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Understanding Mental Health: Talk, Listen, Stay Informed

December 10, 2017

Ask the Experts with Dr Achal Bhagat

 

WHAT IS MENTAL HEALTH?

We all have thoughts, feelings...We all interact with people. What do we want to achieve? Dignity for ourselves, to fulfil our purpose in life, we want to aspire to some things, we want to feel good about ourselves… This subjective feeling of well-being that we want to achieve for ourselves is positive mental health. When we do not nurture ourselves we start developing mental health problems. Mental health needs are universal.

ONE IN FOUR PEOPLE HAVE MENTAL HEALTH ISSUES
About one in four people have mental health problems….It could be social difficulties that we have, relationship difficulties, break-ups, educational stress, stress at work, difficulties which are ongoing, for example, loss, and these could further contribute to common mental health disorders like anxiety, depression, obsessive compulsive disorder, having physical pains without a cause and some major psychiatric disorders: schizophrenia or mood disorders where we start moving away from reality.

INDIA HAS FEW EXPERTS

One in four people have a problem but the reach of the solutions is very limited. In India, the number of psychiatrists is really low -- about 5000 -- the number of clinical psychologists is very low, number of social workers and nurses is very low, to the extent that one psychiatrist could end up being responsible for about ten lakh people in the general population!

THE STIGMA

We talk about mental health as if it’s equal to going mad… the reality is all of us have mental health problems and it’s actually important to seek help and brave to seek help given the stigma.

IMPORTANCE OF STAYING INFORMED

That’s why it’s very important that all of us are informed about what mental health problems are and also seek help.And it’s also very important that self-help measures are in place so that people can also try to help themselves and their friends and relatives… even if psychiatric help or psychological help is not available.

That’s the purpose of this… hopefully we’ll be able to involve you in the conversation and you will  be able to send us your thoughts, questions, and comments. Tell us your stories.   

Tweet: @healthcollectif 

Sadventures: Understanding Therapy and Denial

December 6, 2017

Art by Solo for The Health Collective

Art by Solo for The Health Collective

 

Solo is a writer and cartoonist from Bangalore. She likes reading, playing video games and binge-watching Netflix. Her life would have been rather unremarkable had it not been for her BPD-fuelled imagination.

Read More Sadventures by Solo

What's Mental Health got to do With Pets and Animal Care?

December 4, 2017

THE HEALTH COLLECTIVE

What does mental health have to do with animal care? In our Health Collective special, Amrita Tripathi interviews Canine Behaviourist Rajvi Mariwala for insight into some extreme stressors. Edited excerpts of our interview:

 

1) Can you share a little bit more on what you highlighted wrt mental health stressors in the animal care environment?

Companion animals or pets have been historically part of human society whether you're considering the oldest domesticated animal, the dog, or others like cats, horses and birds. Pets are seen as part of the family more now than they have ever been before. This is because with most pets, there is interaction, communication and considerable emotional engagement.

For some, pets are their babies, family members, familiars, companions or best friends. Many pets, especially dogs, are seen to provide 'unconditional love.' This is seen in nomenclature used -- furbaby, furkid, child, baby and pet parent, or just parents. Pets and their needs add structure and routine to people’s lives. This has led to not just a panoply of pet products, but also a service industry. Thus, it is not just pet parents whose concerns need to be taken into account, but also, professionals who cater to companion animals such as Veterinarians and vet techs, trainers and behaviourists, groomers, pet sitters and kennels, as well as animal rescue workers.

Numerous studies done in places such as UK, Australia and USA have shown that veterinarians and animal rescue workers have much higher than the average suicide rate. They have to deal with cases where the prognosis may not improve as well as animal cruelty cases. I couldn't find any data or information on trainers, pet sitters or groomers. Nor could I find any India-specific information.

(Editor's Note: For Further Reading, check out this piece in Psychology Today)


2) What can you tell us about this survey you mentioned (of animal care professionals) and stressors?

Recently, there were news stories of two people who killed themselves in Bangalore because their pet dog died. I have received many calls and heard many narratives from people who have had trouble coping with a loss of a pet. Even personally, when my first pet dog died, I slept with the lights on at night for 2 months because I could hear his nails on the floor every night.

Additionally, in conversations with vets and trainers I knew, we'd eventually circle back to how stressful work could be. So, I approached iCall to see whether they were interested in learning about and providing services for persons who lived or engaged with companion animals. To prepare better, I designed and carried out a survey of animal care professionals to learn about stressors as part of a training for iCall helpline.

Using the snowball method, I received responses from over 30 vets, 55 trainers, 60 animal rescue workers, over 35 pet sitters/ kennels and 7 groomers.

46% of respondents said that their daily stress levels were 5 or higher (on a scale of 1-10) and 68% faced sadness/ feeling low/ depression after starting this work.

More than half the respondents said that their biggest stressors were:

  • Helplessness due to pet owners or people not heeding advice
  • A dim chance of improvement in a situation
  • Charged emotional situations and pressure
  • Frequent deaths and euthanasia

There is also a common thread of very long work hours, insufficient income and stress from family since you are seen not to be in a proper profession. Furthermore, 33 respondents reported facing verbal harassment/abuse/ violence from clients, 25 respondents each said they have been attacked on social media and by neighbourhood and society. People also reported similar harassment from family, friends and peers/coworkers.

 

Image by Raw Pixel

(Image courtesy: Raw Pixel)


3) Is there any insight or any anecdotes you'd want to share on working with animals -- eg strays. I get a sinking suspicion there's a lot to be said about animal cruelty, for example, the news story this evening on 150 dogs having been found poisoned and buried?

Working with pets or animals who live on streets, is never working with the animal alone, but also with the humans around it. For vets, trainers, groomers and sitters, this means dealing with unreasonable demands, lack of respect, a pressure to provide quick results as well as constant calls and messages after work hours, including at 4 am.

This group as well as animal rescue workers see a spectrum of cruelty towards animals ranging from neglect to apathy to cruelty to torture. Whether it’s a family who may live with the dog, or human-animal conflict on the street, dealing with this means experiencing what is commonly referred to as compassion fatigue or  secondary traumatic stress disorder.

For the animal rescue workers, a work-life balance/ personal limits may be even harder to negotiate. As one respondent said, "The stress is related to the adoptions of fosters, people promise to help but then go silent, potential adopters are sometimes very disappointing. Also the stress of handling very very young animals, the fear of losing them, waking up at all hours to check on them."

"Too many animals come for help. Too few resources. I am physically and mentally tired. Feel that I cannot cope. Also cruelty cases really really affect me badly. Also people take advantage of us through animals. That bothers me."

 ... Certain situations like advising euthanasia, telling a family their pet needs to be re-homed, or putting a puppy without a home back onto the streets is so emotionally loaded.

For example, I had to tell a family to give up a dog they had recently adopted, for both their sake and the dog’s sake. I saw to it that an appropriate foster and NGO would be part of re-homing.  However, the husband of the family made me listen to his wife and kids cry and wail "because of" my professional assessment. I disengaged from the situation only to learn that two people got bitten a day after that and the dog had been palmed off unscrupulously.

Additionally, for all of us professionals, we face the risk of being injured by an animal in the routine course of our work. What hit me the hardest on going through the results of the survey, was responses to question on mechanisms used to cope with work related stressors. Of 115 written answers, only 7 spoke to others about their distress.

Luckily, 90% of respondents thought it would be a good idea to have access to a telephone service (with those) who have been trained to understand this work, where one could reach out for mental health support.


ALSO SEE: COUNSELLORS, THERAPISTS, HELPLINES
 

4) In terms of pet owners -- what are some of the common issues that come up, where counselling might play a role? Eg grief over a pet passing away... And what are some coping mechanisms to share, for example with children?

While the above (especially nomenclature) attests to the unique bond pets share with the humans they live with, this anthropomorphism can cause problems for both the quadruped and biped. For people who live with companion animals, there can be a few major stressors that other family members, friends and work spaces may not understand or be open to. These can be if their pet practices a problematic behaviour or aggression, chronic illness, a pet getting lost or the death of a companion animal.

For many people, family and friends do not understand or treat as less than when you have to care for or grieve over a pet -- the legitimacy of the grief is called into question (For example: It’s just a cat, you can go get another dog today).

There are no grieving rituals to help cope. One's daily life rhythms may be altered drastically with the death of a pet, i.e. walk timings, feed timings or even opening the front door is never the same again. This makes a loss all the more palpable.

For children, it’s best to be honest, talk about their feelings and be honest about expressing yours. Allow your child to memorialise the pet her own way with art writing, or a ceremony.


5) Basically to sum up, is there anything you'd like people to know -- 2/3 things you wish everyone knew about mental health and animal care?

  • Feelings about your pets/animals/you live/work with are legitimate and do not feel worried or ashamed to talk about it to supportive individuals or professionals.

  • Know and respect that pets are support systems and chosen family for many persons across ages, classes, castes, sexualities, genders and abilities.


Views expressed are personal. Material on The Health Collective cannot substitute for expert advice from a trained professional. Your comments are welcome @healthcollectif.

Sexual Harassment and Healing from Trauma

November 30, 2017

By Sukanya Sharma

The recent #MeToo campaign has brought to light again how sexual harassment is an everyday occurrence for many women and men. There’s no question about some of the major after-effects of dealing with an experience like this.

“Trauma is at its core an emotional response to an overwhelming (negative) event. It makes changes in the functioning of the brain,” Janavi Doshi, Program Director for HEAL, tells The Health Collective.

Research conducted in Denmark recently revealed that employees who experience sexual harassment by supervisors, colleagues or subordinates in the workplace may develop more severe symptoms of depression than employees who experience harassment by clients or customers. (Source: Science Daily)

An India Spend analysis of data from The National Crimes Records Bureau reports going back a decade found that crimes against women were reported every two minutes in India.

  • 10 cases were reported every hour of Cruelty by husbands and relatives (under section 498‐A of Indian Penal Code); 909,713 cases reported over the last 10 years

  • Kidnapping and abduction of women (315,074) is the third-most-reported crime followed by rape (243,051), insult to modesty of women (104,151) and dowry death (80,833)
    (Source: IndiaSpend)

Children, as we all know, are also vulnerable to abuse and harassment. The Hindustan Times reports on a survey published this year by World Vision India, which found that one in two children surveyed is a victim of child sexual abuse. The study also reports that one in four families do not come forward to report child abuse.

HEALING AND THE IMPORTANCE OF COMMUNICATION 

What happens to survivors? And what of the healing process?

Doshi highlights some key points to keep in mind:

  • Immediate safety is extremely important after a traumatic event

  • People who have been through sexual trauma may show overwhelming emotions especially anxiety, confusion, shame, guilt and self-blame

  • Talking to a person (not necessarily describing the event) who is calm and understanding can help in the survivor feel more safe and secure, understood, respected and cared for appropriately

Doshi adds advice for those who undergo such trauma:  “Seek out social support by connecting to trusted adults. Don’t keep quiet out of fear that others will not understand or that others will get upset. It’s not essential to talk about the event itself, just having someone who can make you feel secure and understood can make a big difference.”

ALSO READ: ASK THE EXPERTS: GRIEF AND COPING AFTER LOSING A PREGNANCY

Healing as a process looks different to different people, and respecting that process is absolutely essential.

Kirthi Jayakumar, founder of The Red Elephant Foundation, tells The Health Collective, “The first step is to make the choice to deal with the trauma - which starts from acknowledging it. Be aware of all the options you can access or have before you, and see what resonates with you. Talk to people if you want, do your research by reading, if you want. Take the step when it feels comfortable and when you want to.”

Your family, friends, partner play a huge part of this stage in healing, and getting back to a place of self-love.

HOW CAN FRIENDS AND FAMILY HELP

“Recognise that each survivor can show very different impact of the sexual violence. It’s not important for you to know the story. What is more important is for you to be present and provide a safe, secure space for the survivor to come to terms with the event at their own pace,” says Doshi.

Help to provide that safe space, and allow the survivor their own time to heal. Make an effort to understand more about what they might be going through...without intruding.

“Further, the trusted circle need to know that trauma makes changes in the brain functioning. Every time the survivor reacts unreasonably or has overwhelming emotions, the brain has triggered the response system based on their past experiences. All the brain, and in turn the individual is doing is a survival mechanism. As a support person, you can help them be calm in the moment by being calm yourself. Further, encourage the survivor to reach out for professional help and motivate them to keep the appointments. You can also get help for yourself to know more”, adds Doshi.

You can do the legwork in terms of finding resources that could prove helpful.

Kirthi Jayakumar, who coded the SAAHAS app for survivors of gender-based violence, also tells The Health Collective: "Survivors who have faced violence either don’t know where to go for help, or don’t have resources to find out where to go for help.

Sometimes, their situation prevents them from finding help, and that can be extremely dangerous to their safety. Research by the Red Elephant Foundation found that many women couldn't search for resources online due to search engine trails that they couldn't always successfully erase.  Furthermore, many women were unsure of the credibility of the organisations themselves.”
The SAAHAS directory of support enables a one-click platform to identify where services are available for survivors, without leaving a trail, and it also facilitates collaboration.

“Organisations can help survivors in other countries access help, or, can refer survivors who come to them, to others to respond to particular needs," Jayakumar says.*

(Editor's note: Remember that the physical safety of the survivor is paramount. First ensure that the survivor is safe.)

 

The Health Collective
The Health Collective

 What does the survivor need to know? It’s not your fault.

Doshi further explains that in cases of sexual violence, especially child sexual abuse, the offender grooms the victim over time. They make them believe that they are party to the abuse, thus, making feelings of shame, guilt, and self-blame for survivors extremely common.

FOUR THINGS TO KEEP IN MIND

1) Be careful in your choice of words

Questions like “When did it happen?” “How many times?”, “Where?”, “Why didn’t you tell me before?” are intrusive and only serve to push the blame or guilt onto the survivor.

2) Tread carefully

Your choice of words will be determined by whether you’re talking to an adult or a child.

“Younger children will have limited vocabulary and hence require more behavioural communication. Always keep the narrative open-ended and don’t put words in their mouth. Let them describe the events in their own language and vocabulary at their pace. Adolescents and adults can process information cognitively and hence will be a lot more verbal. Regardless of the age, all survivors need to feel secure, believed, and protected. They need to be accepted with dignity and respect,” explains Doshi.

3) Being open and non-judgemental plays an important role in establishing trust between the survivor and the care-giver

ALSO READ: ASK THE EXPERTS: LEARNING TO BE KIND TO YOURSELF

4) Be aware about touch

Many survivors of sexual abuse are averse to and have a, spontaneous reaction to unexpected touch. Caregivers need to remember that their reaction has nothing to do with them...It’s a part of the fight-or-flight response system, and the survivor’s brain takes time to register that this touch is safe.


Disclaimer: Views expressed are personal. Material on The Health Collective cannot substitute for professional advice from a trained expert.

*For more information on the SAAHAS app, visit: http://www.redelephantfoundation.org/p/saahas-gbv-help-map.html

Voices: What is Stressing out Delhi's Girls?

November 25, 2017

By Devanik Saha

The World Health Organisation (WHO) estimates that 10-20% of children and adolescents experience mental disorders. If untreated, these conditions severely influence children’s development, their educational attainments and their potential to live a fulfilling and productive life.

In the recent past, the debate around mental health has got some traction, with efforts being made by different stakeholders to inculcate awareness among everyone. Several organisations are leading mental health training programs for students and adolescents.

Also Read: Ask the Experts: Child and Adolescent Mental Health

In this context, The Health Collective recently visited a senior secondary government school in Sangam Vihar, New Delhi, where we spoke about mental health issues with girls from the ninth standard.
 

Voices from The Health Collective

Photo by Devanik Saha for The Health Collective: The school's morning shift is for girls, the afternoon one is for the boys

 

The discussions revolved around how daily incidents and life experiences of these girls trigger depression and impact their mental well-being. The age range of the class varies from 13-17 years. This is a critical time, as we know -- a myriad biological changes occur during puberty including physical and emotional changes, as well as sexual maturation and changes in body composition.

For those of us who remember going through adolescence, it often feels like you're all alone, that no one gets it.

The Health Collective asked these students, “Do you feel you have someone who listens to your problem without interrupting and without being judgmental?”

Initially hesitant, the students started opening up gradually. Though the reasons and concerns vary, a common thread is the role of gender -- how it interacts with patriarchal family structures and societal processes to discriminate these girls.

Reeta, an enthusiastic and outspoken student, told The Health Collective, “I have a cousin brother who listens to me without being judgmental. Whenever I have any issue, I speak to him and I feel better.”

However, not everyone was so lucky. Vinita said, “Our friends understand us but they interrupt us always and thus, the issue goes out of hand. This is why we don’t discuss our problems.”

As Reeta and Vinita spoke, the conversation moved to problems and issues -- apart from exams -- which have an impact on their mental well-being. 

Voices from The Health Collective

Photo by Devanik Saha for The Health Collective


The Health Collective asked, “Apart from exams, what are the other issues and problems which impacts your mental state and well-being”?

Komal said, “I am not able to focus on my studies because of my parents. They give more importance to my brother and only he can use Facebook and Whatsapp. Because of this, I have started hating my parents and this is a huge problem I face.”

Also Read: Dating in the Teenage Era

A girl who didn’t wish to be named told the Health Collective, “My financial problem disturbs me a lot because in my family, I have five members who are all elder brothers and sisters. Therefore, my father isn’t able to pay money for our studies and sometimes, I and my family do not have anything to eat.”

A 2012 study conducted in China found that early-life nutrition also has a profound effect on neurological development and psychological health during adult life.

The issues some students are facing, are quite simply, traumatic. Priya spoke about the sexual abuse she faced a few years earlier.

“Whenever I sit alone, a certain incident comes to my mind. I was around 10-12 years old, I was sexually abused by a boy who is our relative. My whole family knows this but they do not take any action because he is a relative. But this issue affects me now also as my grandmother told this to everyone.”

Also See: Child Abuse Helplines

More conversations revealed the impact of sexual harassment on mental health and well-being. As you can watch in the video below, Khushboo tells the Health Collective about a boy who has been calling her every day and stalking her, even threatening her with an acid attack if she rejects him*.

“Since the past 3-4 days, a boy has been calling me everyday and saying that I have been after you since two years. How can you reject me? He threatens me by saying that I will harm if you come out. I will throw acid at your face," she tells The Health Collective. "I do not even know who the guy is and I haven’t told my parents till now.”

This 2016 report suggests that sexual objectification is both directly and indirectly linked to various mental health distresses and disorders in women, including anxiety, depression, disordered eating, and reduced experiences of flow and productivity.

Neha* said, “Whenever I tell my mother that some boy passed comment at me, she tells me  that I must be wearing the wrong clothes. This hurts me always and makes me feel bad.”

There are many issues that make children and adolescents vulnerable -- and a disconnect with their parents is definitely one of them.

“Disconnected with parents who are unable to fathom the complexity of this generation, kids often open up to peers/media friends in unhealthy ways that make them vulnerable and easy to exploit. Heart breaks and a deep sense of being let down, leading to anxiety and depression, is increasing alarmingly,” said Dr Amit Sen in an earlier interview to The Health Collective.

Also Read: Coping With Extreme Thoughts

After our session at the school, Arpita Tiwari, a Teach For India Fellow, who teaches this class told The Health Collective that she learned about some of the multiple issues troubling these school kids. “The session started with a giggle around what could be mental health. But with the flow, kids realised that there are a lot of things troubling and they are unaware," she says, "As a teacher, I got to know that how multiple things impact the students’ performance and I was busy judging them on the basis of their academic performance.”

Six girls agreed to speak to The Health Collective on record about their mental health and what issues trigger depression and anxiety in them. Watch a short excerpt of the video right here.

 


 

Coming Soon: More #Voices on The Health Collective


*The Health Collective communicated the disturbing revelations made by some of these students with the Teach for India Fellows in charge of the class.

Disclaimer: Devanik Saha was a Teach For India Fellow between 2011 and 2013 and worked with some of these students when they were in Class III and IV.

 

   

Comics for Mental Health: Self Harm and Healing

November 24, 2017

Self Harm and Healing by Pig Studio

Self Harm and Healing: Art by Pig Studio for The Health Collective

Inspired by Your Stories: Self Harm and Healing

ALSO BY PIG STUDIO: DEPRESSION

Reporter's Diary: Workplaces and Mental Health

November 19, 2017

By Vandita Morarka

Our earlier piece on employee mental health rights in the workplace looked at what the law says about mental health support at the workplace in India and examined glaring gaps in the legislation. While we wait for legislation to catch up to urgent realities, we must look to companies to implement mental health management strategies and policies.

MENTAL HEALTH AND THE WORKPLACE: AN AREA OF CONCERN

A study conducted by 1to1Help.net, a professional counselling company, on ‘The Mental Health Status of Employees in Corporate India’, highlights just how prevalent mental health issues are amongst corporate employees -- one of every two persons in the corporate sector surveyed reported anxiety and depression. They also waited at least a year before seeking professional help, according to The Hindu. The study also highlighted the increasing work and personal life stress as triggers for mental health issues. 
And that’s not all -- an Assocham study released last year revealed that 42.5 percent of employees surveyed suffer from depression, YourStory reported.

ALSO READ: Workplace Stress and the Need for Me Time

With individuals spending more than 1/3rd of their adult lives at the workplace, it seems to be an obvious place of intervention. But what are some of the underlying issues, and can we really blame companies for not prioritising mental health-care management, given that there is no binding legislation?

Sourya Banerjee, a lawyer based in Hyderabad, tells The Health Collective, “The Indian legislative process has always reacted to change and has never really been very proactive. So currently workplaces are not essentially bound to be doing much and hence are not sanitised with respect to the kind of mental problems their employees may face and it's effects.”

Free Royalty-Free Image Courtesy Raw Pixel
Image Courtesy: Raw Pixel


Queasy though one may be with the argument, maybe it comes down to pointing out the impact of intervention on the bottom line.
“You may come across multiple workplaces which acknowledge physical health problems but not mental health,” he points out, “That is not to say that no workplace is not taking care of the mental health of their employees.  Some have realised that a mentally fit employee results in higher work output.”

WHAT SOME WORKPLACES ARE DOING TO TACKLE MENTAL HEALTH CONCERNS

Raja Natarajan, Deputy Managing Director of SAGE Publications shares a decision taken by his company last year, to tie up with ICAS India (Independent Counselling and Advisory Services). It was a proactive measure, Raja says, telling The Health Collective, “SAGE has covered its employees for physical ailments and hospitalisation through Mediclaim facility. All employees are also covered under a Term Life Policy which covers the risk of death and provides financial cover to the family.  While all these are for physical conditions and events, we felt the need to create a platform for supporting their Mental Health as well.”  

Through Sage’s Employee Wellness Programme, employees and their families can get mental well-being from the 24/7 ICAS counselling service free of charge.

“The entire cost is borne by SAGE,” he shares, calling this a “very user-friendly service” which can be accessed by phone or email. “Face to face counselling service is also available, which puts employees in touch with specialist consultants and counsellors to help them deal with a range of issues, in their private and working life,” he tells The Health Collective.

He emphasises that the service is totally confidential. “Management does not get any reports that divulges details of any of the issues or concerns that an employee might have chosen to discuss with an ICAS consultant.”

An HR professional with another company, Arunesh (who prefers not to share his full name), says that his company has an Energy and Resilience portfolio of training programs, which covers mental health. “Probably workplace and emotional stress management is the only aspect of mental health that we dwell (on),” he tells The Health Collective, “There are awareness campaigns and various sessions where people are informed on how to reduce stress -- ranging from physical exercises, yoga, meditation, nutrition (and) overall managing the four energy dimensions well.”

We didn’t get into more detail on the energy dimensions, but he did concede that there’s not much being done on mental health.

ALSO READ: Mental Health and the Case for Insurance in India

We asked Havovi Hyderabadwalla, a consulting Clinical and Forensic Psychologist based in Mumbai, to suggest what workplaces should be doing to tackle mental health concerns.

She shares some key insights with The Health Collective:

  • Having access to an in house therapist is crucial. A culture of de-stigmatisation should be created amongst the employees (and) should be cultivated by all
  • Open door policies should be created where if someone is having a hard time at work juggling stress, anxiety, depression or the likes they should be able to seek support from their superiors
  • Communication between different levels of employee should be accessible
  • In case your immediate boss cannot help you there should be someone else who can help you out
  • Time Out corners with old school games are always helpful in de-stressing, away from screen time -- board games, pool tables, air hockey are some examples
  • Access to gymnasium facilities and sleeping pods facilitate healthy time-outs

ALSO READ: What's Work-Life Balance Got to Do With Stress?

Raja Natarajan also gives similar advice to other companies. He says, “Don’t waste time thinking about it – go ahead and provide this facility. Happy employees make for a great company that can achieve extraordinary results. It’s an investment in people and there are intangible benefits which cannot be easily measured.”  

Of course, as he points out, partnering with the right service providers is important.


Views expressed are personal. Material on The Health Collective cannot substitute for expert advice from a trained professional. Feedback is welcome @healthcollectif

November News: Best of Health Collective

November 19, 2017

Firstly, a BIG thank you to you, our readers and community. We couldn't have asked for a warmer welcome this past year. We aspire to do much more, launch our news series, India's Voxes, Ask the Experts, and more... Do keep sharing your thoughts, comments, stories and feedback here / @healthcollectif.

Check out our November Newsletter right here & don't forget to sign up for your monthly dose of mental health news!

 

Health Collective Thank You

Suicide Prevention: Is India's Data Enough to Tackle the Complex Issue?

November 15, 2017

By Devanik Saha

'Farmers commit suicide due to debt and crop failure'.
'Housewives commit suicide due to domestic violence'.
'Young students commit suicide due to failure in exams'.

You will have seen these phrases, which commonly appear in media reports and social media discussions on suicide in India. More often than not, any debate or discussion tends to revolve around a single cause depending upon a specific demographic (as highlighted above).

This can probably be linked to the official data on suicides collated by the National Crime Records Bureau (NCRB), which classifies reasons of suicide into stand-alone categories of family problems, unemployment, debt, illness and others. However, there are critical issues with this data, which is a hindrance towards the standard process of using data to design policy interventions.

As I reported in IndiaSpend: "When it comes to data regarding suicides and the reasons for it, NCRB figures cannot be trusted at all,” says Vikram Patel, a psychiatrist and Professor at Harvard Medical School with extensive experience on suicide. “Given the complexity of suicides, just listing single reasons for suicide is too simplistic. Further, the police aren’t trained to handle suicide cases and investigations and reporting is done randomly.”

ALSO READ: Is India ready to tackle a mental health crisis?

So what does the NCRB data say?

In 2015, 27.6% of suicides in India were attributed to family problems, followed by illness (15.8%) and marriage (4.8%), as per NCRB data. About 12% of suicides are not listed under any causes.

 

Causes

Percentage of suicides

Family Problems

27.6%

Illness

15.8%

Marriage related issues

4.8%

Love affairs

3.3%

Bankruptcy

3.3%

Drug abuse/addiction

2.7%

Unemployment

2%

Exam failure

2%

Other causes

26.2%

Causes not known

12.1%

Source: National Crime Records Bureau

 

The NCRB has started publishing data separately for farm suicides since 2014.

Causes

Percentage of farm suicides in 2015

Bankruptcy or indebtedness

38.7%

Farming related issues

19.5%

Family problems

11.7%

Illness

10.5%

Drug abuse/alcoholic addition

4.1%

Marriage related issues

2%

Poverty

1.1%

Property dispute

1.1%

Source: National Crime Records Bureau


WHERE TO GET HELP: CONTACTS AND HELPLINES (INDIA)

CHALLENGES OF NCRB DATA

Experts contend that there are two major challenges with NCRB data.

1. Underestimating the number of suicides
2. Portraying a simplistic picture of suicides

"There is now a general consensus that the NCRB data on suicides is an underestimate. The million death study reported 30% more suicides than NCRB, while the WHO estimated nearly 100% more suicides than NCRB data,” Dr Soumitra Pathare, a psychiatrist and co-ordinator, Centre for Mental Health Law and Policy, tells The Health Collective."

Dr Rahul Shidaye, a clinical psychiatrist and research scientist at the Public Health Foundation of India (PHFI), agrees. He spoke to The Health Collective in detail on this issue.

"In several cases, if a person has had alcohol a few minutes or hours before committing suicide, then alcohol is attributed as a cause of death, which is misleading,” Dr Shidaye tells us. “The NCRB collects data at a higher level and attributes single causes for suicides. However, it must be remembered that suicide has multiple cause and in epidemiological research, it is difficult to prove causation.”
 

THE NEED FOR MORE RESEARCH

It must be noted that suicide is not a sporadic act or incident, rather, it's a complex process which is caused by the interaction of multiple factors.

Dr Pathare explains “Suicides are usually to due to multi-factorial reasons with many pre-disposing causes and single/many precipitating causes. Additionally, causes of suicides are different for different groups, in different regions and at different points in time. So, it is an ongoing challenge to characterise the causes.”

Dr Shidaye told The Health Collective HC that to establish causal pathways leading to suicides, there is a need for psychological autopsies must be conducted. This involves collecting all available information on the deceased via structured interviews of family members, relatives or friends, and attending healthcare personnel. In addition, information is collected from available health care and psychiatric records, other pertinent documents, and forensic examination.

For instance, a psychological autopsy conducted in Bangalore in 2004 found that the cumulative and repetitive interaction of several factors -- such as family, marriage, education, occupation, general health, mental health -- and absence of protective factors contribute significantly for suicides. This is at odds with the NCRB data which attributes only a single reason for suicide.
 

Suicide Prevention/ Health Collective
(The Health Collective)


ALSO READ: Ask the Experts: Do We Need a New Approach to Suicide Prevention

As I discussed in this earlier column for The Health Collective, a key debate in mental health is the over-emphasis on the bio-medical approach of treatment, which discards social determinants of mental health. For instance, this 2017 study found that childhood sexual abuse is a strong predictor of suicidal ideation among adults.

However, a critical concern arises that is conducting autopsies feasible in a large country like India. In relation to this, Dr Shidaye said “Even if not all districts or regions, it must be conducted in regions prone to high suicides. For instance, psychological autopsies may help find if the suicides are probably copycat suicides due to reporting.”

ALSO READ: Media watch: Portrayal of Mental Illness and Suicide

The lack of sufficient data and simplistic causes of suicides can lead to flawed policies.

"This simplistic attribution of causes in the case of farm suicides, leads to reactionary policies rather than pre-emptive ones, writes Dr. Shamika Ravi, a senior Brookings India Fellow and member of the Prime Minister’s Economic Advisory Council. “Suicides are characterised by a prior history of difficulties and, in most cases, mental illness that renders the person vulnerable to suicidal behaviour, for which we need to have a deeper understanding of factors that trigger and contribute to suicides among different demographic categories”.

Dr. Ravi’s arguments are substantiated by a study conducted in Vidarbha, Maharashtra, a region infamous for suicides. A 18-month suicide prevention programme in Vidarbha reduced the prevalence of depression and suicidal tendencies by providing psychological first aid to mentally ill persons through community health workers, as reported by Scroll earlier this year.
The study, published in The Lancet Psychiatry, found that the prevalence of depression fell by 22% in the one year and prevalence of suicidal thoughts fell by 51% due to the program.

THE WAY FORWARD

Going forward, there is a clear need for psychological autopsies in regions with higher incidence of suicides. The research needs to be complemented with innovative mental health interventions as in the case of Vidarbha, Maharashtra.

In March 2017, India decriminalised suicide, with the passage of the Mental Healthcare Bill. This was hailed as a huge step forward for mental health in India... however, the lack of sufficient data needs to be addressed if mental illnesses are to be appropriately tackled through policy interventions.


Disclaimer: Views expressed are personal. Material on the Health Collective cannot substitute for expert advice from a trained professional. If you or anyone you know has ever expressed a wish to end it all, or feels suicidal, please reach out for help immediately to a trained counsellor or therapist. Contacts and helplines.

Ask the Experts: Understanding Therapy

November 12, 2017

By Sukanya Sharma

As part of our special series, Understanding Therapy, The Health Collective features Dr Bhavana Gautam. Dr Gautam is a wellness consultant and certified Rational Emotive Behavioural Therapy (REBT) counsellor practising in Mumbai, Maharashtra. She speaks to The Health Collective about therapy and the importance of trust and communication between patients and therapists.

It’s important to keep in mind: There’s no one universal approach. Most therapists use different approaches as a roadmap to understand their client’s issues, and to work out the best practical solution.

Different Types of Therapy

  • Psychoanalysis – founded by Sigmund Freud this therapy believes in connecting with unconscious thoughts and feelings, to gain more insight of the current behaviour and feelings. It works on releasing repressed emotions and experiences. This type of therapy relies heavily on the interpretation of the therapist

  • Behaviour therapy – this type of therapy works on the role of learning in the development of normal and abnormal behaviours. A range of techniques are used to work on abnormal or unhealthy behaviours. most common and popular in this category is Cognitive behavioural therapy (CBT) which focuses on the current problem and how to solve it

  • Cognitive therapy – this type of therapy works on the irrational or dysfunctional thoughts that are the cause of the current irrational behaviour. Rational emotive behaviour therapy (REBT) belongs to this category. CBT could also be categorised here, considering it works on thoughts and behaviours too.
    In cognitive therapy, the patient is an active participant and is encouraged to work on identifying the problem, discovering the solution and enforcing it by self-motivation to ensure a much better compliance and impact

  • Humanistic therapy – in this case the emphasis is on the capacity of an individual to make rational choices and the therapist is not the authority and the individual is shown respect and concern to make changes for his own interest. In both cognitive therapy and humanistic therapy, the role of the therapist is to work together with the client and support them in discovering and implementing rational living.

  • Holistic therapy – most therapists do not have any one single approach and use a blend of the above therapies to reach the desired goal.

ALSO READ: MORE STORIES IN OUR UNDERSTANDING THERAPY SERIES

Why is it important to think about all of these options?
These are exactly the kind of details that need to be readily available to many. Understanding how therapy works opens doors for individuals who are considering stepping into a counselling session.

It's hard to take that first step to get help, sometimes -- it's a leap of faith. We understand that. And while taking that initial step doesn’t make for an easy conversation, educating oneself definitely helps with doubts and concerns.

Understanding Therapy/ The Health Collective
(The Health Collective)

 

Choosing to continue therapy could also prove to be a difficult choice for some.

To quote Dr Gautam:

"Individuals believe that the root of their current dysfunctional feeling is beyond them (a situation or a person). While this is true for a small number of cases, in most instances the problem is within the individual (his irrational beliefs, thoughts, feelings etc) and this can be a very uncomfortable truth to accept."

The hard truth is that this acceptance cannot be enforced by a therapist and must come from within. Loved ones can also play a huge role here. Dr. Gautam believes, “The socio-cultural environment as well as general awareness levels has a significant impact on the acceptance of therapy.”

ALSO READ: YOUR STORIES ON THE HEALTH COLLECTIVE

An individual’s ability to function at her highest potential depends on her mental and emotional health, an understanding that is still absent in Indian society.

What are some reasons for this?

  • The stigma attached with accepting a mental health issue or illness

  • Lack of awareness that results in lack of acceptance of issues like depression, eating disorders, anxiety, stress etc as mental health problems that deserve treatment

  • Lack of access to therapists, and not having knowledge of who or how to approach

  • The desire to find quick pill-popping solutions to a mental health crisis rather than working with a therapist over a period to achieve a more holistic and sustainable solution

ALSO SEE: THE CONTACTS AND HELPLINES PAGE ON THE HEALTH COLLECTIVE

We do know that open dialogue plays a huge role in normalising conversations around Mental Health. Thanks to this sort of dialogue, young adults and adolescents tend to approach therapy with an open mind – a change that is slow and gradual, Dr Gautam feels. It is also significant that people understand that therapy depends on a relationship of mutual respect, concern and trust.

 

Disclaimer: Views expressed are personal. Material on The Health Collective cannot substitute for expert advice from a trained professional.

 

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What It's Like to Live With Anxiety and Depression

Do check out this incredible comic (created by Nick Seluk of The Awkward Yeti). I first saw it on Upworthy and was blown away by it -- like so many others have been. It is reproduced here with the kind permission of The Awkward Yeti.

 

 

This incredible comic was created by Nick Seluk, creator of The Awkward Yeti, based on a story told by Sarah Flanigan, and published on taptastic.com 

It is reproduced here with kind permission from The Awkward Yeti

 

Adolescents, Relationships and Stress

In India, year after year, we are almost inured to stories of students driven to extreme stress by board exams. At times, in the absence of learning coping mechanisms or other ways of releasing these incredibly high levels of stress, a significant number of them choose, tragically to cut short their young lives.


YOUNG SUICIDES

The National Crime Records Bureau report looking at Suicides in India (2004-2014) analyses the 'Percentage Distribution of Suicide Victims by Profession during 2014' to find that 6.1% of suicide victims in 2014 were students. (Another shocking statistic: 15.3% of suicide victims were found to be housewives; find an analysis of the data and concerns about under-reporting here on IndiaSpend)
 


There doesn't seem to be enough attention paid to causes of suicide -- often a web of causes, not just one simple cause.

Nonetheless, many counsellors I had spoken to over the years, including some manning exam helplines for Indian students, mentioned that frequently callers dial in to talk about relationship issues and relationship pressures. It's not just the stress of exams/ Board exam results and the massive pressure we've been socially conditioned to accept as normal, that is.
 

RELATIONSHIP PRESSURE AND ADOLESCENTS

Noted child and adolescent psychiatrist Dr Amit Sen had told me years ago, about how kids are in relationships at ever younger ages -- think tweens or pre-tweens -- and aren't always able to navigate the complications of this; often relationships of course are due to peer pressure.


FROM THE ARCHIVES:
 Dr Amit Sen's own words on the context in India: 

"For the longest time we have found correlations between exam stress and rising depression in adolescents. There is no doubt in my mind that study and exam pressure takes a heavy toll on the minds and well being of teenagers in India. It robs them of other experiences that are vital for adolescent development. Paradoxically, as they begin to slip under the pressure, the system exerts even more pressure.

More recently, we have become increasingly aware of the close relationship between romantic relationship and depression. And indeed, as the article suggests, it is not only to do with break ups but also ongoing/"serious" relationships that often become too complicated for the mid-teens to handle. The cause and effect relationship is,however, not always clear. Its also true that depressed teenagers make themselves more vulnerable and tend to get into messy relationships more easily. A lot depends on the readiness/maturity of the person and clarity about what the relationship means and where the boundaries lie. In India, and perhaps in all places, teenagers often get widely conflicting messages about romantic relationships. This is where life skills and sex education (that is sustained and ongoing) might be preventive/protective of the many ills that plague our children today."

-- This was in response to this article in The Huffington Postwhich, among other things, raised some key points from a startling survey of more than 8,000 American adolescents on issues of depression and romantic relationships.

  

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