An ecological model of mental health, as adapted from the WHO Report on Violence and Health (2002)

The COVID-19 pandemic has been referred to as the most significant global stressor, comparable in magnitude to World War II or the Great Depression of the 1930s. From a mental health perspective, the experience of the pandemic, the associated psychosocial changes, and economic instability have all had negative effects on mental health and well-being. Research has also shown that large scale traumatic events lead to compromises in well-being at the individual, as well as collective level. This necessitates the need for an ecological model of mental health. An ecological model analyses determinants of an outcome at several different levels – societal, interpersonal, and individual – and posits that the outcome is a result of interactions of factors at all these levels. In this context, the impact of the pandemic on people in developing nations like India has been even more severe.

Despite multiple legislations and a comprehensive mental health policy, a lot still needs to be done in terms of implementation, outreach, and intervention. It is stipulated that one in seven Indians live with mental illness. Further, the first National Mental Health Survey pegs the treatment gap to range between 70-92 per cent depending on the typology of illness. These gaps have most likely widened due to the pandemic.

India suffered two waves of the pandemic, with the second wave being extremely devastating. At its peak, it left Indians struggling for access to basic medical care and treatment. In the case of families who lost their loved ones to the disease, regulations led to specialised disposal of the deceased, without families being able to perform last rites. Trivial as rites may sound in face of a serious pandemic, psychologists have always maintained that funeral rites help friends and family to cope with the grief from losing a loved individual and ultimately provide closure. In the absence of this process, there is bound to be a mass of unresolved trauma in a significant section of the populace.

Previous research argues that if a community sustains any form of structural or direct trauma, however contextual and isolated, that can lead to collective victimhood. It can be argued that the pandemic faced by Indians has elements of shared emotions and a sense of loss which are some of the hallmark features of collective trauma. This is concerning given the disproportionate effect the pandemic has had on vulnerable groups such as migrant labourers, urban slum dwellers, and workers in the informal sector.

Almost every aspect of one’s life is impacted by their social position, as determined by socioeconomic class, caste, and gender. The rights-based model assumes that one’s mental health is expressed in terms of their ability to achieve their potential, cope well with daily stressors, work productively, and be well integrated in one’s own community. Access to quality healthcare, housing, as well as social justice thus, become integral determinants of mental health. In India, the intersections of gender, caste, and class determine one’s access to all of the above.

Among all the axes of inequality, the two most prominent that the pandemic has further deepened are those of gender and socioeconomic class. Recent reports suggest that over 120 million people have been pushed to poverty because of the economic fallout from the pandemic. Income and gender inequalities that existed in India even before the pandemic have become starker. Women have been disproportionately affected, both in terms of economic hardship and increased burden of housework and childcare. In addition, there has been a surge of pandemic facilitated violence against women. Conversely, it would be important to explore the strength of family relationships and intracommunity bonds and their role in collective coping and resilience, gaining access to resources, and in collective acts of volunteering and participation in local COVID relief work.

Despite the fact that India’s Mental Health Care Act adopts a rights-based model, existing measures continue to focus on psychological distress at the individual level. No comprehensive ecological assessment of mental health has been undertaken as of now. The understanding of mental health is hardly existent across different social groups, and mental illness has significant taboo attached to it still.

At the Department of Psychology at Ashoka, Prof. Rashmi Nair and I are working on a collaborative project to study how the pandemic has been experienced across gender and socioeconomic classes. We ultimately want to zero in on key determinants of mental health using an ecological model.

Simantini Ghosh is Assistant Professor of Psychology. Her research interests lie in understanding how chronic stress affects the mind, and the various components that underlie stress responses.