As the battle against the coronavirus is being waged outside, one-third of the world’s population is confined within the four walls, adapting to work from home, many even staring at pay cuts and job losses. These situations have led to pronounced mental health issues across the globe. Impact on mental health can have severe repercussions of violence against vulnerable groups like adolescents and women, for whom the home is no longer the ideal sanctuary.

Economic insecurity, uncertainty and living within closed spaces can cause high-stress environments, encouraging substance abuse and lead to risk of violence against the partner and children. The unavailability of alcohol amid the national lockdown had a direct correlation to the rising number of domestic distress calls, which spiked by 200% in the country. It was primarily as a result of withdrawal syndrome and increasing the threat to the safety of women and adolescents.

In a public health emergency such as this, healthcare workers are focused on attending to patients at hand, thereby, reducing the available assistance that a domestic violence victim would need. There has been a surge in domestic violence cases worldwide. The Tamil Nadu government last week informed the Madras high court that a total of 616 complaints of domestic abuses was received across the state from March 25 till May 14 on the designated helpline.

In such situations, a child is most vulnerable. For some, adolescents the stress at home is telling. Evidence suggests that most perpetrators of abuse and rape are someone who the victim knows. Girls, in particular, are overburdened with household responsibilities and exposed to household tensions, which can cause mental stress. In addition, school closures have meant their routines are disrupted and their usual support systems outside their home is unavailable. The lockdown has isolated adolescents from their friends and led to cancellation of classes and events important to them. Students who are finishing school or graduating from college are subject to stress and uncertainty about their future. Staying indoors all day with online classes as the only academic interjetion, screen time for adolescents has increased. Along with the isolation, confinement and anxiety, this can increase exposure to online predators. These factors might cause depression, disappointment and anxiety among them, especially for those subject to stigma related to Covid-19.

While the health systems around the world are burdened by the soaring Covid-19 cases, the mental health crisis remains neglected. There is an impending need to grant due recognition to mental health and the psychosocial aspects of this pandemic and develop frameworks for mental health support. Protocols to ensure safety of women and children must be incorporated into the health system response to Covid-19. Self-quarantine measures must be recommended only after evaluating the level of safety from violence at home. The victims of violence, whose houses are not deemed safe, must be provided alternative shelter options. Canada has invested $40 million into the immediate need for shelters and sexual assault centres. France is moving domestic violence victims to hotels and covering the cost of 20,000 nights of accommodation.

Constructing better tracking systems would enhance the efficiency of these initiatives. Gender-sensitive social safety nets like direct cash transfers, tax relief and food vouchers, would enable the independence of women in taking care of themselves and their children. Additionally, the government must support and empower women working at the grassroots level, like women-led self-help groups.

In India, 6 million SHGs are functioning as frontline responders for the country’s most economically vulnerable population. This network of 67 million women are identifying and surveying vulnerable households, producing PPE kits, creating awareness on sanitation and physical distancing in many states.

To support the mental health needs of people, online counselling and social support systems must be encouraged on OTT platforms. Universities in India such as Jamia Millia Islamia and Ambedkar University in Delhi and, Symbiosis International University and Flame University in Pune are providing tele-counselling services and psycho-social support to students. The Indian Psychiatric Society and other organisations have set up COVID helplines to take distress calls pertaining to psychological help.

While help is at hand, adolescents need to be sensitised about mental health issues and risks of online sexual violence. Parents must maintain a low-stress environment at home, communicate and spend time with their children to ensure good mental health. Connecting with friends to avoid feeling depressed or worried. Thus, both the government and people have to actively participate in combating the mental health crisis looming in the shadow of the Covid-19 pandemic.

(Dr Lakshmi Vijayakumar is the founder of SNEHA and Dr Sukriti Chauhan is a public health advocate)