A fortnight after the worst deluge in Chennai’s recorded history fatally inundated homes, schools and hospitals, the helplines at SCARF (Schizophrenia Research Foundation) have been relatively silent.
But this could just be the lull before the storm, says R. Thara, director of the institute. She vividly recollects the pattern of calls that came in the first few weeks after the tsunami of 2004. A pattern, which she anticipates, will repeat itself now after the Chennai floods.
“We received barely any calls to our helpline [set up to address mental health issues] the first fortnight after the tsunami. And then there was a spike.” Those with existing mental health conditions reported that they had got worse, and new conditions were triggered. “Anxiety disorders turned to panic. Symptoms of obsessive compulsive disorders became acute. Depression relapsed. Dementia took a turn for the worse,” she says.
At the State-run 104 health helpline, calls have begun coming in. B. Prabhudoss, head, marketing and hospital relations of GVK EMRI, which manages the helpline, says that on Tuesday the helpline received 30 calls from flood victims. Schoolchildren, senior citizens, homemakers, bedridden patients, students preparing for competitive exams — all reached out for help.
B. Elayaraja, a counselling psychologist with the 104 helpline received a call on Thursday morning from an anguished 60-year-old woman in Padi. She told him she was terrified and that she suffered from palpitations. “She lives near a temple tank and is constantly worried that water from it will enter their home. She has not been able to sleep, she's not able to concentrate on daily activities and has now stopped watching television. Her diabetes and blood pressure are also not under control,” he says. Counselling was given, and the woman has been asked to call every day for the next few days for follow-ups.
On the brink
Tamil Nadu is particularly vulnerable when it comes to mental health, says founder of suicide prevention centre SNEHA, Lakshmi Vijayakumar. The State recorded the second-highest number of suicides in 2014 according to the National Crime Records Bureau. “The rate of suicides in Tamil Nadu has also been increasing in the last few years,” she says. In 2014, there were 16,122 suicides in the State. Among major cities, Chennai topped the list at 2,124 suicides.
While Tamil Nadu has a better government healthcare system than many other States in the country, a shortage of mental health professionals plagues it as well, says Dr. Thara. The State has just over 400 psychiatrists and under 100 clinical psychologists. Mental health does not seem to be a priority nationally: according to the Mental Health Atlas 2011 of the World Health Organisation, mental health expenditure by the centre was just 0.06 per cent of the total health budget, compared to 0.44 per cent in Bangladesh and 10.65 per cent in the Netherlands.
“There is a huge brain drain of mental health professionals. There are more Indian psychiatrists outside the country than within it,” Dr. Thara says.
The progressive National Mental Health Policy of 2014 aims to address some of these lacunae and also recognises the role of disasters and emergencies in catalysing psychological distress.
“Many local ‘disasters’ (building collapses, slum-evictions, floods, riots etc) do not get sufficient attention. Adequate recognition of mental health consequences and provision of both medical and social welfare responses is necessary for persons affected by disasters,” says the Policy. People affected by disasters and emergencies are listed as “vulnerable populations” along with people living in custodial institutions such as rescue homes and prisons. Dr. Vijayakumar says that in the aftermath of the floods, three categories of persons would require help: those with mental health conditions whose symptoms have exacerbated, who have relapsed or those who have lost their medications and prescriptions; people who have lost family members and friends and those who have lost a lot of their material possessions. “In addition, the mental health of volunteers should also be considered,” she says.
However, one cannot immediately pathologise all anguish and despair, says Vandana Gopikumar, co-founder of The Banyan, an NGO that works in the area of mental health. People have suffered real tangible losses of life and property, and their response to these losses cannot always be medicalised. “So mere psychological responses in the absence of social care facilitation, such as compensations, may not help, as material and economic losses and deprivation could be at the core of such stress,” she says.