The pandemic has brought an ‘epidemic’ of mental distress: NIMHANS director

As an institute at the forefront of neuroscience, the National Institute of Mental Health and Neuro-Sciences (Nimhans) has also found itself at the tip of the spear in the campaign against the coronavirus. Its faculty and students have not only provided pioneering mental health support to thousands of people across the country, but its genomic sequencing unit has been instrumental in breaking down the mysteries of the virus. After being helmed by a series of acting directors since the retirement of Dr B N Gangadhar in December, the post has now been filled by Dr Prathima Murthy, former HoD, Psychiatry, who took over as full-time director of the institute on June 18. In an interview with DH’s Akhil Kadidal, Dr Murthy laid out her vision to shape the institute to tackle the challenges of the present and the future.

The institute has had a reputation for breakthrough science. Are any new initiatives being planned to enhance research and/or academics at the institute?

Nimhans has the advantage of having faculty working in clinical, community and in laboratories, so it represents a unique and rich blend of talent and scope to apply new scientific knowledge to patient care. We span a wide variety of areas meriting further research, from Autism to Alzheimer's disease, from mental wellness to illness. This underscores the need for a developmental perspective to understanding determinants of disease and looking at both the upstream factors for disease in addition to downstream effects including disease manifestation and outcome.

Are any changes planned to enhance Nimhans’ mental health and genomic sequencing programmes, both of which have been influenced by the pandemic?

Both for mental illnesses and neurological illnesses, colleagues in the institute have been working on examining genetic correlates of a variety of disorders. For example, the ADBS grant has been looking at cross-cutting aspects in schizophrenia, bipolar mood disorders, obsessive-compulsive disorder, addiction and dementia. The c-VEDA project has been examining associations between genetics, imaging and other parameters in populations at risk of addiction. Similarly, there are studies examining genetic correlates of Huntington's Disease, Parkinson’s Disease, ataxias, dementia, ALS and other conditions.

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What about Covid-19?

During Covid, as well as with other infections, the focus has been in studying genetic variations of the infective organism. Thus, there is scope to study both genetic variations in the host as well as the disease agent and how these can dynamically be altered through epigenetic and other mechanisms. This can help us to better understand individual variations for disease risk, manifestation, treatment response and outcome. The areas of genetic epidemiology and applications for personalised medicine hold much promise.

Are lab infrastructure or staff increases on the cards to scale up the pace of sequencing?

We hope to get more support for cross-cutting studies across different disease conditions. It will be very important to follow-up disease cohorts and families to understand vulnerability to disease and pathoplastic factors.

Mental health support had a big role to play during the pandemic. How can this be viewed from the Covid-19 standpoint?

The pandemic has brought an epidemic of mental distress. At the same time, it has brought attention to mental health in the forefront. Manifestations of mental distress have ranged from anxiety over the lockdown to fears of contracting Covid-19, fear of loss of livelihoods, stigma over infection, to hospitalisation and isolation due to Covid-19. Loss of family members and lack of the usual support systems for the grieving have led to increased disturbances in mood, depression, anxiety and substance use. Persons with pre-existing illnesses are at greater risk as they may have had difficulties in accessing mental health care, medication and rehabilitation facilities. Those in the ICU are more at risk of developing longer-term psychological difficulties.

Have Nimhans’ mental support professionals encountered vaccine-related anxiety?

Yes. Aspects of mental support also had to be extended to cover the initial anxiety related to vaccination, leading to 'vaccination hesitancy.’ Later, when vaccination drives were expanded, these translated into ‘vaccination urgency’. There are also anxieties about a potential third wave.

What is the status of Nimhans’ National Psychosocial Helpline?

The helpline has been running for over a year and has received more than five lakh calls. There is an effort to specifically address the concerns of children and women through this helpline. While a lot of the calls initially were with regard to services and Covid-19 related information, progressively there have been more calls related to psychological distress.

With talk of the third wave, how have children fared during the pandemic so far, from a mental health point of view?

Absence from school, outdoor play with peers, and online classes have posed tremendous challenges. There are concerns about behavioural and emotional problems increasing among children because of this. Concern has also arisen due to increased use of mobile phones and TV watching. Children in difficult circumstances are particularly vulnerable as many of the welfare schemes have not been optimally running for more than a year. There has been an increase in the calls related to child abuse reported by the National Commission for the Protection of Child Rights and other child helplines. A flagship programme at Nimhans, called SAMVAD, has been training child protection functionaries through tele-training and mentoring to provide first-level responses to children in distress.