COVID'19 - Mental Health and Drug Addiction

With another adamant wave of COVID in sight for India. It is time that we take a deep look into one of the biggest issue that is faced by many in this nation, Mental Health and Drug Addiction. The Problem: We as a nation are becoming more aware about the importance of mental health with each passing day but there is still a lot of stigma around these issues which restricts many people from asking for help because they fear that this might affect there social standing or they maybe considered as brain damaged or weak. This is the major reason why people don't reach out for help, even from the one's who are closest to them. I have read far too many suicide cases where their family members and friends quoted that, "Yesterday, we were laughing and having a good time. There was not a glimpse of sadness on his/her face". This is horrifying because if you cannot see it then how can you stop it and this is just the tip of the iceberg. Research says that mental health disorders and drug addiction accompany each other, 1) 50 percent of individuals with severe mental disorders are affected by substance abuse 2) 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness 3) Of all people diagnosed as mentally ill, 29 percent abuse alcohol or drugs. After a national lockdown was announced on 25 March, within five days Kerala had registered eight cases of suicide by individuals, who failed to cope with alcohol withdrawal. It is known that cessation of alcohol consumption after periods of very heavy drinking may precipitated the alcohol withdrawal syndrome. The severity and pattern of bodily and mental disturbance varied from individual to individual, it could also lead to self-harm. The news reports which interviewed psychiatrists of leading hospitals in New Delhi explained that depressive patients had started complaining of anxiety related to fear of COVID-19. Some patients expressed the fear of contracting the infection, while others expressed uncertainty related to losing the job or familial disturbances. The experts expressed concerns over rising level of disharmony and discords in the family atmosphere due to lockdown, lack of social connectivity for patients and withdrawal symptoms for alcohol and substance users who are habituated and dependent. In India, 10 per cent of the population has common mental disorders and 1.9 per cent of the population suffers from severe mental disorders. Schizophrenia, bipolar affective disorder (BPAD), depression, anxiety disorders, psychoses, phobia, suicide, mood disorders, neurotic or stress related disorders, post-traumatic stress disorder, marital disharmony, sleep disorders, alcohol dependence and substance misuse and dementia are becoming common problems in the general population. These statistics are derived from registered cases and we have no way of estimating the real statistics because the Indian mental health system faces major challenges such as lack of knowledge about the mental illnesses as well as lack of adequate mental health services. Also, it doesn't have the required resources to tackle this problem because India spends < 2 per cent of its annual health budget on mental health which is far less than many countries of the world. Causes : Risks to mental health are an outcome of interaction of varied factors; both proximal and distal. While the proximal factors act directly to cause the disease, the distal causes act indirectly via many intermediary causes. The current situation of COVID-19 is exercising a strain on the individuals and the families who may be directly affected by the virus or hit indirectly due to fear of infection, social isolation, financial crisis or factors illustrated in the below mentioned conceptual map. There are a number of protective factors which may help in overriding these stressors and may be/are helpful in maintaining good mental health amongst families and communities.

1) Domestic Violence: There have been reports of a sudden surge in domestic violence and child abuse incidences in midst of the COVID-19 crisis. During this lockdown, there have been a number of stressors which have caused distress amongst population, for example, quarantine, pay-cuts, unemployment, uncertainty, fear, violence, abuse etc. While quarantine is a necessary preventive measure to curb the spread of infectious disease, many studies have reported a negative psychological impact of quarantine on individuals. Confinement at home is not a blessing for many, especially those who have been in abusive relationships. The lockdown has aggravated the situation for victims of domestic violence according to the statistics release by the National Commission of Women. The total complaints from women rose in the period between 23rd and 30th of March 2020. During this week, 214 complaints were received out of which 58 are of domestic violence. The increase has been attributed to abusers being confined in homes with no outlet to their anger or frustration and the helplessness of the victims to share their grief or travel to their near or dear ones due to social isolation. During the 11 days’ lockdown period the Government of India’s ‘Childline’ helpline has received more than 92,000 distress calls on abuse and violence requesting for protection, this period became prolonged confinement for children confined with their abusers at home. 2) Economic: The frequent concerns are expressed due to the prolonged lockdown situation which has resulted in an unprecedented economic crisis that has subsumed households. According to a survey by the Center for Monitoring Indian Economy, India’s unemployment rate could have climbed to more than 20 per cent as the economy lost due to loss of jobs after a nationwide lockdown took effect in the last week of March 2020. There are abundant of research literature on negative effects of unemployment on mental health. The abrupt enforcement of the lockdown obviously impacted the underprivileged and vulnerable populations in numerous ways. Due to deep apprehensions related to the loss of livelihood and starvation among migrant workers in the informal sector, there has been a mass urban-rural exodus or reverse migration. The scale and scope of exponential progression of COVID-19 on global economy is hard to grasp, but several experts expresses an apprehension related to an impending second crisis, in the form of an economic recession. Since 1930s the researchers had established that unemployment affects mental health. It tends to make people more emotionally unstable than they were previous to unemployment. 3) Information Overload: In the present situation of nationwide lockdown, continual social media news on COVID-19 are the cause of common over-reactive behaviour among the general public. The news channels are replete of incidents and personal accounts of people of healthcare workers, patients, suspects and quarantined families who are facing stigma and discrimination by the communities. There is an upsurge of information on the virus coming from all sources. From morning till evening, we are reminded about the virus through news, mobile notifications, WhatsApp messages, social media updates and what not. The thoughts and fears could be overwhelming and all-consuming. A study was conducted to estimate the prevalence of mental health problems and examine their association with social media exposure illustrated a positive correlation between the two. 4) Social Isolation: Another emerging aspect which adversely affects the populace is the stigma which is attached to the disease. This stigma leads to social isolation.

The WHO reported that COVID-19, being a new disease, is bound to cause confusion, anxiety and fear amongst people. These factors can give rise to harmful stereotypes. Due to associated stigma people can be compelled to hide their disease due to fear of discrimination, prevent people from seeking health care immediately and may discourage them from adopting healthy behaviours. Stigma has been observed against infected individuals, families and even healthcare workers. There have been reports of healthcare workers being attacked owing to the stigma. The reported effects of coronavirus disease might be profound and there are suggestions that suicide rates will rise. In India there are some reported cases of suicide related to coronavirus in various newspapers. To get a better understanding of the causes look at the chart below.

Psychosocial Interaction and Implications for Mental Health in the COVID-19 Era

We have talked about the problem, its major causes, and now most of have one question in our minds, What can we do to improve our mental health and help others to do the same? I have researched in-depth into the problem but I am not a qualified psychologist to provide you with answers regarding to this question. But, I can provide you with a sense of direction towards solving this problem. For starters, get aware about the problem for that I would recommend you to read, "Dual Diagnosis: Substance Abuse and Mental Health" by Lawrence Robinson, Melinda Smith, M.A., and Jeanne Segal, Ph.D Next Step is to seek out for help, I would recommend you, RehabPath. RehabPath helps make the first step in an individual's path to recovery the right step through knowledgeable, relevant, unbiased, and helpful information online while continuing to provide relevant resources throughout their entire recovery journey. It has got information regarding 1,500+ rehab centers across all states and with that it provides you with recovery resources which includes webinars, drug guides, groups and communities. For more information, click on this link.