After the loss of an immediate family member to COVID-19, a woman who had been treated earlier for mental health problems became very stressed and was having suicidal thoughts.
As the first priority was to get her to stop contemplating suicide, the psychiatrist who got in touch with her let her ventilate. He listened to her, and tried to instil hope by getting her to think positive.
In another instance, a woman looking after two COVID-19 positive members of her family, one of whom had mental and physical health issues, on her own, for days on end, ended up completely stressed. Then, she too tested positive. Without rest or proper food, her physical health suffered. She couldn’t sleep, was disoriented, and experienced mood alterations, and had to be put on medication.
COVID-19 has triggered mental health issues among many, but those with pre-existing mental health conditions are especially vulnerable.
Besides death or infection, livelihood issues and resultant financial constraints also weigh heavily on people who already have mental health problems, says Unnikrishnan R., psychiatrist with the Thiruvananthapuram district mental health programme (DMHP).
While some people suffering from bipolar disorder or schizophrenia may have disability certificates that ensure pension and medicines, others may not have these and thus, are at risk of relapse or worse.
“The pandemic has also prevented people on long-term psychiatric treatment from accessing it, particularly those who depend on private hospitals such as the elderly,” says Tom Varghese, psychiatrist at Beach hospital, Kozhikode.
People under treatment may not also not know how to access it when lockdown and other restrictions are imposed.
Mobility issues during lockdowns or closure of institutions that provide mental health treatment exacerbate matters. Anil Kumar L., superintendent of Mental Health Centre, Peroorkada, Thiruvananthapuram, says while their out-patient consultations have seen a huge drop in patient numbers, the number of in-patients, including those who have COVID-19, is more than their bed capacity.
Since the hospital provides free medicines, most patients did not have to worry about how they could afford it. However, access to medicines may not be easy if the lockdown is extended for longer than a month, he points out.
In the second wave, people in the peripheral areas with mental health problems were asked to get their medicines from primary health centres (PHCs) under the DMHP; only new patients or those showing symptoms were asked to visit the DMHP team for consultation in community health centres. During lockdown though, all patients have been asked to get their medicines from the PHCs till they can meet the DMHP team in person.
However, some people may not be aware that such an arrangement is in place and without medicines may be at risk of relapse. Yet others may be comfortable visiting only their usual institution and not keen on getting medicines from elsewhere and hence stop taking them, says Dr. Unnikrishnan.
Getting medicines for psychiatric issues from medical shops is not easy in the absence of prescriptions, unlike other problems, says Dr. Varghese. Once medication is discontinued, their symptoms start worsening, affecting the entire family. People with bipolar disorder or schizophrenia who have COVID-19 may end up walking around, spreading infection.
Many people may also not approach primary health centres to avoid the stigma of being on psychiatric medications, he points out.
As the number of people with mental health issues increases, so do teleconsultations under eSanjeevani that ensure mental health support in the privacy of homes, without fear of stigma. However, the large number of patients also prevents extended sessions of psychotherapy that may be required by some patients, says Dr. Varghese.
Since last year, nearly 2,000 mental health out-patient sessions have been conducted through eSanjeevani, says its nodal officer Divya S.
