The mental health care crisis in Indian campuses

Interviews with students, teachers and mental health professionals in over 20 educational institutions show that the causes of student suicides are varied and intersectional.

Delve Mental Health

Sagar Mondal had a peculiar habit of propping up a bedsheet on a rope and cordoning himself off in a room he shared with two others in the boys hostel of the Indian Institute of Science Education and Research (IISER), Kolkata.

He was anxious about his exam and retired to bed early, to which his roommates, immersed in their own studies, paid little attention. He always liked his privacy and over time, the roommates had gotten used to his habit of propping up the sheets.

When the roommates woke up in the morning, they noticed that Sagar had left the room and assumed that he had gone to the library to finish studying. But when Sagar did not show up for the examination, the roommates sensed something had gone terribly wrong.

They formed a search party to look for their friend, eventually finding him in an unused floor of the hostel. He had hung himself to death with the same rope he used to prop the bedsheets up.

The incident happened on May 1, earlier this year, and continues to haunt students and faculty at IISER-Kolkata.

Sagar, the 19-year-old son of a daily-wage worker came from a Dalit family and dreamt of being a scientist when he left Majherpara, a village in Nadia district of West Bengal, to join IISER-Kolkata. A first generation school-goer, he was also the first person from the remote village to make it to IISER, on a scholarship under reservations.

In his first year of undergraduate studies, he mostly kept to himself. Whenever his friends asked him to step out and eat with them, he would refuse, saying he did not want to spend money. His friends also said he was anxious about exams. “He was not struggling in his studies, but he always pushed himself to do better,” says a faculty member who did not wish to be named.

But we will never know what exactly pushed him to take this extreme step. Sagar suffered an illness that no post-mortem can reveal, but its brutality remains very real. The 19-year-old was depressed, but his institute – like many others across the country – did not have the mechanisms to help him cope.

Ignoring mental illness as a cause of suicide

Sagar’s suicide sent the administration at IISER-Kolkata into a frenzy. A fact-finding committee was formed and the inquest into his death began as the news spread through campus. A report sent to the Ministry of Human Resource and Development (MHRD) made no mention of Sagar’s history of mental illness, even though sections of the faculty alleged otherwise.

“We had two days to file the report. So, we gathered all the information that we could verify and sent it to the MHRD,” says Arindam Kundagrami, the Dean of Student Affairs at IISER-Kolkata.

However, Dr Pinaki Sarkar, a psychiatrist who previously worked with IISER, confirmed that Sagar came to him seeking help for depression a year ago, in April 2016.

When the Dean was asked about Sagar’s visit to the psychiatrist through the campus’s own counseling system, he replied, “Just because someone visits a psychiatrist does not mean he has a mental illness.”

Sagar had also covertly travelled with his uncle to Christian Medical College, Vellore, seeking mental health help. Dr Pinaki was the only psychiatrist on campus, and in September 2016 – just a few months after Sagar first approached him – the institute failed to renew the contract with the doctor. The reason cited was that very few students were visiting the psychiatrist in campus, which points to both a lack of awareness about mental health, and mismanagement from the administration to not employ a resident mental health professional.

Five months after the tragic incident, the institute is still searching for a full-time resident psychologist.

In life and in death, the spiral of silence surrounding Sagar’s mental health only grew further. He preferred to remain silent about his visit to CMC Vellore, not mentioning it to his friends while even his family knew nothing more than the fact that he had visited Vellore. After his death, the administration at IISER-Kolkata reportedly preferred to remain silent about his history of mental illness in its report to the MHRD, and the suicide was reported as a “spur of the moment” incident.

The incident brings to fore an institutes’ built-in reaction to suicides committed by students on campus – denial. Concerns over a reputation hit drove officials at IISER-Kolkata to suppress details of Sagar’s suicide, which in turn contributes in understating the extent of mental health problems plaguing India’s campuses.

The deadly cost of India’s campus suicides

The system surrounding Sagar – his friends, family, faculty and institution – failed to cope with his academic and personal pressures, a story that repeated itself 8,934 times in India in 2015, according to the National Crime Records Bureau’s (NCRB) latest available statistics of student suicides in India

In the five years leading up to that, 39,775 students committed suicide in India. About 70% of suicide victims in India had an income of less than Rs 100,000 per annum, according to data revealed by NCRB. Even though the figure is not disaggregated for students, it reveals the link between financial issues and suicide.

A combination of rising parental expectations, apathy of college administrators, lack of mental health help and a fiercely competitive academic culture is driving students across the country into despair.

The stories of Rohit Vemula (HCU, Hyd), Rajani Krishnan (HNU, Delhi), and Sagar Mondal (IISER, Kolkata) are among a number of suicides that have brought the multitude of pressures faced by students into sharper focus.

While every suicide is ultimately a “spur of the moment” decision, our interviews with students, teachers and mental health professionals in over 20 educational institutions across the country show that the causes of student suicides are varied and intersectional. They include economics, caste, gender, sexuality, academic performance and interpersonal problems, that often go unreported, or get tied down to a single cause.

Excel or fall behind

The pressure begins as early as 11th standard, when students pick their subjects of preference. “Many parents force students to pick subjects without looking at the aptitude or interests of the child. So many students come to me saying why am I studying this,” says Madan Lal Agrawal, a psychiatrist based in Kota, an unassuming town in Rajasthan that has emerged as a competitive test-prep hub in the last twenty years. This pressure only increases when students reach college.

The unhappiness of not being able to pursue their own interests is among a number of issues students have to cope with in their college lives. The sudden change in lifestyle and having to live away from home and look after themselves causes separation anxiety among both students and teachers.

“The change in the lifestyle which happens at the same time as physical, sexual and psychological changes in the body, means that this period is a particularly vulnerable time for a person’s mental health. Through all this, the pressure to perform well in studies is the only constant,” says Nigesh K, a psychologist working with IIM-Kozhikode and University of Calicut.

Students across India studying a range of subjects stroked their chins in general agreement when they were asked about the immense academic pressure in college campuses. The pressure is normalised by faculty and administration alike as an ideal preparation for the high level jobs the students are aiming for, say the students.

“The pressure is intense in IIT-Kharagpur. Many students join IITs as toppers of their respective classes and coaching centres, but when they come here, the competition multiplies. The same person who topped his class in 12th standard is now an average student, and this leads to low self-confidence,” says Sushant*, a student of IIT-Kharagpur.

At the other end of the country, Radhika*, a student of IIM-Kozhikode, conceded that the pressure often demoralises students “There is a flurry of continuous academic activities with quizzes, assignments and presentations. You end up staying up a lot of nights working to complete them. Those who can handle it, excel, while those who cannot, get demoralised in spite of having done well in the past, ” she says.

The silence surrounding mental health problems, and the stigma attached to seeking professional help, also breeds an environment of ignorance among college-going students, who are oblivious to both sub-clinical as well as serious mental health problems. “A girl approached me saying she has been hearing voices for the last three years and she did not even know what is schizophrenia,” says Madan Lal Agrawal.

“I would have readily taken my life at that point”

Abhishek*, a student in a premier research institute in the country, is hesitant when I ask him to share his story. “Do not reveal anything about my identity. I hope to apply in universities abroad,” he says with a smile.

When the episodes started, Abhishek did not understand what was happening with him. He had, over a period of time, become uncharacteristically hostile and aggressive in his interactions with his friends.

“I would have readily taken my life at that stage. You don’t realise when the episode is going on. The idea is so compelling that it convinces you that what you are seeing is real,” he says.

Abhishek was suffering from psychosis, a serious mental illness where a person loses contact with reality and sometimes experiences apparitions and visions.

On his girlfriend’s insistence, he agreed to visit a psychiatrist in the city but even after visiting the psychiatrist, Abhishek was still no closer to diagnosing his condition.

He admits that this period in his life is murky and he relies on other people’s memories in recollecting what happened. “Even the psychiatrist was unsure of what was happening to me until I had an episode during a session with him. He identified that I was suffering from psychosis and gave me antipsychotic medication,” he recollected from shoddy memory of the incident.

When Abhishek identified his condition and began taking medication, his academic results dipped. “My mind was cloudy and I could not concentrate on my studies,” he recalled. From scoring As and A+, his grades had slipped to Cs and Ds. “At this point, some professors were understanding of my issues while others were not,” he admitted.

During his recovery, Abhishek began paying attention to simple details. “I began differentiating between what is real and what is not. I started getting a handle on when I am not supposed to be angry. I still get episodes where I hear and see things. But I strictly follow a few rules I have devised for myself now and that is helping,” he says.

Ask Abhishek what the rules are, and he says he just walks away from any situation that might make him angry. He also does not travel in public transport since he is not the person in control.

He was also the student body head at the institute around the same time when his psychosis reached its peak, and the stress didn't help.“After starting my recovery process, I left my position in the student body. But I was more scared during recovery than when I was oblivious to my condition,” he says. Soon enough, his condition improved, and he now he only resorts to medicines if he is experiencing a high level of stress.

Early detection and his girlfriend’s conviction that Abhishek’s experiences were “just like any other sickness and can be treated” helped him mitigate a potentially life threatening experience, when his teachers, administrators and people working at the student counseling unit in the institute, remained oblivious to his ordeal.

Lack of student counseling centres

While dedicated student counseling centres are now a norm in premier governmental institutes like IIT's, such centres with resident psychologists who can intervene at the onset of emotional and mental problems, are yet to become commonplace in both governmental and private institutions in the country. The situation is better at top-notch private institutions in cities, whereas mechanisms are almost non-existent in smaller institutes in tier-2 and tier-3 cities.

The National Assessment and Accreditation Council (NAAC), an autonomous institution of the University Grants Commission (UGC), lists grievance redressal counseling centres as one of the minority factors in accrediting an institution. “There are much more important factors like research, infrastructure,” says MS Shyamsundar, regional coordinator for NAAC in South India. Institutes are not incentivised to maintain an accessible and responsive counseling system with trained psychologists, as the UGC in its April 2015 guidelines only mandates teacher counselors as guardians of students. Most colleges in India maintain a mentorship programme in which a group of students are overseen by a faculty member.

Naveen*, a student of National Institute of Technology, Surathkal, however pointed out that he is not comfortable sharing his problems with his teachers. “Students do not want to speak to faculty members about their problems and the psychologist only visits the institute once a month,” he says.

Mushrooming of student support networks

India is facing a mounting number of campus suicides in the midst of an acute shortage of mental health professionals in the country. According to a reply by the Ministry of Health and Family Welfare in the Lok Sabha in 2015, there are 3,800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1,500 psychiatric nurses nationwide. That translates to 1 psychiatrist available for every 200,000-300,000 people, which means that even institutes that wish to employ psychologists have to painstakingly search for a viable candidate.

Students with diagnosed mental illnesses and students with sub-clinical problems will both benefit from having a resident psychologist on campus. “Not all students with mental illness are at risk of suicide, but it is better if institutes do away with the mentorship system in favour of a psychologist. There is a big difference between mentoring and counseling, and counselors step in when students are emotionally affected,” says Nalini Dwarakanath, a psychologist based in Bengaluru who works with Indian Institute of Information Technology (IIIT) and Indian Institute of Science (IISc) in the city.

She spearheaded a Student Support Network at IISc, an early detection system manned by volunteer research scholars and students of the institute. Anyone who wished to reach out could email the Student Support Network and volunteer students would set up a discreet meeting with them. If the volunteer students felt that the issue was more serious than they are equipped to handle, then they would reach out to the psychiatrist - Nalini Dwarakanath - and let her take over from there. The identities of student volunteers are kept confidential due to the stigma attached to students being seen seeking mental health help.

Earlier this year, the Student Support Network in IISc expanded from employing a sole visiting psychiatrist to four persons, including two psychologists (one male, one female) and two psychiatrists (one male, one female). A dedicated counselling centre is in place attached to the health centre at IISc “A revolution is happening. A year ago, I was overburdened with work but now I see advertisements for counselors in institutes frequently in newspapers. Institutes are now aware of the mental health burden they are carrying,” adds Nalini Dwarakanath.

Similar support systems that are delinked from academic and hospital records have emerged to combat the growing demand for mental health help in campuses. All premier governmental institutes including IITs and IIMs now maintain a dedicated counseling system that operates autonomously.

Manipal University has introduced a Student Support Centre earlier this year. Debasmita Phukan, a psychologist working with the counseling system in Manipal says that the Centre deals with around 30-40 students walking in every month. “We deal with many cases where students are brooding over academic underperformance, interpersonal relations and also diagnosed cases of anxiety and depression, ” she says.

A first-line-of-support delinked from academic and hospital records, allows students to freely discuss academic and personal issues with an unbiased third party, who has no bearing on their college life. “It helps that we work outside of the University apparatus as it makes it easier for students to come in here and talk to us about the issues they are facing. They can even talk to us about issues with the administration and we hear them out,” Debasmita adds.

Priya*, a student of Manipal University, missed a semester after she was diagnosed with clinical depression. When she started her second year of studies, she says she spent most of her days cooped up in her room. “I did not know what was happening and neither did anyone around me. I had lost interest in studies and spending time with friends. I remember I spent hours and hours in my room crying,” she says.

On the advice of her parents, she visited a psychiatrist in Bengaluru, who diagnosed her with clinical depression. After receiving therapy and medication, she resumed her studies after missing a semester. She now occasionally visits the Student Support Centre. When Priya returned, her experience had become common knowledge amongst her classmates and she recalls how many students approached her saying that they were feeling unhappy and disconsolate. She advised them to immediately visit her psychologist at the Centre.

A long way to ‘ideal’

Many students, however, are unaware of serious mental illnesses even though they know buzzwords like depression and anxiety. Depression, anxiety and other psychological disorders are not viewed as illnesses but either taken lightly by fellow students with a “Hey, this is a phase and it will pass” attitude or are viewed violently, as though the mentally ill person is crazy. “Only those who experience or observe someone close to them experience it, appreciate the nuances of living with a mental disorder,” says Toshi Parmar, a student of IIT, Bombay.

Students and teachers alike tend to underestimate mental health concerns, and deny any pain caused by it. “Everybody has it,” is the common response as though 'everybody' is a standard metric for pain. For this to change, we need to call mental health problems for what they are - “a sickness like any other that can be treated.”

*Names changed on request