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“The worst are the headaches and the pain in my eyes,” said Paul, who lives in Kolkata, West Bengal. “I have had more panic attacks this year than in my entire life combined.”

Research conducted by the Suicide Prevention in India Foundation (SPIF) in May found that nearly 65% of 159 mental health professionals surveyed reported an increase in self-harm among their patients. More than 85% of therapists surveyed said they were experiencing caregiver fatigue, and over 75% said fatigue had impacted their work.

Another survey in April, by the Indian Psychiatric Society, showed that, of 1,685 participants, 40% were suffering from common mental health disorders, such as anxiety and depression, due to the pandemic.

The lockdown may have eased, but the situation isn’t improving. The report’s authors told CNN in August that there’s growing anxiety and uncertainty about when the pandemic will end.

Before Covid-19, India had the highest suicide rate in south-east Asia — now medical experts say the country’s mental health system is being pushed to the limit.

“The system was already creaking and overburdened, now with Covid, we are experiencing the catastrophe of increased demand, woeful supply, and fatigued frontline workers,” said Nelson Moses, founder of SPIF.

No words for mental health

India doesn’t have a long history of discussing mental health.

In 2016, a National Mental Health Survey conducted across 12 states documented a list of over 50 derogatory terms used for people suffering mental illness. “Usually, the public believes that individuals with psychiatric illnesses are incompetent, irrational and untrustworthy consequently, they have low marriage opportunities,” said one of the participants.

“People think that talking about your feelings makes you weak — there are a lot of misconceptions,” said 23-year-old Baldev Singh, a volunteer counselor with the MINDS Foundation, an Indian nonprofit that aims to reduce the stigma around mental health.

Experts say the historical reluctance to address mental health in India could be partly due to a lack of terminology. None of India’s 22 languages have words that mean “mental health” or “depression.”

“People think that talking about your feelings makes you weak — there are a lot of misconceptions.”Baldev Singh, volunteer counselor

While there are terms for sadness (udaasi), grief (shok) or devastation (bejasi) in Urdu and other Indian languages, the specific terminology to address different mental illnesses is lacking. That’s because the practice of psychiatry is largely Western, said Dr S.K. Chaturvedi, Head of department at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore.  “It is easier for people to talk about physical symptoms and illnesses than to express to their families that they are feeling low or depressed,” he said.

Growing up, Paul says her middle-class Indian family didn’t talk about negative feelings.

“Ever since I was a kid it was ingrained that we don’t talk about things that bother us.”

Problems were pushed aside and minimized, she said. “They might just compare it with someone else’s problem and make you feel guilty about it.”

Straining mental health system

The stigma around mental health may prevent some people from recognizing that they need help. For those who do want treatment, facilities are limited.

According to the 2016 National Mental Health Survey, 83% of people suffering mental health problems in India did not have access to adequate mental health treatment.

The same year, India had three psychiatrists for every million people and even fewer psychologists, according to the World Health Organization (WHO). For comparison, the US had 100 psychiatrists and almost 300 psychologists for every million people.

In many cases, access to mental health treatment in India depends on where you live.

“The divide basically comes in the urban versus rural, so if I look at Mumbai, I know that today I can just get up and go to a hospital in my own area,” said Pragya Lodha, the Mumbai Program Director for the MINDS Foundation.

For people in rural India, it’s much harder.

Sub-district hospitals cater to roughly 30,000 people or 15 to 20 villages. However, these hospitals typically don’t have mental health services, according to Amul Joshi, MINDS Foundation’s program director in Gujarat.

Some villagers may have to travel up to 60 kilometers (37 miles) to get treatment, said Joshi. That takes time — and money. “We sometimes pay for their travel to the hospital as an incentive. However, this means that treatment is usually limited to medication as people cannot keep going to the district hospital for therapy,” he said.

People in rural India tend to have other priorities.

“The struggle in rural communities is often about basics so mental health tends to take a backseat,” said Lodha.

The urban-rural divide

India was heading into harvest season when the government announced its nationwide lockdown in March. Farmers were confused about whether they could hire migrant workers amid the ban on cross-border movement, and whether crops could be transported to market, said Singh, the volunteer counselor.

“People have to deal with a lot of stress in villages — farmers have to deal with their produce going bad when they can’t take it to the market or distribute it in time,” said Singh, who lives in Nara Village, a rural farming community of around 2,000 people in Gujarat.

Singh said people in rural India are feeling more isolated than ever.

“In rural India, where people aren’t aware of mental health issues and can’t talk to their friends about their stresses, the situation is only getting worse.”Baldev Singh, volunteer counselor

“In urban India, this may have led to more dialogue among family members. In rural India, where people aren’t aware of mental health issues and can’t talk to their friends about their stresses, the situation is only getting worse,” he said.

Technology has become crucial to mental health intervention in many communities during the pandemic. However, online therapy is not often available to people in villages who don’t have access to smartphones or the internet.

The MIND Foundation trains volunteers — like Singh — to become “community leaders” to raise awareness of mental health and encourage people to seek help when they need it.

Government programs

Changing attitudes in a country of 1.3 billion people is an immense challenge. But in recent months, there have been signs of change.

Chaturvedi, from NIMHANS, is part of a central government initiative to address the mental health of migrants who were disproportionately affected by the lockdown that stretched for 68 days.

“(It’s) definitely proof of the fact that there is a shift in attitudes, and that people understand the importance of mental health,” Chaturvedi said.

Millions of migrant workers lost their jobs and became stranded in cities when lockdown rules closed workplaces and froze public transport. Some were forced to take shelter under bridges or other public spaces or walk hundreds of miles to get home.

Migrant laborers (were) displaced, forced to go back to their villages, ignored by the state machinery, treated as collateral damage,” Moses said. Sometimes they were unwelcome in their own villages, he added, due to fears they were carrying the virus.

“Thanks to Covid, everyone is in the same boat of despair and despondency.”Nelson Moses, founder of the Suicide Prevention in India Foundation

Under the direction of the Ministry of Health and Family Welfare, NIMHANS set up a helpline that refers prospective patients to mental health professionals. Separately, the government released guidelines on addressing the mental health issues of migrants and health care workers, and advice on identifying patients whose mental health had suffered during the pandemic. And the Health Ministry shared posters stressing the importance of wellness practices, such as yoga to improve mental health.

However, some mental health practitioners say these initiatives are insufficient. “These are helpful but seem to be reductive and appear to pay mere lip service,” said Moses.

Mental health experts say what’s needed is more funding. Of India’s total 2020-2021 budget, just 2% has been set aside for healthcare. And of that figure, less than 1% has been allocated to mental health.

Moses believes now is the time for the Indian government to start prioritizing mental health services.

“Never before have we witnessed more engagement surrounding mental health. Thanks to Covid, everyone is in the same boat of despair and despondency,” said Moses. “It has gone from (being) swept under the carpet to hitting the ceiling.”

Paul chose to speak about her panic attacks to raise awareness of a problem that often is ignored in India. “It is no longer acceptable to label mental health as “taboo,” and move on without addressing the issue,” she said.

“There needs to be a lot more communication … we need to start from ground zero in schools and colleges and rope in parents and make them comfortable with it, so that their children can be comfortable talking to them about their issues.”

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McDonald’s new pastries are here. Here’s how to get them for free

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The expansion of the company’s McCafé lineup adds three new sweets — an apple fritter, a blueberry muffin and a cinnamon roll — to menus as it finds itself in a competitive battle with rivals over the first meal of the day.

McDonald’s is giving away one of the new items free with a purchase of a hot or iced coffee on orders placed through its app. The promotion runs from November 3 through November 9 and is valid once per day at any time.

McDonald’s (MCD) regularly tries to entice customers to use its app with a variety of promotions and coupons, as well as a limited rewards program aimed at boosting coffee sales. Increasing the app’s user base is “key,” according to Morningstar analyst R.J. Hottovy, because the promotion could build customer loyalty: Customers might be coaxed to come back because of future offers.
The chain could use the boost, as it faces more competition at breakfast. Its most notable rival is Wendy’s (WEN), which launched its own breakfast menu nationwide for the first the time earlier this year. It features a mix of salty and sweet items such as the Breakfast Baconator and Frosty-ccino.
Breakfast now accounts for 8% of Wendy’s total sales, and the company also launched a robust rewards program on its app this summer.

Meanwhile, the future of McDonald’s own All Day Breakfast remains hazy. The chain has not announced when or even if it will bring that menu back after cutting it in March because of the pandemic. The new sweets launching Wednesday might partially fill the void.

In the US, McDonald’s sales have finally turned a corner following a bleak spring. Sales at US stores open at least a year jumped 4.6% in the third quarter compared to the same period last year, the company said in a regulatory filing earlier this month. The company said it grew sales during “all dayparts,” an encouraging sign that it finally stemmed its declines during breakfast hours.
Sales improvements in the US were driven in part by “strong performance” at dinner and new items and stunts, including the Travis Scott Meal and spicy nuggets. This month, it hopes to replicate the success with a new J. Balvin meal — and now, new baked goods.

McDonald’s will release full third-quarter results on November 9.

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Tony Chung: Hong Kong activist detained near US embassy charged

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Hong Kong teen activist Tony Chung has been charged under a new national security law, just days after he was detained outside the US consulate.

Mr Chung, 19, had reportedly planned to enter the consulate and claim asylum.

The activist faces the possibility of life in prison if found guilty of secession, conspiracy to publish seditious content and money laundering.

Mr Chung, the second person to be charged under the law, was denied bail by the court.

The controversial law was imposed by China on Hong Kong in June, making it easier to punish protesters and reducing the city’s autonomy.

What do we know about his detention?

According to the South China Morning Post, Mr Chung was detained on Tuesday morning at a coffee shop opposite the US consulate.

UK-based activist group Friends of Hong Kong said he had planned to enter and claim asylum. Instead, footage taken from near the consulate showed him being carried away by plain-clothes police.

Mr Chung, who was a former member of pro-independence group Studentlocalism, said activists had not given up fighting.

“At the right moment, we will come out to protest again,” he told BBC Chinese in a recent interview.

“Yes we lose at this moment. But the road to democracy is always long.”

He will remain in custody until his next court appearance on 7 January next year.

What is Hong Kong’s new security law?

Hong Kong’s national security law was imposed by Beijing in June after months of huge pro-democracy protests last year against an extradition bill.

The new law makes secession, subversion of the central government, terrorism or collusion with foreign forces punishable by up to life in prison.

In July, several were arrested under the new powers, including a man carrying a “Hong Kong Independence” flag.

  • China’s new law: Why is Hong Kong worried?

  • UK makes citizenship offer to Hong Kong residents

The law gives Beijing extensive powers it has never had before to shape life in the territory.

Critics say it effectively puts an end to the freedoms guaranteed by Beijing for 50 years after British rule ended in Hong Kong in 1997, but China says it will return stability to the city.

After the passing of the security law, the UK’s Prime Minister Boris Johnson said he would offer up to three million Hong Kong residents a chance to settle in the UK and ultimately apply for citizenship.

China has condemned this, saying it would take countermeasures against the UK should it grant residency to Hong Kong residents.

Related Topics

  • Hong Kong national security law

  • China
  • Hong Kong

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AOC: ‘I don’t know if I’m really going to be staying in the House forever’

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President Donald Trump has taken particular pleasure in warning that Ocasio-Cortez poses a threat to Schumer, while describing prominent Democratic leaders including presidential nominee Joe Biden as beholden to her more liberal agenda.

Ocasio-Cortez is also viewed as one of the likeliest inheritors of Vermont Sen. Bernie Sanders’ progressive coalition if she were to run for president. The congresswoman, who endorsed Sanders in the 2020 White House race, turned 31 earlier this month and would meet the constitutional presidential age requirement of 35 by November 2024.

Another possibility is Ocasio-Cortez joining a potential Biden administration in some capacity. She was tapped in May to serve as a co-chair of the Biden-Sanders joint task force on climate change — one of six working groups meant to advise the Biden campaign on policy.

But Ocasio-Cortez told Vanity Fair she did not “want to aspire to a quote-unquote higher position just for the sake of that title or just for the sake of having a different or higher position.”

“I truly make an assessment to see if I can be more effective,” she said. “And so, you know, I don’t know if I could necessarily be more effective in an administration, but, for me that’s always what the question comes down to.”



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