Sweta Dash
In December 2019, the first comprehensive study of the prevalence and disease burden due to all mental disorders for every state of India from 1990 to 2017 was published in the Lancet. It indicated that one in every seven people in India is affected by mental health problems and called for urgent systematic procedures for better diagnosis and management of mental disorders across the country. But, with the impact of the pandemic, we have every reason to believe that mental health only went on to be a more serious and ignored problem in the country.
Gender remains a crucial factor influencing mental health. In 2000, the World Health Organisation (WHO) took cognisance and declared “gender determines the differential power and control men and women have over the socioeconomic determinants of their mental health and lives”. As a feminist public health organisation committed to human rights, we believe that mental health and gender must not be treated as mutually exclusive but that the interlinkings need to be studied thoroughly. Without that, it would be a brutal disservice to both issues as well as erasing the lived experience of people affected by them.
Rajim from the Dalit Adivasi Sangathan Manch in Chattisgarh told us how the pandemic has become a catalyst for “double oppression for women.” From her experiences with people’s movements in rural Chhattisgarh, she notes that women have had to face a whole gamut of problems ranging from domestic violence to limited access to non-covid healthcare including even contraception options. In fact, the 2020 World Population report by the United Nations Population Fund (UNFPA) also comes to similar conclusions. Their estimates produced in collaboration with partners Avenir Health, Johns Hopkins University, and Victoria University, suggest that there could be millions more cases of violence, child marriage, female genital mutilation, unintended pregnancy, and more due to pandemic. All data and anecdotal evidence only confirm the veracity of such observations and unfortunately it is not limited to women alone.
Increasing Unpaid Care Work
According to a report released by Oxfam last year, women and girls spend 3.26 billion hours of unpaid care work on a daily basis, contributing about 19 lakh crore rupees to the Indian economy per year. The pandemic, especially because of the lockdowns, has increased domestic workload. A rapid assessment study conducted by the Population Foundation of India confirms this with their finding that 51% of female respondents in Bihar, Rajasthan and Uttar Pradesh experienced an increase in domestic workload during the nationwide lockdown, while just 23% of males did. Rajim confirmed this data with her experience and added that with the increasing domestic workload, women often complain of less time to rest and this adds to their mental burden.
Domestic Violence and the limited means for redressal
With the national lockdown, the number of domestic violence cases spiked up in a way that even the National Commision for Women (NCW) took immediate notice of the situation. Between March 25 and May 31, the NCW received 1,477 complaints of domestic violence, and this was an increase by at least 2.5 times the earlier numbers. In fact, the NCW received 23,722 complaints of crimes committed against women in 2020, the highest in the last six years. In an attempt to take control of the situation, they had launched a WhatsApp number for reporting domestic violence cases.
Meera Singh, from the Mahila Mandal in Jharkhand, narrated her experience with a domestic violence survivor. The woman, aged around 50, had reached out to Meera for help and they had reported the domestic violence incidents at a nearby police station months ago. The police personnels dismissed it as a “mia biwi lafda” then. Meera said that she received a distress call from this woman recently, “After returning from her natal home, this woman found that the husband has divorced her. It was all so sudden that she is unable to make sense of this now. She has at least four children and no source of income. She is far too worried about their fate.”
Meera works with Chhatra Child Welfare committee and One Stop Sakhi centre in Jharkhand, and is not new to domestic violence cases. But, the pandemic has increased these incidents and remedial measures are limited. Access to the police station is affected badly and helplines/social media reporting is surely not something that all women can access. “There is also a red alert due to the cyclone now and all movement is restricted. I have suggested this woman to reside at a relative’s place, for now, and we will take this up as soon as it is possible.”
Abuse and violence against children and adolescents
The pandemic and the lockdown put the lives and mental health of children and adolescents at risk too. Perhaps, a glaring example of that is how ChildLine, India’s children’s helpline, received 4.6 lakh calls reporting child abuse and violence during 21 days of the national lockdown. About 2000 of these calls were for preventing child marriage, physical abuse, emotional abuse, sexual abuse, trafficking, abandonment, neglect, and child labour.
In an attempt to address heightened vulnerabilities of young people’s mental health, the government of India started Manodarpan, and provided a toll-free helpline number and a handbook of life skills necessary to survive a health crisis. States also joined forces with their own helplines and support centres. But, these efforts were barely scratching the surface of the problem.
When schools and colleges moved to online education, the glaring digital inequities wreaked havoc. According to the Telecom Regulatory Authority of India (TRAI), India’s overall tele-density is just 87% and only 58 of every 100 people are internet subscribers. “Smartphone penetration in India is not great. It is less than 40 per cent, even among age groups which are believed to be more tech-savvy, such as the 18-45,” said Mishi Choudhary, technology lawyer and founder of Software Freedom Law Centre India. A push for online education without taking into account these inequities has had devastating impacts, including driving several students into suicide.
Disproportionate impacts on sexual minorities
For the queer community, staying locked up indoors has not been a simple affair because of regular stigmatisation and discrimination taking a toll on their mental health. Living with hostile families meant a lot of stress and trauma, especially for those who have recently undergone sex reassignment surgery or are taking hormones.
Soni Sil, a transgender person who works as the City Mission Manager with Cuttack Municipal Committee, Odisha, notes that the pandemic has restricted earning opportunities for the community. “Most transpersons rely on begging, sex work, or baddhai, and very few of have stable salaried jobs. Who will look after their livelihoods?” said Soni. Taking cognisance of this “serious disruption of livelihoods” for transgender persons, the Ministry of Social Justice & Empowerment promised a subsistence allowance of Rs.1500. They also launched a free helpline for psychological support and mental healthcare for transgender persons. This, however, was surely not enough.
Besides, the queer community continues to battle exacerbating levels of discrimination, phobia and stigma during the pandemic. For the transgender community, these problems affect their access to healthcare services as well. “Healthcare practitioners don’t know how to deal with trans people outside of surgery. There are questions like, will you put a transwoman in a male ward in quarantine and would you have a female assistant to take care of them?” said Chayanika Shah from LABIA.
Realising the need for urgent interventions, the Ministry of Health and Family Welfare (MOHFW) had released guidelines for managing mental health during the pandemic. But, the diversity and complexity of the mental health problems seems to have evaded these guidelines. A report published in The Lancet studies the guidelines in context of India’s mental healthcare situation and argues, “An immediate requirement for the National Mental Health Programme is to understand the extent of the additional burden of mental health disorders in the population owing to the COVID-19 pandemic, and to plan appropriate mitigation strategies…The COVID-19 pandemic also offers the opportunity to broaden the reach and scope of National Mental Health Programme activities through engagement with a wide range of stakeholders within and beyond health care, including sectors in education, workplaces, social welfare, gender empowerment, child and youth services, criminal justice and development, and humanitarian assistance.”
Additionally, we must take cognisance of the accessibility and affordability of mental healthcare. When 63 million people in India are pushed to poverty every year due to healthcare costs, mental healthcare remains a distant dream. This is especially shocking given that according to the 2016 National Mental Health Survey 2016 reports a lifetime prevalence of 13.7% for any mental illness in India.
Sweta Dash writes on public health, food security, and identification documentation issues. She is currently working as a Research Consultant with Sama.