenges where social scientists can contribute. During the first week of lockdown, the government further launched a toll-free helpline number for those who might face mental health issues due to the ongoing lockdown. The National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, was made the nodal centre. My obvious curiosity took me to the webpages of three of the professional associations pertaining to the psychologists of this country— the Indian Academy of Applied Psychology (IAAP), the National Academy of Psychology India (NAOP), and the Indian Association of Clinical Psychologists (IACP). To my dismay, IAAP and NAOP did not think of talking about COVID-19-related behavioural issues at all!

The IACP’s response was timely. They have put a full presentation on ‘How to minimize stress and improve well-being during COVID-19 pandemic’. Besides this, they have also mentioned key resource persons and their contact details who can be approached for any such assistance. However, the IACP website (checked on April 1, 2020) mentions the following: “Indian Association of Clinical Psychologists (IACP) is compiling a list of psychology professionals who can provide Pro Bono telephonic/online counselling and first aid to the persons emotionally affected by COVID-19 pandemic. The willing professionals may please fill up the Google form on the link below and volunteer to serve. The list will be circulated through various platforms to the public.”

This is an indicator of how well the clinical psychologists of this country were and are prepared. Even though the government seems to have started responding to the possible pandemic in early January this year, the psychologists have not been very responsive. Or else, the list would have been complete before the lockdown was declared.

I searched the website of the Indian Council of Social Science Research (ICSSR), a body meant to ‘promote research in social sciences in the country’ to see if they did anything during this period of national crisis. To my surprise, there is complete silence.

LET US LOOK at the response of the American Psychiatric Association. Their webpage clearly mentions APA Coronavirus Resources which provides Disaster Distress Helpline, National Suicide Prevention Lifeline, Crisis Textline and Veterans Crisis Line. Besides that, it is also providing resources to psychiatrists through webinars.

The American Psychological Association has also put up general resources on their webpage which has web material on grief and mourning for the deceased, the management of mental health, self-care advice and podcasts, etc.

Hence, where are we, Indians?

On March 28, the Joint Secretary in the Union Health Ministry announced the inauguration of the National Teleconsultation Centre (CoNTeC) at the All India Institute of Medical Sciences (AIIMS) for doctors across the country to get clinical guidance on COVID-19. He further announced the commencement of online training for doctors and nurses on the management and follow-up guidelines for COVID-19 suspected patients.

I must say, if the medicos could do all of these crucial things along with attending the patients and going door-to-door for screening, the social scientists, especially the psychologists, could have done their bit very easily. However, why are we shying away?

There has been lot of talk around the effectiveness of complete lockdown and the need for doing so to contain the spread of COVID-19 among 1.3 billion Indians. While the scientific community of the country quickly engaged in developing ventilators, test kits, anti-virals, and vaccines, the response from the social scientists has been cold. Some have opened-up phone or social-media-based counseling; some have resorted to video messages, posts, and audio messages about anxiety, loneliness and stress arising out of lockdown.

In this context, let me take an example that most of us would be aware of. The story of the Chief Medical Officer of Bhopal, Dr Sudhir Dehariya, returning back home after intense duty of five continuous days, and having tea sitting outside his home, maintaining distance from his family members, got limelight in the mainstream media as well as the social media. I keep wondering; did the psychologists, psychiatrists, psychiatric social workers, and others in a similar field think what could forced isolations like this result into? Should there not be a contingency plan put in place for such medicos and their family members? And why only medicos, police personnel and the skeleton staff of essential services — everyone would need such a service.

Of course, what the medicos would be experiencing might be very different from what the police personnel experience and that might be very distinct from what a grocery seller or cleaner would be experiencing. Is there not a need for customized mental health care?

The mental health professionals need to state it loud and clear. If there is a need for customized service, let the process evolve. It’s better late than never.

I am not sure if the nature of anxiety would be the same for the doctors, nurses and paramedics, and all those who come in close contact with the patients, compared to those who are in the frontline but are not in close contact with them, such as media persons, policemen, etc. Those not in the frontline would also experience the heat, but of a different nature.

I also wonder if the police force, which is used to a ‘certain way’ of managing people/crowd as a law enforcement exercise, is sensitized to handle people during a lurking pandemic outbreak. If the answer is no, then some group of academic professionals should have taken a step forward.

What about their mental health and quality of life? What about the burnout of healthcare staff and policemen? Is burnout not different from stress? Are remedies common to both?

I did not find any mention of steps towards the maintenance of ‘Quality of Life’ (QoL) of those in isolation or those serving others in isolation. Perhaps it’s a luxury that we cannot afford. However, there are reports from China which was hit the first and has been one of the worst sufferers. The mental health institute at the Second Xiangya Hospital, Hunan, offered a protocol for maintaining the QoL. Look at the research papers published by Indian scholars. My guess is that more than half of them have QoL as one of the variables in their research. With so much of research on QoL, why did we fail to propose a customized QoL protocol?

Our training of research and action derivative needs serious rethinking. Chinese scholars have also published the effects of online counselling for healthcare workers and those in isolation in the aftermath of COVID-19 in China. One study that caught attention of the Indian media was by Qasim Bukhari and others at the Massachusetts Institute of Technology (MIT) which analysed the COVID-19 infection data on two weather parameters: temperature and humidity. One might argue that it is too early to expect a social scientist to publish a study based on the Indian sample. Is it too early to expect a write-up in the newspapers or magazines?

On March 18, Debanjan Banerjee published, ‘How COVID-19 is overwhelming our mental health’ in Nature India. Beside that I have only seen small quotes by colleagues in the newspapers. At the end of the first week of 21-days lockdown, came the most disheartening news of the congregation of about 2,000 people in the Tablighi Markaz in Nizamuddin in the capital of India. There was an outpour of messages on the social media. This further intensified with the fake news of spitting by the volunteers of Tablighi Jamaat on doctors and caretakers in the hospitals/make-shift hospitals. This was a religious congregation and people assembled in the name of religion ignoring health concerns and the government advisory.

In a critical article published in UnHerd on March 31, 2020, Stuart Ritchie, a psychologist at King’s College, London, wrote that “psychologists are disgracing themselves anew over the coronavirus”.

Sociologists work on the sociology of religion. Psychologists also work on the psychology of religion and spirituality. There is abundance of literature on religious coping, religion and mental health, and the like. Is it not their responsibility to examine/explain the phenomena and suggest at least the theoretical way forward?

ANOTHER DISTURBING INFORMATION came from the National Commission for Women (NCW) which has recorded a rise in complaints of domestic violence post-lockdown. The trend shows the rise mostly in North India, particularly Punjab. I wonder if the behavioural tips would remain same across different types of needy citizens: those who need financial help, those suffering the double burden of managing work from home as well as family, those experiencing domestic violence during the lockdown, and so forth.

Some of the trending news such as the postponement of Olympics, the cancellation of Wimbledon for the second time (first time, during World War II) etc. might attract our attention. But look at the other pressing news items. On March 31, Takeshi Kasai, the regional director of the World Health Organization (WHO) for the Western Pacific, made it clear that the Coronavirus outbreak will not stop anytime soon and countries should step up ways and means to slow down the transmission of the virus.

So, the challenge remains. Indeed, this is an earnest and urgent call for the social scientists and psychologists of this country. Let’s be late, than never.

Dr Braj Bhushan is Professor of Psychology,  Shri Deva Raj Chair, Depratment of Humanities & Social Sciences, Indian Institute of Technology (IIT), Kanpur.