WO: Could you tell us what it means to be mentally healthy?

Dr Shikha Jain (SJ): Being mentally healthy is a dynamic state of internal equilibrium - a harmonious relationship between the mind and the body. According to the World Health Organisation, mental healthiness is a state of well being, in which an individual can realize their capabilities or abilities, and can cope up with normal stressful situations. She/He can work productively and is able to make a contribution to his/her community or society, so in short, we can say that it is a state of complete physical, mental and social well being.

If someone thinks that they have a mental health issue, what should be their first approach? How should they deal with it?

SJ: You should visit professionals - only they can decide if you truly have a mental issue, and the severity of it. Then the best kind of treatment for your issue is decided by them.

Mr Ashfaq Ahmad (AA): So we need to look into three parameters - our emotions, behaviour and thought processes. For example, one indication is when any lifestyle change disturbs your mental equilibrium or your functionality because of your emotions, thought process and your behaviour. Then, of course, you need to meet a mental health professional or counsellor. A counsellor is a trained person who can identify and assess the level of the problem, and can give the intervention needed.

WO: A lot of myths surround the description of various common mental illnesses like anxiety and depression. What do these illnesses actually look like? What does the treatment look like?

SJ: Actually, one needs to understand that mental illness is very different from physical illness. We can see and diagnose physical illnesses - for example if a person has fever, we can measure the temperature with a thermometer; if a person has a cut, one can see the wounds. But when it comes to mental health- one can’t simply gauge the severity of anxiety or depression by just externally viewing the situation.

So, the first thing to do is, approach the professionals so that they can then decide what kind of treatment is required for that particular situation, after taking into consideration various factors. In the case of depression - an aged person would display different symptoms as compared to a child. A depressed adult may feel sad, may be slow to react, or he may even say he doesn’t feel like doing anything. But in the case of a depressed child, it is different. A child may be a bit aggressive while depressed and may also show tangible effects like poor performance in school. So, the symptoms and severity vary from person to person and depend on age as well.

AA: One very important thing to address is our society’s wrong perceptions about mental illness. There is a norm of labelling a person “crazy” if they display ‘deviant’ behaviour. So, our main responsibility is to identify the problem in the initial stage itself. Usually, we are not able to do that. Especially in the case of anxiety and depression. If it is identified and solved in the initial stage- it won’t render the person too dysfunctional. A mild level of depression or mild level of anxiety is easily treatable with psychotherapy or some kind of medication. But, if because of the social stigma surrounding these issues, one hesitates to meet the mental health professionals, the mild anxiety issue may become extreme. This is when the person becomes dysfunctional, starts having suicidal thoughts or loses the energy to do anything. And so, there is a great need to reduce these myths from the community. Answering the final part of your question regarding the treatment - basically, there are two models we usually follow. One is psychotherapy, where the counsellors interact with and help the person cope with the anxiety or try to alleviate the depressive state. Second is medication, wherein we basically prescribe medicines to try and reduce or cure the symptoms.

SJ: Collaborations in which psychologists, counsellors and psychiatry all work together give really good results. Currently, in IIT Roorkee, we are doing the same thing with the counsellors and consulting psychiatrists.

So in IIT Roorkee, do we now have both psychologists and psychiatrists in the Wellness Center?

SJ: Yes, the physiatrists are available in the IITR hospital and we counsellors are available in the Wellness Center. Sometimes the counsellors may accompany the student to the psychiatrist at the IITR hospital to make them comfortable.

AA: The point was to emphasise on the collaboration we do, that we collaboratively work along with psychiatrists. We are not working independently- and so when we consider doing an intervention, the psychologists discuss the case with the psychiatrists and vice versa. So we are on the same page, and have a proper module for our intervention.

WO: How frequently do the students and members of IIT R visit you? How open and frank are they during these visits (in terms of wanting to discuss their issues)?

SJ: At present we have around 8 to 10 students visiting the Wellness Center daily. They come to not only discuss their mental health issues but also if they have any kind of academic, financial or scholarship related problems, wherein they do not know whom to approach. We are now planning to establish some more activities in the Wellness Center so that students feel free to come and discuss any problems. These activities that will be organised will be done in hopes of removing the social stigma and spreading awareness.

Now regarding the second part of your question. The level of frankness and familiarity depends on the rapport achieved between us and the student. First of all, we try to establish some rapport with the student and that might take more than one session. Once that is done, the students are more at ease and are more open in discussing their concerns and their feelings. Usually, with psychological problems, childhood history (i.e the growth period during their school days) is also very important. So, gradually they open up about themselves, and how they feel about their family, friends etc. A lot of ‘trust’ barriers need to be passed before the student is able to communicate freely with the counsellor.

AA: So earlier, the concept of counselling focussed on just treating mental illnesses. People came to the counselling center with just their mental health concerns. However, now we are also looking at something called ‘positive psychology factors’, where we help the students answer questions like- “How can I be more attractive in my personality?”, “How can I be more self-confident while working?” or “How can I bolster my warm relationship with everyone?”.

Basically, apart from mental illnesses, we are also taking care of other areas like personality development. The first step was that we changed our counselling center name - now as you know, it’s a wellness center. The message being that we take care of the entire well being of the student.

WO: Based on your experiences so far, how would you describe the mental health literacy of IITR when students come to visit you? Are they educated in terms of what they are feeling? Do they know that these illnesses are legitimate?

SJ: Well, usually students do a lot of research using the internet before coming to us. So, they are not entirely unaware of their symptoms.

The entire Wellness Center team is working hard to remove the stigma surrounding these issues, and spread literacy about mental health issues. The aim is that students should be able to recognise symptoms of anxiety, stress or depression early on, and should feel free enough to approach us immediately. Then we will be able to take care of their mental health smoothly during the early stages of the illness. And secondly, in my opinion, every student body in IITR should come forward and help us in our mission to stop this spread of social stigma regarding mental health. The members of the wellness team can’t achieve this on their own. When all the bodies come together and collaborate, work is done more effectively. For example, Wellness Center has their own web page, Facebook page and we regularly upload mental health-related articles. I feel the team should consist of more students, to work better and effectively.

AA: I think we really need to appreciate the activities and work done by Team Wellness because it’s a students’ volunteer body. They’re working hard to spread mental literacy. In the last two years alone, Team Wellness has conducted almost 30 programs in IIT Roorkee. It’s almost like one program per month, and each was related to mental health. So I can say with some confidence that IIT Roorkee is quite literate about mental illness.

SJ: I want to give one example - in 2018, the Dramatics section put up a street-play “Jimmedar Kaun” (Who’s responsible?). In that, they addressed suicide and related concerns.

AA: I would like to add that this time, Wellness Center conducted and organized the Orientation Program. This was really helpful, since we were able to introduce ourselves to the student community from the very first day, and were able to convey the message that we are there to help them, to facilitate their well being. I think you all must have also received emails regarding the lectures, bhawan visits and various competitions we organize from time to time. Therefore we’re now taking an active stance to promote literacy about mental health.

WO: What are some policies that the institute has adopted regarding mental health issues? For example, what is the institute’s policy when it comes to prescribing medication for mental illnesses?

SJ: Mental Health Act 2017* has given us the proper guidelines, and normally we and the psychiatrists follow those. Sometimes we need to take help from the administration - e.g. suppose a person is having self-harm or suicidal tendencies, we may need to inform the parents. Before doing that, we - i.e. the counsellors and psychologists - together assess the situation. After informing the parents, the administration also accommodates the family on campus so that they can stay with their wards to provide emotional, psychological support and also take care of the treatment. I have seen sometimes that students stop taking their medicines or forget to take them. That is not good, this might worsen the student’s situation. We involve the administration when there is a threat to somebody’s life - only in severe cases like severe depression, drug abuse. In those particular cases, we need to inform the parents. That is because we prefer the parents to come to stay with their wards to take care of their emotional and mental health as well as supervise their treatment. So as far as confidentiality is concerned, we maintain confidentiality throughout the whole session, it is only breached in certain rare cases.

WO: To break the stigma surrounding the treatment of illnesses, could you tell us what life for students after being diagnosed with illnesses like anxiety and depression looks like in terms of how they carry on with their daily life, how often they need help etc.?

SJ: Following good lifestyle practices like having a proper balanced diet, doing regular physical exercises and most importantly sleeping for a good 6-8 hours is essential for improving and maintaining mental health. In IITR I have seen that students often don’t follow a proper diet and sometimes believe that just three or four hours of sleep is enough. But now more and more research is being conducted which says that six to eight hours of sleep is necessary for every adult, in order to work efficiently. Another important advice for those who are prescribed medications to combat anxiety or depression - they should not stop or change their medicines without any supervision or guidance.

AA: We use either psychotherapy and pharmacological management (i.e. medication) to treat the student. In psychotherapy, we have different modules like cognitive behavioural therapy, interpersonal psychotherapy, behavioural therapy. These are very, very effective, in reducing or removing altogether the depression, anxiety and mood disorder symptoms. How some psychotherapy modules work is that they help people cope with their daily stress which lightens their mood and brings in positive emotions. So when they get this hope, this positive emotion actually reduces the chances of going back to the same illness. For example, suppose someone failed an exam. This might lead them to have a mixture of constant negative emotions like irritability, disappointment, sadness. But they need to understand that it’s okay, they just need to strengthen their strategy to get a better score next time. If one thinks in a positive manner, of course, they will have the energy or positive emotion to make more such steps and eventually get more marks. The first step in the positive direction matters.

SJ: Yeah, one more thing I need to add is that in anxiety and depression, one should change his own thought processes and perception. For example, if you have a friend who called you, but you don’t pick up right away as you’re busy. If your friend has anxiety, he/she might think that you didn’t pick up the phone on purpose, because you’re trying to avoid the person. This is quickly followed by a negative and harmful rationalisation in the person’s head. So the ones suffering from depression/anxiety ultimately need to change their perception, need to turn their thought processes from being negative to being positive. A lot of daily situations can be viewed under a negative light or a positive light. It therefore depends upon the person, and therapy and medication strive to inculcate these positive thought processes in the person.

WO: Movies like Requiem For A Dream, and TV shows like Bojack Horseman have been successful in portraying mental illnesses/substance abuse problems and bringing mental health to the forefront of social discussions. What is your stance on such movies and shows?

SJ: These types of movies and shows are very good. They break the stigma surrounding such taboo topics and spread awareness regarding mental health. For example, movies like Padman have made it easier for people to talk about menstrual health issues. In fact, I feel showing such movies to the student community would do a great deal in breaking the stigma and spreading more awareness too. I firmly believe that if the whole student community comes up and takes even the smallest step to spread awareness it will have a massive positive effect. The concerned student groups can recommend such movies and get them screened. “A Beautiful Mind” is an example.

AA: These movies and series can be highly impactful. I would recommend “The Aviator” which depicts OCD (Obsessive Compulsive Disorder). These movies are highly influential because of the way they depict a person afflicted with an illness, and the struggle they go through before eventually getting better. Movies like “Requiem For a Dream” and “Udta Punjab” show the transition between stages of the lives of the subjects that occur due to substance abuse. Series like “Breaking Bad” and “Bojack Horseman” also depict some very harmful drugs. But movies can be double-edged swords.

WO: Meme culture and meme pages are ubiquitous and rampant. All of us have been exposed to the same at various points in our life. In light of recent events (like the expose of a private, misogynistic and offensive social media group ‘Boys Locker Room’), how do you think the psyche of students across the country have been affected (men and women)?

SJ: In the case of “Boys locker room”, we need to create more awareness among the parents and students at the school level. Also, accountability on digital platforms must be increased.

AA: This problem is typical in the millennials. Adolescents are in the midst of an identity crisis. They are unable to conceive their place in society. So, they prefer being on social media in order to conceal themselves, and are content with projecting a different identity. It is similar to how children experiment with smoking in order to appear similar to adults. The ability to put out content anonymously is proving to be quite dangerous.

WO: The Mental Health Wellness Centres at universities like the Massachusetts Institute of Technology (MIT), have a rigorous and well maintained online presence in terms of the documentation of these illnesses, their treatments, the university policies, session booking mechanisms etc. Are there any plans for doing something similar in IITR?

SJ: Currently, an online Google Form can be used to book a session and we are providing online counselling also. During this pandemic, we are providing the online sessions in the form of video, audio or chat; with confidentiality maintained throughout the session.

We maintain records as well, but only to be used during sessions as a reference, in case of a change of counsellors. We are available 24X7 (YourDost for normal cases and counsellors for emergencies)

We do have a web page and we are currently working on this domain. Our web designers are collaborating with us and completing all the relevant details there. Soon, the information regarding psychiatrists, counsellors and speech therapists will be uploaded there.

Link