Episode 03 : A Perspective on the state of Mental Health in India

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Episode 03 : A Perspective on the state of Mental Health in India

We are in conversation with Pratika Khandelwal, the Co-Founder & Chief Executive Officer of Felicity, a startup focused on mental health and well-being. Listen to her sharing insights on the state of mental health in India and describing her entrepreneurial journey with a cause.

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Voice Over

You’ve tuned in to Badlaav for better. A podcast by B Medical Systems saving lives through reliable and innovative technology hosted by Jesal Doshi.

Speaker- Jesal Doshi

Hello and welcome to our new episode of Badlaav for Better, which is our attempt to make changes in the Indian healthcare system for the positive through small conversations that can have a ripple effect.

 Today is a very special episode for us because we are going to talk about something which is an integral part of each and everyone’s life yet taboo at times, and that’s mental health. Today, we are pleased to have Pratika Khandelwal with us. Pratika did an MBA in human resources from XLRI Jamshedpur and subsequently worked with several corporates including HCL Technologies and Robert Bosch before finally joining an Ed-tech startup in 2015. And after 3 years in a business leadership role. She started something completely unique and something which is, in my opinion totally unrelated to everything else she had done before, which is a startup focused on improving Mental wellness called Felicity.
Felicity, as it reads, looks at, making the world a happier place. Pratika, thank you so much for joining us. It is really an honour to have you here.

Speaker- Pratika Khandelwal

Thank you, Jesal, for having me here and my congratulations to you on starting this amazing podcast, that really brings to the fore, lot of very important, pertinent topics for us as a society. So, thank you having me here.

Speaker- Jesal Doshi

Thanks Pratika. So first of all, you know I mentioned in the introduction, you’ve done a wide variety of things and then suddenly out of nowhere you started felicity. Which, if I understood correctly, Felicity means state of joy or happiness.

Speaker – Pratika Khandewal

That’s correct.

Speaker- Jesal Doshi

So can you tell us why what caused you to take the plunge to not only have your own startup, but also on focused on something which is, I would say, maybe not as taboo today as it was before, but certainly taboo back when you started it, which is a mental health. So please tell us why you started Felicity and how did that happen?

Speaker- Pratika Khandelwal

Sure, I guess, I get asked this question very often, why did I start Felicity? I think the idea of starting out on my own was seeded sometime in 2015-2016 when I joined a startup. That’s when my journey with startups began. And I learned the whole orchestra that goes behind the running of a startup. You know this demand side, the supply side and the idea was that, you know, I could do it on my own as well. So I spent 3 years working in the startup and, with a very clear understanding, I left the company that I’m going to now start out on my own. I was exploring ideas.

I have an MBA in human resources, so it’s giving me a lot of exposure to psychology. So, when you say cognitive behaviour therapy and LP debt, it’s not Greek to me. I’m not a psychologist by any stretch of imagination. But there’s a lot of background, and in my decade long work experience, I always felt. That there was such a void that existed when it came to emotional support systems because I had a background in human resources a lot of times, I saw people turning to HR folks for that kind of support and we did not have the required training at the required skill set to be able to provide that kind of support. That’s a different profession, altogether, so I always felt that that void existed, I very strongly feel that as human beings we evolved to survive the African savanna. So, you know when something happens in the bushes, for example, if you’re living in a jungle, it could mean a predator in the bushes, right? And something happens in your body.

On a biochemical level to alert you to that danger. The environment has changed. Bodies have not yet evolved further. So, you we are living with traffic horns. We are living with push notifications and those things are happening on a biochemical level. So, I strongly feel that as people we have heightened levels of stress and anxiety as compared to our ancestors. And a very big reason for that is simply the change in the living environment that has happened. While the, most of the products that come out most of the businesses that are set up, they are set up to optimize for creature comfort.

To make human lives physically more comfortable in any manner, and I felt I wanted to optimize for mental well-being to make people happier because at the end of the day, that’s the only true barometer of a good human life. So that’s where the idea came from. And I came in contact with,3 very senior doctors in 2019, Dr. Amit Desai from Jaslok hospital, Dr. Shubha Thatte, who’s our advisor to date, she has 50 years of psychology experience behind it and Dr. Bhimsen Singhal, he’s a Padmashree winning neurologist, and all 3 of them spoke to me about how mental health was becoming the silent pandemic.

Nobody was talking about it. You know, you read all the statistics about 1 in 8 people globally living with a mental health condition. But that doesn’t even scratch the surface when it comes to non-clinical stress and anxiety. So, you know that’s where the idea was seeded, that this is something that we should do. And I got around to starting Felicity.

Speaker- Jesal Doshi

Fascinating. And it’s really interesting to see how you started off from your experience in the corporate world. And you realize that you know, mental well-being is an issue there and how you kind of use that to actually do your own startup. So, one of the things that my listeners hopefully are getting used to is getting some recommendations from you. And based on what you just said about the African Savannah and how humans are actually programmed to be in that Savannah, I think a fascinating book on that is “Sapiens” by Yuval Noah Harari. And so for all our listeners, if you have the time and the patience this book does not need anymore recommendations. But I would strongly recommend it.

Another aspect that you mentioned is about, you know, being alone as well as mental Wellness. And recently the US Surgeon General has released a report which talks about loneliness being the new pandemic in the US. So clearly what you’re doing, I think,  is the need of the hour, not just in the US but also in India.

Now for our listeners and our listeners are very broad based. You know it is somebody listening in a village right to the senior most bureaucrat at the Ministry of Health.

So wide variety of listeners. But I think one of the questions that would interest all of them is really understanding what exactly is mental health and wellness. Can you tell our listeners what is your understanding of that?

Speaker – Pratika Khandelwal

Sure. I think that’s a good starting point for our conversation. Mental health is a word which is very loosely thrown around. It’s become part of our public discourse. A lot more. It has moved few inches from the fringes to the mainstream. As simple as it sounds, often people have a very narrow and limited understanding of what mental health means. It very simply is how you feel mentally on a day-to-day basis. Obviously includes absence of any kind of clinical psychiatric disorder, psychosis or clinical depression, or clinical anxiety, but that’s not it. Mental Wellness goes beyond just not being clinically ill. It is not just about surviving; it is about thriving. It is about excelling. So, a lot of emotions that we experience on a day to day basis, be it stress, anxiety, sleep issues, relationship issues. All of these constitute your mental health, so it could not be more wrong to say that if you don’t have a clinical disorder, you’re absolutely fine. You don’t need any kind of support.

Loneliness, like you mentioned, it has become indeed a pandemic. You might not have anything clinical going on in your body. But you are not able to engage with life. You’re not able to operate at your maximum potential. And that is not sound mental health. So sound mental health is when you can engage with life when you’re able to operate at your optimum potential levels, you know, you are there in terms of energy. You are there in terms of focus. That is what mental health is. So the moment you broaden the definition, almost everyone on this planet could use some help with their mental health.

Speaker – Jesal Doshi

Indeed. And it’s a very important point that you touch because you know sometimes a lot of us have this policy, that mental health is an urban issue or it’s an issue of the West.

Speaker – Pratika Khandelwal

Right.

Speaker – Jesal Doshi

You know, it doesn’t affect us in India or in other developing countries where we have many other things to be to worry about. But what you’re saying is actually quite the opposite, which is you need to be able to perform at your best, and you need to be able to feel that you’re at your best every single day.

Speaker – Pratika Khandelwal

Right.

Voice Over

You’ve tuned in to the 3rd episode of Badlaav for Better, an Indian healthcare story.

Speaker – Jesal Doshi

So just kind of based on your experience now of running Felicity for several years, a question just came to my mind based on what you said that.

You know, is it an issue or a real issue for, let’s say a housewife in a remote village in Bihar, as an example versus, you know, a housewife or a business person living in Mumbai who’s making millions of rupees, right?

How do you look at both of these scenarios and maybe?

First question is, is it an issue for both of them?

Speaker- Pratika Khandelwal

For sure. I’m glad you brought that up. I would like to share a little anecdote here. So the first client ever that we acquired that Felicity was a housewife from Bihar, incidentally.

Speaker – Jesal Doshi

Wow !

Speaker – Pratika Khandelwal

Ah, yes, from a small town, not even from Patna. And she reached out to us for marital counselling. Now all our whiteboard assumptions were thrown out of the window. You know, when we were working on the product, we really visualize our clients to be more urban. You know, we saw them as individuals living in Metro City, speaking English, aware, well-read, well-travelled.

But we couldn’t be more wrong, she knew that counselling as an option, marital counselling, as an option existed and she was open to the idea of seeking help and we connected her to a psychologist based in South Mumbai, educated in the UK.

Now this is something, this kind of help. There’s no way she had access to in her own vicinity. It is impossible for her to find that help here. And that’s the day when we found that product market fit and we said OK, we are solving for access.

You know, there are so many people who are not able to access the right help because of where they are based or not being aware of their options. And this is precisely what, we were able to solve for this lady today, 40% of our clientele comes from smaller towns. We offer therapy in all regional Indian languages in addition to English.

And it is something that, really has a lot more scope, so we also get rural crowd lot of times because we offer therapy in regional Indian languages and I just think that I’m very glad to see that kind of awareness and they are at least trying to get a second opinion. Typically, it’s very common in rural India for people to directly go to a psychiatrist.

Most people don’t know the difference between a psychiatrist and a psychologist. Be at rural India or even urban India. Psychiatrists directly medicate. They are not trained on therapy. Psychologists are trained on therapy. A large number of cases can be handled with therapy before getting into medication. Of course, there are cases that require medication and pharmacological support where they are relevant. But lot of times it is not essential and there is a lot of abuse of this medication in our country. It is very casually getting prescribed.

I have seen so many people come to us from villages where they’re on such heavy doses that it is very hard for our doctors also to kind of taper them off because getting them off such heavy doses has severe side effects and you know they need to be !! There needs to be someone who needs to physically monitor them during that period.

So had this not happened?

Had they reached out to us earlier?

Had we existed earlier? P

Probably the person had a better shot at getting the kind of help that they really needed, and things wouldn’t have really reached this stage.

Speaker – Jesal Doshi

So, you know, you spoke about the difference between a psychiatrist and a psychologist. To be honest, I did not know it myself. So, I think this is not very common and I’m sure our users, our listeners are getting a lot of insights from this. Can you highlight for our listeners what are some of the common issues if you do spot any trends, you know, what are some of the basic issues that a lot of potential, a lot of people face?

Speaker – Pratika Khandelwal

I think, 70% of the times people reach out to us for issues like anxiety, stress, depression, relationship issues, self-confidence and sleep issues. The remaining 30% top of it would be conditions like obsessive compulsive disorder, ADHD -attention deficit hyperactivity disorder, grief, loss, trauma and then lot of others, you know, on the psychiatric spectrum. So, but the big thing here is that 70% of the issues are around these and a lot of times they can be handled with counselling alone and little bit of work with mindfulness and CBT and people start feeling better within a span of one month, so these are the issues. I would also like to maybe share some demographic details. We get a lot of young adults, adolescents who reach to us, there are so many people reaching out in the age groups of 15 to 18 with concerns like self-harm.

We also work with universities where we’ve built a product for universities to identify early signs of self-harm, so they are able to nip things and the bad and we started working with the university on 15th of March and till date we have had more than 50 cases of self-harm detected. You know where people have a strong urge to harm themselves, you know, which could sometimes it is very active suicidal ideation. Sometimes it is an urge to otherwise physically harm themselves so.

I think that is a very, very common problem among the youth of this country. This was an eye opener when we started working with universities and this product came into being every day for one university ,we report at least 3 self-harm cases, people who are very close to harming themselves, so immediately it is notified to the university and they are able to take proactive action and manage things there. So, I think that is also a very big issue in our country. India has the highest suicide rate among the youth anywhere in the world.

Speaker – Jesal Doshi

You know, talking about this reminded me recently. I was listening to the principal of one of the most prominent schools in Mumbai. And he was saying that a lot of 8, 9 and 10 grade students have suicidal tendencies. And these are students coming from very nice families, good backgrounds. You know, money is definitely not a concern. Were probably travelling every summer abroad for a vacation, so on the periphery you would think that life could not have been more perfect for these kids.

Speaker – Pratika Khandelwal

Right

Speaker- Jesal Doshi

And yet you do see these issues. So indeed, I fully agree with you that this is a very real issue coming back to some of the common issues you mentioned, I’d like to focus on one of them, which is sleep.

And why?

Because I was talking to my colleagues at the workplace. And these are guys in their late 20s. You know, enjoying life. Having no real issue as such, but not being able to sleep well. And it kind of got me curious and start wondering that why is this such a big issue?

So, could you, could you give us a little bit of insight around this specifically?

Speaker – Pratika Khandelwal

Sure. I think sleep is a very, very common issue. Like you said, right. And it comes from a place when it comes to the corporate client. Like I was talking to one of our corporate clients, the CEO of this company and she specifically came to us with the use case. But I have a very young crowd in my company. These guys, they glamorize to grind, you know, they think it’s really cool to be in office till 10:00 PM and then go out drinking, have a party and then, you know, not sleep.

And they have disrupted their sleep patterns so much already, and they don’t realize it. Right now, the body is able to take it. But how it’s going to hit them over a period of time. So I think when it comes to sleep, one of the biggest contributors to disturb sleep according to me is obviously the screens that we all carry in our hands, they’re enough in more studies talking about the blue light and what it does, how it disturbs the entire rhythm of your body.

So, you know, there’s a very interesting book because you spoke about recommendations by Dr. Matthew Walker. It’s called “Why we sleep”. It became very popular when Bill Gates read it and recommended it on social media, a lot of people went ahead and read it

So, he gave some very, very powerful insights and some small little things that can matter. For example, he talks about not using a mobile phone 2 hours before your bedtime, and when you wake up right after that, start staying in dim light. You know, our post, say 6:00 PM in the evening, so naturally I try to align your body to the circadian rhythm. So that all is completely disturbed. Earlier people used to rise with sunrise, and they would kind of go down with the light.

But our lifestyles have changed. That is a very big contributor to disturbed sleep. Heightened levels of stress and anxiety , there is a direct correlation. If there is a lot of anxious thoughts in your brains, you are overthinking everything.

You are not going to be able to slow your body down and bring it to a state of rest. So that is also another very common contributor to disturb sleep. And I think generally, the importance of sleep is not very well understood. I think. You know we’ve all been there. Like I always thought it.

It was not very cool to just go to bed at 9:00 PM, but it is actually a very wise thing to do if you want to improve your overall quality of life. So yeah, there’s all these factors have contributed to disturb sleep in humans.

Speaker – Jesal Doshi

So you would say if somebody is having sleep issues, they should stop using mobile at 7:00 PM and go to bed by 9

Speaker – Pratika Khandelwal

Well, it’s not my…….

I’m not an expert, but lot of experts have spoken about this that the blue light or the rays that come out of these devices, they really hamper, you know, sometimes it is also how melatonin is generated in the human brain. And that’s why they affect sleep adversely. So, there’s a lot about sleep, right. There’s REM sleep. There’s what?

And it’s directly linked to even creativity and how you perform. So, in this book, Dr. Matthew Walker talks about, you know, a particular US school where the grades suddenly went up when they started….

The start time was pushed to say 10:00 AM instead of 8:00 AM because the early morning sleep was very important. It was really….

It’s like food for the brain, you know, sleep is something that really helps you rejuvenate your mind. And suddenly the student grades shot up. So that’s how deep the link is. So, I’m sure it’s the same with mobile phones.

Speaker – Jesal Doshi

That’s fascinating, and I hope that we have some listeners who are running schools or involved in running of schools and they take this advice to heart. So if there is anyone out there who is actually planning to change, please do let us know and reach out to us and especially to Pratika

VOICE OVER

Aap Sun Rahe Hain Badlaav for better, a podcast by B Medical systems saving lives through reliable and innovative technology. Jesal Doshi Dwara hosted.

Speaker- Jesal Doshi

Just going back to something you mentioned earlier about this housewife in Bihar, who was suffering from marital issues and needed counselling.

I mean, you mentioned there was a psychologist in South Mumbai. It’s phenomenal that you’ve created that kind of access which would have never been possible without technology.

But in addition to access, there’s also in India question about affordability.

Speaker – Pratika Khandelwal

Right

Speaker – Jesal Doshi

….which is a very real question for the vast majority of us.

What is your take on that in terms of how affordable, let’s say, you know, I am somebody living in a Tier 3 city.

And I realized that yes, you know, I’m not performing at my best. I stress, anxiety, sleep issues, OCD as you mentioned. But how affordable practically is it for me to actually get some counselling or treatment for that?

Speaker – Pratika Khandelwal

I think that’s a very valid point. That is something that we have to solve for as a country. So, to just give you a perspective, offline therapy is a lot more expensive if you go to any major city psychologist for an in-person session would charge anywhere between 1500 to 5000 bucks and it could be even higher if you go to South Mumbai.

When it comes to online sessions, it’s slightly cheaper. So, the way we are solving for it as an organization is that our value proposition to our psychologist is the volume, right.

So, when they are practicing privately, when they have their own practice, they’re heavily reliant on word of mouth, so they cannot release scale their practice to that extent, today we have psychologist who have clienteles to the size of say 700 unique clients with Felicity, there’s no way they would have been able to do that on their own because they are very reliant on word of mouth. They don’t have a client acquisition strategy in place, so we tell them that we’ll give you the volume. You know, you work at a lower cost per session. But you, whatever, you do not make in terms of per session amount that is compensated with the volume of sessions that you’re able to do so lot of them, what they land up earning with us is more than what they would earn with a full-time job or 48 hours a week with lesser hours. They’re able to earn a certain amount of money. It is because we have an algorithm that matches the supply with the demand. So, every time there’s a user, the therapist database is scanned. You know the algorithm does a matching based on what the user is seeking help for that is the time and everything, so that’s how we are solving for it. But having said that, we still have a long way to go.

It is not possible to retail therapy sessions, for example, that 200 bucks. You can’t do that. You know you have to be fair to the profession as well, that would not fly. I think the larger ecosystem has to solve for it coming from the place of, for example, insurance providers.

So, we had a landmark legislation, mental Health Care Act of 2017, that came out. I really think that it was very refreshing to see such a legislation getting enacted in our country.

What that does is it creates a framework for care of people who need this kind of help. So umm, it has to come from that place. You know, insurance providers need to be onboarded.

Government needs to allocate budgets, right?

 I’ll tell you, I’m a startup today. There are so many schemes, you know, for example, for manufacturing startups, right? Where you know, it could be in terms of funding. It could be in terms of connections able to govern bodies and everything. But there are not so many schemes when it comes to mental wellness. We can provide very affordable support, but we need the environment, the infrastructure to be able to provide it, the connections to be able to provide it.

So, I think on a macro level that needs to be solved for sure and that’s how we will solve for the pricing because fact of the matter is there is a dearth of professionals in our country, you will read a lot of statistics around how there’s one psychologist for so many 1000 people available in India. So, we have to solve for it also from the point of view of ensuring that more and more graduates come out every year, we establish universities. They are more degree courses around psychology. There are more training institutions. A proper framework is defined and that’s how we’ll be able to solve for it.

Speaker – Jesal Doshi

So I….

What I find really fascinating is, you know, for our listeners, this was supposed to be understanding more about mental health. But it’s also a lesson in how to run a startup, you know, now you spoke again about customer acquisition cost.

And…

And  it’s really refreshing to see, you know, putting all of these terms into action, right? Because you learn a lot about these in Business School, but you’re really looking at it and running a real business at this point. I’d also like to make special mention and a shout out to Mr S Gopal Krishnan with the special Secretary of Health and the Ministry of Health. Prior to this, he was at the Prime Minister ‘s office as a joint secretary.

He is particularly interested in improving mental health and I would like to make a shout out that here’s a young lady who is actually doing a lot to improve mental health and she’s made a very valid point, Sir, that we should look at some sort of incentives for mental wellness and looking at it to actually improve many, many future generations to come, so hopefully he will listen to this and there will be some positive news coming, just not your way, but also for improving overall mental Wellness in the country.

Speaker -Pratika Khandelwal

Thank you

Speaker – Jesal Doshi

I’d like to end with maybe just.

Some practical advice from you, especially you know, you spoke about mental wellness for the youth. Also 15–18-year-olds. And it is obviously of great but concern that we have so many youth feeling mentally unwell, not happy, stressed. So, what would be some of the practical advice that you would give out to such? I mean, and the youth in our country are in the millions. You know, what would?

You tell them how can they improve their happiness, their mental health, in practical in small, practical ways.

Speaker – Pratika Khandelwal

Right. It’s going to sound very repetitive, right, but essentially basics are the same, right? Take some time off your screens, maybe squeeze in 10 minutes of meditation or mindfulness practice in your day. Exercise, the signs of endorphins.

And all the other hormones, it is really real.

Make sure you stay connected with people. Try to forge real connections. As humans, we are social beings, so anything that we do, we need to share, we need to have deep, immersive experiences with other people. So, try to have a strong group of friends, a support system around you. You need these kinds of bonds to get through life. It’s not whatever you do in life, it’s really a solitary effort or endeavour. You are supported by a lot of people. You know, they are there for you when you need them. Sometimes when you might need to just brainstorm ideas. So, I think that staying connected, it’s great to read a lot of books.

There’s a lot to learn from people as well. Get out, you know, forge connections. Maybe establish communities, be very active in those communities, right. Like we try to do a lot of support groups for people. For example, all the people who have been through trauma, you know, getting into a support group together like an online equivalent of alcoholic anonymous. But that power of community is so strong when it comes to mental wellbeing, so I would really urge people to get all out, especially youngsters, and get connected with the world. Don’t just try to look everything up on the Internet.

And finally, I think, don’t believe everything that you think, lot of thoughts that come to you are not real. You are fed a lot of information, crazy amount of information on a daily basis. You know you’re absorbing a lot from social media, from different handles and what it is doing to you is that, it is trying to alter the way you think, alright. In fact it is trying to basically numb you to the extent that you don’t apply your own mind. You know, opinions are served on a platter, lot of things you read are not well researched. They are not edited you know because that’s the power of the Internet. Anybody can go and write anybody in there take, can go and write anything and they take us for it. So, I would just say that be very careful about your information sources.

And just maybe take some time off, try to have a structure routine goes the wrong way. So, when you wake up in the morning, if you have a day charted out that I’m going to do this and do that, you will realize that not just that they happen to be productive, but you typically have a higher sense of satisfaction.

At the end of the day, so this would be my advice and most importantly….and lastly, please seek help if you feel you’re struggling to manage by yourself. There’s a lot of help available. You know, do not be shy. Seeking help is a sign of strength. It’s not a sign of weakness. Don’t look at it as a personal failure of people who seek help, are smart, are intelligent, are very brave. Recognize when you need help and ask for it. You know, somebody just reach out, reach out, meet friends, meet family, meet an organization, a community. And you will feel, you will find, that there will always be someone there to help you. So that would be my recommendation.

Speaker- Jesal Doshi

And thanks a lot Parthika very, very practical and helpful advice. And on that note, we conclude today’s episode. We will be back soon with another very interesting conversation.

Till then, please keep listening to Badlaav for better, An Indian healthcare story.

VOICE OVER

You were listening to, Badlaav for better. An Indian healthcare story, a podcast by B medical systems, saving lives through reliable and innovative technology hosted by Jesal Doshi.

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