Empower family physicians to give psychological first aid: Dr Parikh

 

Dr Samir Parikh, consultant psychiatrist and chairperson of Fortis National Mental Health Program, Fortis Healthcare.

Namrata KohliNew Delhi

What happens when you or your loved one has a mental illness? “In the first episode of depression, empower the family’s general physician for psychological first aid and he will advise whether to consult psychiatrist, a psychologist or a counsellor as the next step,” says Dr. Samir Parikh, MBBS, DPM, MD (psy) Consultant Psychiatrist and Chairperson- Fortis National Mental Health Program, Fortis Healthcare

Namrata Kohli speaks to Dr Samir Parikh on why there are more suicides amongst youth, and cases of depression and ways to keep mentally fit.

1) A premier engineering college in the country had three suicides in three months. Is suicide an extreme manifestation of mental health problems?

Suicide is a concern. Several hundred thousand people die by suicide. In young people, suicides continue to be a concern globally but whenever we talk about suicide, we must always focus on suicide prevention. To say suicide is an extreme form of mental illness is not the correct way to look at things. That probably also creates more stigma both around mental illness and suicide. There are two aspects at play which may lead to a suicide- one is the longitudinal and other is the short term/immediate issue. The longitudinal could be a mental illness like say depression. So, let’s say if I am having depressive features for a couple of weeks or months and then there is an immediate stressor such as exams or academic pressure. Already my moods, thoughts were affected and then when I had a trigger I could not cope.  

Also, certain illnesses by themselves give thoughts around not wanting to live like depression. A student who is trying to prepare for exams, and has chronic depression for 8-10 months and is also dealing with parental/peer/teacher pressure makes that one exam, everything. With this approach, s/he loses a bit of social connect, self-confidence and then a perceived bad result makes that individual feel that there is nothing left in the world. Rather than being able to speak to someone because of the disconnect that has happened, s/he ends up opting for self-harm.

2) Is there a spurt in mental illnesses or is it being identified now?
I don’t think there is a spurt spurt as such of mental illness even though the WHO talks about a 25% increase post pandemic for both depression and anxiety. But I think the right approach to look at this is, that whether a pandemic or otherwise, mental ailments have always continued to be. It’s just that some of us are talking more and through social media, we get more feeds and information around it because the algorithm sends it to us. And yes because of overall increasing awareness, access to help and efficacy of the help, you go for help, you get treatment and you become better. That in itself starts a cycle. That’s why more people may be reaching out for help now. But at the same time, almost 75% of the people who need help do not seek help because of the stigma and perceived discrimination.

3) Prevention is always better than cure. What should be done to keep mental illness at bay?

I think prevention needs to be looked at from a couple of angles. If I look at schools, then from the early years, there needs to emphasis on balance of lifestyle with a lot more input of physical activity, exercise, yoga, sports, inculcating life skills such as communication, social assertiveness, coping with stress. I feel schools also must have a mental health curriculum and focus on emphasizing the role of community which helps in supporting individuals – be it family and friends or at school- peers and teachers or in workplace scenario or neighbourhood at home. Help seeking behaviour needs to be encouraged and not looked down upon and also ensure that access is available to experts.

 

4) If one is confronted with anxiety, depression or any mental illness, whom should one approach. People are still talking to general physicians. Should one speak to a psychologist, a counsellor, a psychiatrist or a neurologist and in which order should this be approached?

I am of the opinion that the primary family physician needs to be empowered a lot more. I don’t think we have the kind of experts in terms of ratio to population that every person in the first episode of depression should go rush to a psychiatrist. That’s not a doable thing. I think three things need to be done. First is to strengthen the family physicians’ network and let them decide what is the next step and whether the patient requires a psychiatrist or a psychologist. Second, the digital medium needs to be encouraged as it removes the inequity in terms of access. In some parts of country, you will have very few experts available than others but digital could be the solution. Finally, we should encourage people to speak to each other and if you notice someone struggling with a mental health issue, be the one to help him get the psychological first aid. Be the one to talk to them with empathy, positivity, without any judgement and help them find the solution by linking them to a professional.

 

5. How should we ideally be conditioning our mind to be mentally healthy?

Look at the more positive side of things. Every now and then, you will feel negative about something or the other but flip it and see if you can change your thoughts. Focus on social communication and social support. Have a balanced life where apart from your work or academics, you have time for friends and family and also some “me” time. Plus, time to indulge in sports, physical activity, pets, plants, art; basically, things that you like. Try to build meaningful relationships which is especially important in this era of social media where we are lost in scrolling our phones all the time. It is very important to ensure that you have time and energy left to cultivate some real relationships. Work on developing a more problem-solving attitude. Problems are bound to come but try to figure out a solution. If you are struggling with anything and not able to navigate issues on your own, do not hesitate to seek help from friends, family, experts.