Weighed down by a heavy mind, the vice-president of an American multinational investment banking company felt the urgent need to just talk to someone who could calm him down. He felt uncomfortable opening up to his family and colleagues.
He did not wait till the following morning to meet with a therapist. The 42-year-old turned to his laptop to find a professional counsellor online. “The therapist listened carefully to whatever I had to say for over 30 minutes, then spoke to me in a manner that made me feel back in control of my life,” said Mehta.
This was in 2016. Mehta has since become an associate director of a technology firm but whenever he feels anxious or depressed, he simply texts or calls his therapist through the digital platform YourDost. “I encouraged my twelve-year-old daughter to use it when she developed self-esteem issues because of bullying in school,” he said. “The support system has made her emotionally stronger and better equipped to deal with her peers.”
The National Mental Health Survey (NMHS) released in 2016 states that nearly 150-million Indians suffer from some form of mental health issue and that only about 30 million seek help. The situation is similar the world over.
According to the World Health Organization (WHO), 76-85% people in low-and-middle-income countries receive no treatment for their mental health disorders. Reasons for this range from stigma and lack of awareness about mental illness to expensive treatment costs and lack of access to professionals.
The first step
The NMHS points out to another damning data: Depression, anxiety and substance abuse disorders affect one in 20 Indians but the country has only about 900 clinical psychologists and 1,500 psychiatrists.
“Most treatment centres are concentrated in metros and tier-1 cities. This is where digital ventures step in to bridge the gap,” said Puneet Manuja of the city-based mental health startup YourDost. About 40% of the platform’s 1.5-million clients are from tier-2 cities and about 95% of them have never sought help before.
“Apart from the stigma, there are also gender and cultural stereotypes like ‘men don’t cry or become vulnerable’ that dissuade people from going to counselling centres. This might also explain why 55% of our clients are men. They are comfortable with anonymity.”
Enquiries on online counselling platform HealthEminds, launched by Yale-educated paediatric cardiologist Sunita Maheshwari, have increased from four-five enquiries a week in 2015 to about 110 a day presently. About 15% of this translates into paid, long-term sessions.
“Mental health is a story in the making. It cannot be marketed like a product in the crowded digital arena. Businesses like ours only grow with more awareness and word-of-mouth (publicity),” Maheshwari said.
The ability of the digital space to provide ease of access to mental health professionals has also prompted the National Institute of Mental Health and Neurosciences (Nimhans) to roll out Push-D (Practice and Use Self Help for Depression).
Launched in a testing phase last year, the mobile app used activities, audiovisuals, statistics, infographics and other materials that helped users (adults up to 35 years of age) recognise depressive symptoms, seek treatment and get counselling over a month and a half.
Right now, the team at Nimhans is scaling it up to include new features. “Our observations indicate that it has significant potential to reach individuals in distress and who are not seeking professional help. It is also resulting in significant improvement in depressive symptoms and functioning,” said Dr Seema Mehrotra, professor at Nimhans department of clinical psychology, who is heading the project. “Depending on funding support, we plan to have Push-D available in Hindi and Kannada as well.”
Complementing, not competing
However, not everyone is comfortable opening up to a digital screen. For 28-year-old Nandini (name changed), only a year-long of face-to-face psychotherapy sessions could help her out of depression caused by a breakup. “Typing out your anxieties on your laptops and smartphones is just not the same.”
While online platforms offer anonymity and convenience, they cannot deal with more complex cases like severe depression, psychotic illness, traumatic experiences or suicidal tendencies, explained Dr Sapna Bangar, head, client care (psychiatrist) at mental healthcare centre Mpower.
“One cannot use interventions like expressive arts, music or pet therapies online,” she said. “One also misses out on non-verbal cues like body language, postures and eye contact that have traditionally helped professionals diagnose and treat issues in a more holistic manner.”
Puneet Manuja of YourDost admits that online ventures cannot be a replacement for face-to-face counselling. “Platforms like ours are here to help people take the first step of recognising these issues and seek face-to-face help, if required. Mild and moderate cases of depression have been completely tackled online.”
The startup has also collaborated with about 50 schools and corporates to offer subsidised mental health services. There are also training modules for managers and HR professionals on how to recognise and treat people suffering from mental health issues at the workplace.
“Online platforms also help with psycho-education, where counsellors clear doubts or misconceptions and direct people to relevant professionals nearby,” said Dr Fariha Farooqui, who is a counsellor with both the HealthEminds portal and the Parivarthan Counselling Centre in Indiranagar.
The Mental Health Care Bill passed by the Parliament in March 2017 empowers people suffering from mental health issues to access treatment without discrimination, recognises consent, discourages seclusion and solitary confinement and allows people take full charge of the course of their treatment.
In August this year, the Insurance Regulatory and Development Authority of India directed all insurance companies to make provisions to cover mental illness in policies.
The legislative push, along with social media-driven initiatives that encourage people to talk without fear of being shamed or mocked, is creating an ecosystem that does not isolate but support those with mental health issues.
Dr Bangar pointed out that certain problems like lack of sufficient infrastructure and government mechanisms remain. “Provisions mentioned in the Bill are yet to be fully implemented but it is a game-changer. Together, we are taking a step in the right direction.”
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