With telemedicine becoming the new normal in the times of the pandemic, a recently released report by the Telemedicine Society of India (TSI) recorded an overall increase of about 302 per cent in online mental-health consultations.
It all happened after the central government released telepsychiatry guidelines for the first time in March 2020. As people grappled with increasing anxiety and other mental health issues amid an altered lifestyle imposed by COVID-19, they were at least assured of the accessibility to therapy from their homes.
Dr Sandeep Vohra, Senior Consultant, Mental Health & Psychiatry, Indraprastha Apollo Hospitals, New Delhi, tells indianexpress.com, “According to one of the surveys of Indian Psychiatric Society, there has been around 20 per cent increase in the number of people who have anxiety and depression. In fact, we have patients who specifically have coronavirus-induced anxiety and depression (all their life, they have had no problem but are facing issues amid the pandemic).”
Dr Vohra, who started telemedicine practices much before it attained legal status, however, says that as a country, we still have a long way to go in terms of accepting this new form of treatment. However, teleconsultation, he points out, is being more willingly embraced by the younger generation — both in the case of mental health professionals and patients — as opposed to the older age group, who still have a phobia of technology.
Even today, a lot of people prefer meeting their therapist or psychiatrist in person, says Vohra. “Patients would always be reluctant to avail telepsychiatry because they would prefer meeting physically. However, the pandemic left them with no choice but to gradually adjust to online consultation — some adjusted immediately, others are taking a little more time.”
The discomfort of technology, however, is not the only reason. For 32-year-old Ragini (name changed), teleconsultation helped her continue her therapy sessions as she moved from Delhi to live with her parents in Jhansi post-pandemic. She claims that while there is hardly any difference between offline consultation and that on a video call, she hesitates to be “completely vulnerable” before her therapist while at home. “One concern for me was that even if I lock my room during a session, I keep worrying that someone might listen. So, there is some hesitation there as compared to going to a clinic where I know the room is locked and noise-proof and so anyone sitting outside may not be able to overhear.”
But therapy is not just about verbal communication, it is also what patients express through their body language, which may give important cues for diagnosis. “About 70-80 per cent of our communication is non-verbal so when you are talking to someone on call, you miss out on the non-verbal cues. Even in a video call, you can mostly see only the face and not the body language–whether someone is leaning forward, being jittery or shaking their feet, which could be indicative of anxiety,” explains Kamna Chhibber, head of department, Mental Health and Behavioral Sciences, Fortis Memorial Research Institute, Gurugram.
Text messages, Chibber says, does not really work in this case as they can only provide crisis intervention at best, not therapeutic intervention, and can be “limited in scope and relevance”. The same holds true for the patient as well. “Whether in chat or audio call, it is a little different because you cannot know the expressions of the therapist or if she is being able to relate to my problem,” Ragini points out.
‘Teleconsultation bridges gap between demand and supply’
This is not to say that online mental health consultations are any less effective. In fact, the pandemic has very well proved how the digital platform can be effectively appropriated for mental health services. With teleconsultation, people now have accessibility from anywhere, anytime. As per the TSI report, the majority of the patients for online mental health consultation were from tier II cities, while one in every three consultations came from women. “Through tel consult, we are getting to connect with people who are in the most remote parts of the country,” Chibber tells indianexpress.com.
Apart from accessibility, online consultation also helps one save time, money, and the hassle of commute while giving one the opportunity to choose from an array of mental health professionals from any corner of the world while ensuring continuity of treatment. Besides, it also enables a patient to maintain anonymity and feel comfortable while consulting from home, helping them open up, given the taboo around mental health.
Anam Farhat, team lead, BetterLYF.com has observed that patients feel more comfortable on chat and call. “At BetterLYF, almost 40 per cent clients opt for chat therapy, as they are comfortable expressing themselves through writing from their own comfortable space. We have also observed clients transitioning from chat to call, and then call to video based on their growing comfort and trust with the therapist and with the process of therapy.”
Shreya Lahoty, growth head, MindPeers, a mental health portal that offers consultations at a really affordable rate, asserts, “The one thing we have noticed in the past year is that people have started seeing how important their mental health is. The feature in our portal which matches our customers to the therapist that best fits their demand takes away half the roadblock of hunting for a good therapist and then the fact that it is available in three modes (video, audio and text), gives them the option of choosing whatever they are comfortable with. By the end of the day, all one seeks before, during, and after a session is comfort, right?”
“I think pandemic pushed for a lot of online modes to be more acceptable to both parties as well. It also helps clients to be comfortable in their own space while taking the consultation,” agrees Himani K, Counselling Psychologist, Chaubara: A mental health initiative.
Logistically, another important advantage of teleconsultation is that it helps bridge the gap between the inadequate number of mental health professionals and the increasing number of patients, emphasise both Dr Vohra and Chibber. “In a country where there is about an 800 per cent shortage of therapists and psychiatrists, I would say teleconsultation is definitely the way forward,” the latter remarks.