In Conversation with Dr. Padma Angmo, (MD Psychiatry) Psychiatrist 

By Stanzin Dasal Leh, Nov 02, 2020
Leh :

Q. How many cases and what kind of mental health problems are registered at Mental health OPD?

Mental Health OPD was formally inaugurated by Lieutenant Governor R K Mathur on July 13 and since then mental health services are provided regularly thrice a week OPD, (Monday, Wednesday, and Friday).  We are providing facilities such as mental health helpline for teleconsultation, psycho-education for patients and caregivers, various psychotherapies, behavior, and motivational enhancement therapies as well as organizing various awareness generating programmes. 

In this period of three months, 145 new patients got registered and a total of 502 new and follow-up patients have received mental health services. Nine patients have also received in-patient treatment in liaison with the Medicine Department. Depression and anxiety disorders were the most common diagnosis in new cases. In many of the cases, the COVID-19 outbreak had precipitated the symptoms. Many young patients presented to us with alcohol and drug addictions including cannabis, opioids etc.  Most of them reported that the use of these substances increased during the lockdown.  Few new cases Schizophrenia and bipolar disorders also got registered in this period. 

We have also started disability certification of eligible patients with mental illness so that they can avail of various benefits like disability pension, scholarships etc. 

Q. Do you see an increase in mental health issues during the COVID-19 pandemic. What precautions can be taken and how to cope with the situation?

Yes, COVID -19 pandemic outbreak has definitely lead to an increase in the number of cases of anxiety and depression. It is not just the direct impact of the pandemic but also the indirect impacts like social isolation, loss of jobs, financial loss due to the lockdown that has impacted people’s mental health. Many patients who had tested positive also had sleep disturbances, anxiety. We have seen many people presenting with severe anxiety precipitated by the fear of catching the contagion or spreading it to the family members. 

Students are getting affected in a big way, getting used to virtual classes, not being able to meet their peers, and now as their academic year is about to end uncertainties about their exams. Many students are coming to us with sleep disturbances, loss of appetite, inability to concentrate, and worries about their exams. Substance use also seems to have increased during the lockdown period. The health care professionals and other frontline warriors also seem to be experiencing burnout. 

People have to get the right information from reliable sources about the pandemic. Media exposure should be limited to watching the news just once or twice during the day. Tracking the news about the infection day and night can cause unnecessary stress. People should have a more or less fixed routine with activities ranging from yoga or meditation, spending quality time with their family, discussing issues other than COVID-19, taking out time for the hobbies like reading, painting cooking etc. besides going for their jobs.

Physical activities like taking a walk, cycling, etc. while taking precautions are important not just for your physical health but also for relieving stress and maintaining a good mental hygiene. We should be physically distancing but not socially isolating ourselves. We can be in touch with our friends and relatives through calls and the internet. Above all we have to know that we can protect ourselves from the infection by following some simple steps of maintaining physical distancing, wearing masks and washing hands or using hand sanitizers. 

Till the vaccine is ready and available, we have to know that only taking precautions can keep us safe.

If the fear and worry about the infection is distressing anyone and causing dysfunction, they should visit the hospital or call up on the helpline number (01982-252334)

Q. What are some signs and symptoms of a potential mental health disorder?

Even today, awareness about mental health and illness is limited everywhere. Please understand that fear, sadness, anxiety, anger, grief  are types of normal human emotions, and experiencing them inappropriate situations and degree is absolutely normal. Mental illness is ubiquitous and can affect anyone of us, irrespective of age, gender, race and socioeconomic strata. 

Discussing signs and symptoms of all the disorders is not possible here but if there is an unexplainable change in the behavior, thoughts, or emotions of an individual, with disturbance in the basic biological functions like sleep and appetite and dysfunction in many domains of life, it could be an indication of mental illness. For e. g.,  in depression, there is a sadness which persists for most of the day and pervades across all situations, loss of interest, inability to experience pleasure, negative thoughts, decreased energy levels, preferring to remain by themselves, and getting thoughts of committing suicide, with disturbance in sleep, appetite, and libido, if such symptoms persist for more than two weeks then we diagnose the person to be having depression. In anxiety disorders, the patients have an explained fear without any reason, associated with increased heartbeats, difficulty in breathing, tremors feeling of being on the edge, negative thoughts, etc. which can be present throughout the day or in episodes.

We are trying to generate awareness about various types of mental illness and their signs and symptoms through various platforms. 

Q. The growing concern and alarming issue in Ladakh is substance abuse. Can you brief us about the issue, the reason behind youths getting addicted to it and the ways to control it?

Substance use disorders are definitely taking the form of a public health crisis amongst the youths of Ladakh. The situation seems to be similar in both districts. According to the First Report on Substance Use Scenario in Leh District, substances of addiction are not limited to tobacco and alcohol, today, all sorts of illicit substances like cannabis (ganja, charas, bhang) opioids ( heroine, smack, pharmaceutical opioids), etc. are being rampantly used. Some patients also reported using an injectable drugs which is the most severe form of addiction. Addiction to alcohol and drugs can have not just implications on the physical and mental health but also the social, legal, moral, and financial aspects of life. It seems to be affecting the youths from all backgrounds, age groups, and even gender. Most of the patients seem to be starting it while in school. They eventually end up indulging in illegal acts like stealing, gang activities, prostitution, etc. to procure the drugs. Dropping out of schools and colleges, losing jobs, incurring business losses to getting infections like HIV and Hepatitis, etc. can be its consequences. So it will end up impacting the whole society.     

In Ladakh, tourism seems to have played a major role in introducing these substances of abuse to our youths. Youths going out of Ladakh for studies and job opportunities also seems to have picked up the addictions. Peer pressure, family history of substance use, and lack of family involvement are risk factors. A major part of our society seems to be in denial of this problem believing that it cannot affect “our” children. Ease of availability and laxity in the implementation of the laws can also lead to an increase in the cases. The lack of awareness about the ill-effects of substance use among the people of Ladakh in general and the youths, in particular, is the biggest risk factor.

So, we have to act at all levels. There is a need to increase awareness, actively screen for substance addictions in all the school and college students, stringent implementation of the NDPS Act, the involvement of the religious organizations and NGOs to spread awareness, and most importantly establishment of a De-Addiction Centre to provide a quality, affordable and accessible facility for identifying, diagnosing, treating and rehabilitating patients of substance use disorders. 

Q. Tell us about various challenges faced to provide mental healthcare. 

The lack of awareness about mental illness and the stigma attached to it are the two biggest challenges in our way to provide mental healthcare. The awareness about mental illness and understanding of the biological causation is limited not just among the masses but at all levels. People of all backgrounds still end up going to faith-healers before they come to the Psychiatry OPD. I have seen patients who were kept tied up by ropes for days before the family decided to bring them for treatment even in Leh. 

Stigma related to mental illness, belief that it is a shame to visit a mental health professional, what would the society say if I am seen in the psychiatry OPD hinder the patients from coming to us. Many of my friends and relatives advised me not to choose Psychiatry as I would be called “NYOMBE Doctor”.  Even educated patients who come to the OPD, ask me if I can see them someplace private. 

Lack of infrastructure has been a big hindrance to us. We are currently running only OPD services. Many of the patients like case of acute psychosis, severe depression with suicide risk, alcohol, and other substance withdrawal, etc. needs inpatient/

treatment. With no psychiatry ward and adequate trained staff, we face many problems. We even have to refer the patients to higher centers.

There are various policies, acts, and programmes related to mental health in India, like the National Mental Health Programme, Mental Health Policy, National Trust Act 1999 (for the welfare of children with mental retardation and autism spectrum disorder, cerebral palsy), NDPS Act 1985( Narcotic Drugs and Psychotropic Substances Act), POCSO 2012 ( Protection of Children against Sexual Offences Act), Rights of Persons with Disability Act 2016 and most important of all, the Mental Health Care Act 2017. There is an urgent need for effective implementation of all these policies, acts, and programmes in Ladakh.

Q. What are the way forward to cope with the mental health crisis? 

Masses have to be made aware of mental health and mental illnesses through various means like radio, tv, internet, and by including the grass root level workers. School and college curriculums should include chapters on mental health. “Happiness curriculum” model of Delhi Government schools can be improvised and adopted in our schools also. Religious organizations and leaders can play a major role in spreading awareness of mental health. NGOs can collaborate with the Health Department to work in this field. 

Implementation of the above-mentioned policies and programmes would be the basic step towards ensuring adequate mental health services to the people of our Union Territory.

Strengthening of the mental health infrastructure and manpower, ensuring the availability of medicines, facilities like modified electroconvulsive therapy, training the health care professionals in diagnosing and treating mental illnesses at CHC level and beyond, availability of psychiatry ward needs to be done.

Message to the readers

“Take care of your mental health just as we take care of our physical health. Same as we try to seek the best treatment for physical health issues, seek treatment for mental health problems also.”