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Save the Soul of India – A Mental Health Priority

Dr. Samson Gandhi

Where there is no counsel, the people fall;

but in the multitude of counsellors there is safety. Proverbs 11:14

Covid 19 Pandemic has taken the world by surprise. It has exposed the inadequacies of a modern world. In the face of an onslaught by an invisible virus, humanity finds itself helpless, hopeless and worthless. No known drug is effective. The highly trained medical fraternity is reduced to care-giving to assist the bodies to heal on their own.  They watch helplessly those that do not recover and die. Vaccine is far away. There is no hope today. All success and achievement seems meaningless when one cannot prevent sickness and dying especially during a pandemic. More people are asking existential questions – what is the meaning and purpose of life? Unable to find meaningful answers, they want to go back to doing what they did – to eat, travel and work, even if it means running the risk of getting infected. Naturally, the problem of mental health gets compounded.

“Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.” – U.S. Department of Health and Human Services. Anxiety of the future, fear of loss, disease and death are setting people on the edge. As a result slightest provocation is pushing them over the precipice. The media is calling attention for relief and recourse.

Globalisation and urbanization has uprooted people from their comfortable social settings and planted them in urban jungles leading to loss of identity. Under pressure to create an identity and facing an acute lack of proper support system, people are facing extreme stress and are experiencing severe loss of mental health. The current pandemic has exacerbated the problem and the country in not in a position to address the mental health tsunami.

In India, mental health is a luxury. More than 22 percent of our population lives below the poverty line which is a hand to mouth existence. Their mind is preoccupied with finding the next meal. Emotional, psychological and social well-being are alien to their existence. They exist on the fringes where neither the government nor the non-government agencies make a difference. Lower middle, middle and upper middle class constitute over 60 percent of our population. They have time and space to reflect if they are happy or not and make an effort to find a semblance of well-being. Many agencies operate here but are woefully inadequate. They are a significant drop in an ocean of need.

Although more than 150 million people need therapy, only 30 million seek help. The main reason is because of scarce resources and lack of accessibility. We have about nine thousand psychiatrists in India. It roughly translates to 0.75 psychiatrists per lakh. While the desirable figure is three per lakh. There is a deficit of 75 percent. We need about twenty thousand clinical psychologists but have only a thousand. There is an acute shortage of mental health professionals. Even if the government increases seats they are in no position to address the growing need in the short run.

There is an urgent need to train Community Counsellors (CC). These are para-mental health professionals who are trained to assess the level of need and interventions. Those that need psychiatric treatment, would be referred to psychiatrist and those that need intensive therapy to clinical psychologists and for specialized therapy to appropriate psychologists. The CCs will take on cases where the services of none of the above specialists are needed. This raises the question of their training.

CCs would need training in communication and counselling skills of relating, attending, listening, empathizing and confronting.  They should be encouraged to develop client friendly attitudes of respect, genuineness and concreteness. They could be trained in client-centred approach of counselling, emotion focussed counselling, solution focussed counselling and CBT to a certain degree. They must have a basic understanding of human personality. At this stage they can pick electives and specialize. Marriage & Family, Parenting, Debt, Emotional Wellbeing (depression, self-harm, suicide), Abuse and Domestic Violence, Grief, Crisis are a few of them.

Trained CCs can then be put into a practicum program under counselling psychologist. On satisfactory completion of the same they must be certified as Community counsellors who are para-counselling professionals. Like any other professional practice they must be committed to Continuing Professional Development (CPD) and remain under professional supervision of senior CCs or Counselling Psychologists.

 Once they are certified, based on their interest and specialization, they can be attached to or placed at the Primary Health Centres (PHC), District hospitals, Mandal Revenue Offices, National Disaster Response Force, District Collectorates, and all state and central government departments. Wherever people are likely to experience distress, a trained Community Counsellor must be made available. Educational institutions, universities, sports complexes and all coaching centres must have a certified CC.

The government and the local community must create a positive eco system to seek counselling. There is a lot of stigma attached to receiving counselling. Counselling must be made a positive, constructive part of the social welfare programme of the nation. A narrative must be built, influencers roped in and all elderly must be encouraged to become catalysts of  nation-building.

Development of infrastructure is good for commerce. People prosper. Government makes a massive investment in economic development for material improvement. Some investment is made into health sector. But the time has come for the government to look at mental health in a whole new light. It is important for government – central and state – to consider making a policy decision to create a mental health vertical for the emotional well-being of its people. It calls for investments to match the scale and proportion of the need.

India is a very religious country. It carries a massive spiritual capital accumulated over millennia.  It must not be forfeited; it must not be sacrificed on the altar of economic development. India can be a shining example to the whole world if it can set right priorities. India has placed a smart phone in many hands. It has come in handy for commerce, entertainment and education. But they do not know how to harness it for the well-being of their souls. Pornography on phones is corrupting millions of souls. More than 275 million people were lifted out of poverty in the past decade. But today India must listen to the cry of the soul of more than 300 million troubles souls. They need a shoulder to cry on, a listening ear to pour their heart out, and some light of hope in their despairing soul. An army of certified and caring Community Counsellors is the need of the hour. If we don’t address the millions will lose their soul. If people lose their soul, India will lose her soul!

Jesus said, “What does it profit a man, to gain the whole world, and lose his own soul?” It still begs for an answer.

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