The mental health landscape in India & how technologies like VR can help

In India, mental health issues have unfortunately had a longstanding history of not being taken seriously at best, and severely stigmatised and ostracised at worse. In view of this fact, we will start this article with some numbers that will capture the current mental health landscape and the gravity and scope of the challenge facing us.

According to the World Health Organisation (WHO), around 100 million Indians suffer from mental health issues or anxiety disorders. Every year, almost 200,000 people in our country take their own lives, factoring in the number of people who attempt suicide would take this number significantly higher.

The National Survey on Extent and Pattern of Substance Use in India reported that around 5.7 crore people are estimated to have a dependent alcohol use problem. A nationally representative survey commissioned by the Ministry of Health and Family Welfare stated that over 13-crore people in our country require mental health services. Experts agree that the COVID-19 pandemic has only served to exacerbate the situation further, leading to a prevalent mental health epidemic in the country.

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Let’s now take a look at the resources available to tackle this dire situation.

NCBI reports that for a population of over 1.3 billion, India has 9000 psychiatrists, 2000 psychiatric nurses, 1000 clinical psychologists, and 1000 psychiatric social workers. I did a double-take the first time I read these numbers wondering if I had missed a zero somewhere, but they are accurate.

At the current rate of human resources produced per year in these domains, it would take anywhere between 40 to 70 years for India to catch up to the median requirement of 3 mental health human resources per 100,000 people, and significantly longer (hundreds of years in fact) to arrive at the developed country standard of 1 mental health professional per 10,000 people in each category.

The government did take several positive steps toward improving the mental health and wellbeing of the population with the progressive MHCA legislation introduced in 2017. However, with the current national spending on mental health falling under 1% of the total healthcare budget, and the wide chasm between where we are and where we need to be as a country, conventional measures on their own will just not cut it.

As I write this article, technology is already being used to fill in the gaps in the mental healthcare landscape across the globe, including India. Use cases include teleconferencing setups, depression and anxiety helplines, web-based diagnosis tools, and smartphone applications that provide support for everything from depression to anxiety to PTSD and substance abuse through self-help guides and medical practitioner intervention where needed.

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Usage of telecare and other digital mediums to seek support for mental health issues has also gone up during the pandemic, commensurate with trends visible across the entire healthcare landscape, not only easing the pressure on the system but also making it possible for patients to seek help without fear of stigma, ostracisation, and recrimination.

With that said, technology has the potential to do so much more.

For instance, consider virtual reality: The technology has been around for decades (the first rudimentary VR concepts were created as early as the 1960s) however, it is in the last few years that it has matured enough to evolve into end-customer products that are rapidly becoming more affordable. While some of VR’s primary applications are focused within the entertainment and gaming industry, it is finding scope in other areas as well, including mental health.

VR is now allowing therapists to conduct exposure therapy where the patient is treated for anxiety disorders through incremental exposure to the anxiety-inducing stimuli in a safe and tightly controlled, monitored environment. Similarly, VR therapy can be used to gradually bring patients who suffer from PTSD or depression, face to face with their trauma or trigger memory, allowing their therapist to study their response, and slowly help them heal.

Psychologists also argue that VR can be used to help diagnose conditions like Alzheimer's, schizophrenia, ADHD, and autism, faster and more objectively compared to the current interview-based diagnosis methodologies by immersing patients in identical environments and then studying their responses. From Anhedonia and PTSD to phobias and anxiety disorders, VR-led therapy is driving real results in successfully managing a variety of mental health issues.

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Alongside mental health, VR is also proving extremely useful in treating developmental disorders in children by combining innovation with empathy and ingenuity. For instance, in 2020 Robert Bosch Engineering and Business Solutions (RBEI) collaborated with Rødovre Kommune and Københavns Professionshøjskoles (KP) in Copenhagen, Denmark to help children struggling with autism develop a sense of independence by simulating a bus ride that they took all on their own. The exercise allowed the participants to overcome their fear of traveling alone and develop self-esteem, while in a safe, virtual, and monitored environment.

The concept provides a fascinating look at how futuristic technologies can help therapists provide in-situ coaching to patients, enabling them to apply and practice the psychological techniques recommended by their therapist in real-world situations while at the clinic or at home, thus dramatically improving treatment efficacy.

According to a NLM study for instance, a single VR session was able to reduce paranoid beliefs and fear of real-world situations by half in the patients monitored for the duration of the study. Another study published on the same platform that studied the efficiency of VR cognitive therapy in treating delusions and resultant real-world distress reported a 22 percent decrease in delusion conviction after just one 30-minute session.

Consider scenarios where a combination of AI and VR could be used in conjunction with NLP to enable digital agents of mental health that are equipped with the knowledge and capabilities to listen to the patients, advise them, and refer cases that require deeper intervention to human mental health professionals by order of priority. Imagine immersive VR/AR-led setups similar to self-help books that can be prescribed by mental health professionals, and consumed off the shelf, helping people face, come to terms with, and eventually overcome their mental health issues in the comfort and security of their homes.

These scenarios are still some way in the future, but one thing is very clear. Accessible, available mental health services for the masses in countries like India are likely to lie at the convergence of digital technologies with forward-looking policies and regulations driven by innovative public-private partnerships.

The correct use of digital technologies can not only help remove the stigma and avoidance syndrome associated with mental health issues in our country through awareness, education, and diagnosis initiatives but can also ensure that mental well-being is accessible, affordable, and available to everyone, as guaranteed by our constitution.