Talking of Mental Health

In case you missed the video, here’s the Transcript of the interaction of Rajeshwari Luther (Director, Hope Trust) and Anupama Dalmia (award-winning writer & social influencer on Mental Health:

What got you interested in the human mind, and how did you get the idea of establishing Hope Trust?

My interest in the human mind has always been there since childhood. In school, I would observe how different people reacted differently to the same situation. Some got angry, some blamed, some approached issues and people with kindness and compassion. This observation continued through college and my early working days.

We had a personal experience of addiction with a close family member and went through a long, tiring and painful journey trying to help him. I closely saw all the aspects – the denial, the irrational thinking, the massive damages including broken relationships. Finally, the person got sober after lots of trials and errors. During the treatment process, I came in touch with the element of counselling and how it helps individuals and families. This led me to further pursue my studies in psychology. And we decided to establish Hope Trust in 2002, to help other families struggling with addiction issues. Gradually, Hope Trust extended its services from addiction treatment to a broader spectrum of mental health, as addiction is primarily a mental health issue.

What are the challenges you have faced as a counsellor? Do you think there is a certain mindset where people don’t value counselling and view it as “gyaan”?

Well, every profession has its challenges. When we started Hope Trust as a rehab, there was a widespread belief that rehabs are rough and tough places where clients are mistreated. I must admit there was some truth in that, as a decade ago, there were hardly any professional addiction treatment facilities. Slowly, that mindset is changing as people are experiencing recovery in a comforting environment.

Similarly, there are preconceived notions that counselling means giving “gyaan”. The clients are already sick of receiving advice from all and sundry. However, there are evidence-based techniques of counselling, such as CBT and Motivational Interviewing, that are client-centric and participative. The counsellor merely facilitates the client getting insights into their problems, viewing blocks in progress, and finding solutions. Ultimately, it’s the client who must walk the journey, and the counsellor is merely holding hand, giving strength and throwing light on real issues.

You must be getting a general perception through your profession. Is mental health still somewhat a taboo? Do you see people coming forward a lot more today to seek professional help to tackle their issues?

In my experience, two main elements that are common to addiction and other mental health issues: Denial and Taboo.

A person struggling with either addiction or mental health problems (or both) is unlikely to think he or she has a problem. This is called denial. If they feel they don’t have a problem, they will obviously no seek a solution.

Secondly, the social taboo which is real, but the situation is improving, especially with the younger generation in urban areas which seem to be more open about seeking professional support.

A lot of people I interact with have a limited understanding of mental health. It’s either viewed as someone being mad, or they think of “depression”. Can you give a perspective in this for better clarity on mental health and mental health issues?

Mental disorders are among the leading causes of non-fatal disease burden in India. According to a study by NIMHANS (National Mental Health Survey 2015-16), one in ten Indians have a mental health condition, and 1 in 20 Indians have depression. Hence, for Indians to deny it, and to say this is all ‘touchy-feely, new-age hogwash’ and cite that our ancestors never got depressed is really not facing the reality.

Everybody gets upset, feels low or anxious at some point in their life. That’s not a disorder. The disorder comes when those feelings become intense, do not go away and hamper your everyday life. It’s when the feelings stay for weeks, months and years. It’s the intensity and longevity that classifies it as a disorder. It needs attention and interventions.

Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviours.

However, unlike other diseases, help can come in different ways for mental health problems. For infectious diseases, we can pop antibiotics to kill the bacteria and recover. For mental health, medication is one of the options. Therapy, which involves a trained therapist changing the way you think or approach life, is also very helpful. A therapist helps identify what is causing the condition — a hostile work environment, economic losses, a relationship, a highly-competitive career (for instance show business) that you need to walk away from to fix the problem. Sometimes, therapy alone doesn’t work, and medication could be given. The therapist will refer to a psychiatrist for appropriate support. Sometimes a combination of psychotherapy and medication works best.

Another myth that needs to be busted is that a therapist can magically cure problems. I would understand there has to be an effort from the patient’s side. Can you talk a little on your approach, and how do you decide when to push and when to step back so that the patient is comfortable?

The therapeutic process is a joint project. The client and the therapist both have to be invested in the process for it to succeed. Of course, there’s no magical cure!

Trust is essential. So I first establish rapport with my clients in the initial stages. Sometimes, the client is unclear about the problem or unable to open up. Once trust is established, it becomes more comfortable to work together.

After getting clarity on the problems at hand, I lay out the goals which we hope to achieve so that there are no unrealistic expectations of a ‘magical cure’. While we work through stages of the process, we review our progress periodically. I also give ‘homework’ to my clients.

Moreover, I employ a variety of methods like art therapy, mindfulness, interventions and use assessment tools if required.

I have to careful that the client doesn’t become too dependent on me – it’s called transference. The goal of therapy is to empower the client to be self-sufficient in managing his or her problems in the long run.

Some suggestions on how a friend or family member can support someone who is suffering a mental health problem.  What are the things we can keep in mind to provide the right kind of help?

First, don’t be dismissive when a friend or family member voices any concerns. Don’t give advice like “move on” or “divert your mind”. Take the cues seriously and suggest to them to seek professional support.

Secondly, be kind and compassionate. Creat a safe space. What is a big problem for them may not appear to be significant to you. But you are not them, and their issue is real for them.

Third, do some research and identify a qualified and experienced therapist and ask them to get an appointment. In times of COVID 19, online options are available.

What can we, as a society, do better to ensure a robust mental health ecosystem and infrastructure in our country? What are the little things we can do in our daily lives towards this cause?

Life in India is hard. Right from getting a decent hospital to getting a job, commuting to work, buying a house and even just surviving the rains, life for an average Indian is complicated. With everyday life being so difficult, feeling frustrated, angry, upset, sad, disappointed and anxious is just part of life.

Hence, when someone mentions ‘mental health conversations’ or caring for people with ‘depression’ or ‘anxiety’, most Indians start saying: “What the hell are you talking about?” This is how all Indians feel as part of life”. They believe people complaining about this are just ‘weak’ or ‘losers making excuses’.

Without anticipating a coronavirus pandemic, the WHO earlier predicted that by 2020, roughly 20 per cent of the population will suffer from mental illnesses. That means, today, more than 200 million Indians may have mental illnesses, and the situation is likely to worsen. The psychological impact of lockdowns, quarantine, economic downfall is expected to add to these numbers.

Although the world’s fifth-largest economy, India has spent only 0.05 per cent of its health budget annually on mental health over the last few years.

The amount spent on mental health comes about to 33 paise per mental health patient if we take into account the 150 million people requiring urgent care.

The amount spent is comparable with what Indian billionaire Mukesh Ambani makes in just 3 hours, or barely the cost of a Rolls Royce car.

Further, India has 9,000 psychiatrists – that is one doctor for every 100,000 people. The desirable number of psychiatrists is three for every 100,000 people. This means India has a shortage of 18,000 mental health doctors.

Despite the unused funds set aside in its budget for mental health, the government hasn’t organised any major awareness programs even on World Mental Health Day.

The government doesn’t seem to realise the fact that investing in mental health care makes economic sense. Mental health correlates positively with a country’s economic growth. Unemployment affects mental health, and mental health problems may make it more difficult for a person to obtain and/or hold a job, resulting in a vicious cycle.

It’s no wonder that the economic loss to the Indian economy caused by a mental health crisis is estimated to be more than $1 trillion between 2012 and 2030, according to the WHO.

So more doctors, psychologists, awareness programs to de-stigmatise mental health and providing access to mental health in rural areas are some of the efforts the government should do.

As individuals, we can arrange sensitisation programs and seminars in schools, colleges and community and support those who need help by networking with mental healthcare professionals and institutions.

When do you think a person should reach out for help? Most of the times, people say we don’t know or understand when is it that we should be seeking medical or professional help.

As I said, denial and taboo prevent or delays seeking help. In health-related matters, the earlier, the better. Whenever the signs of dysfunction or any thoughts/ emotions/ behaviours are negatively impacting our everyday functioning, it is the right time.

You don’t lose anything by speaking with a therapist. But may have a lot to lose!