Community mental health services in India: The pandemic and beyond

Abstract

Both popular and professional narratives during the COVID pandemic have focused on the perceived mental health needs of the population. Anxiety and distress have figured high in the list of mental health problems anticipated either during the crisis or in the aftermath. Some of this has been based on previous experience of disasters, but the current pandemic is unique in that there are no modern-day comparable equivalents. A number of cross sectional studies, many from China, have reported high levels of symptoms, particularly anxiety. However, the interpretation of these is difficult as it is not clear if the reported high scores on questionnaires translate into the presence of diagnosable mental disorders. By focusing on the population effects of the pandemic, we are in danger of neglecting the needs of the existing severely mentally ill. It is also becoming increasingly clear that the pandemic could continue for months or years. Existing mental health services have been badly affected by the ongoing lockdown. Considering that the treatment gap is already wide in India and resources stretched in meeting the existing needs, we cannot afford to lose the gains we have made in meeting the needs of people with severe mental disorders. This paper describes, in the light of an example from Kerala, how we can adapt to the changed circumstances without care being significantly compromised. It could also be that these changes forced on us now, could actually make the delivery of mental healthcare even better in future. The COVID challenge also provides opportunities for reform.