I can’t call you

The mental health challenges of the current Covid-19 pandemic are formidable. The media is awash with articles about the effects of isolation and quarantine and how we should keep ourselves mentally robust during this difficult time. Suicides related to Covid-19 are occurring around the world, including in Bangladesh.

In response to this crisis, both physical and mental health services have moved to phone and online-based modalities. These options are well-established as important mechanisms for addressing psychological issues during natural or manmade crises, with the Covid-19 pandemic as no exception. Indeed, for this crisis, the phone makes more sense than ever before, as it allows people to get help while maintaining social distancing. In Bangladesh, options for tele-health and tele-counselling have rapidly increased in the past few weeks. Across the world, crisis helplines of various kinds are reporting surges in the calls and texts they are receiving.

But this might not be the case in Bangladesh, as I illustrate below, and I would encourage mental health service providers (especially those who are now focusing their services into being more phone-based) to consider why.

Kaan Pete Roi (loosely translated from Bengali, it means "My Ears Wait to Listen") is the first and only suicide prevention helpline in Bangladesh, and is staffed by trained volunteers. Kaan Pete Roi (KPR) follows the model of Befrienders Worldwide, a global authority on suicide prevention. This model espouses the use of compassionate, open-minded listening to prevent suicide, with the majority of this listening taking place over the phone. Since its inception in 2013, KPR has received over 20,000 calls.

As of the middle of March, coinciding exactly with the coronavirus lockdown, Kaan Pete Roi experienced a sharp decrease in calls, by almost 60 percent, and has stayed low in comparison to the standard average call rate of the past several years. To try to understand why this might be, the KPR administration ran a simple, two-option poll from its Facebook page, asking the following question (translated from Bengali): "I'd like to get help from KPR, but I can't. This is because: 1) My circumstances at home don't allow me to talk or 2) I can't add credit to my phone." As of the time of writing this article, two days after this poll was published, this poll has 187 responses, with 96 for the first option and 92 for the second—essentially, an almost even split between these two options.

I would encourage mental health providers to consider these points while they are providing health-based services (of course, these are not the only factors that will affect the ability to make a call—but they are a good starting point!). First, privacy, or circumstances at home—everyone is stuck inside their houses right now. For the vast majority of families in Bangladesh, this means there is no privacy to make a phone call—much less a sensitive phone call to a mental health hotline, to discuss their mental health status. Enough space, or the social circumstances to make a private phone call inside the house, is an extreme luxury in Bangladesh.

Second, the ability to add credit to phones. I've heard many cases already of people who would normally recharge their credit by handing their local shopkeeper some cash on the way to work or school. Now that they're not leaving the house, it's much harder to do so. Even if they do leave the house for essential errands, the agents who assist in recharging credit aren't always there, so they have to go further than planned. It's an immediate, clear logistical problem—one that I'm surprised hasn't been directly addressed by mobile companies already.

It is also extremely important to note that these issues will vary based on demographics. Notably, the gender breakdown for the respondents of the above poll differs. Of those who say the circumstances at home are the problem, 56 were male, and 40 female. Of those who say that recharging their phones were a problem, 66 were male and 26 female. Women are more likely to have caretaking and domestic responsibilities inside the house—a greater burden on their time and privacy; indeed, of the 66 female respondents to the above poll, 60 percent report home circumstances as being the issue.

There are several services providing tele-counselling and tele-health in Bangladesh now. For those of us working in this sector, it's important to keep barriers to reaching services in mind. To address privacy, the solution might be night-time hours of service provision (itself a logistical challenge on the provision end, of course) and chat/text-based options (we all recognise the increased privacy and ease of texting over a phone call). For the credit options, these services will have to be toll-free or as cheap as possible—an appeal to the mobile operators is perhaps in order here. 

As health service providers, we will rarely, in our entire lifetimes, collectively experience such a vast and extreme challenge to which we have to respond swiftly and decisively. There is one point I haven't mentioned yet—although calls to Kaan Pete Roi have decreased, actively suicidal calls have increased by 10 percent. People need our help, and they need it now. We have to make sure we can get it to them.

Kaan Pete Roi is an Emotional Support and Suicide Prevention Helpline. Trained volunteers provide emotional support through confidential, compassionate, and open-minded listening. Please call 01779554391-2, 01688709965-6, 01985275286, 01852035634, 01517969150, every day from 3pm–9pm, Thursdays from 3pm–3am. 

Yeshim Iqbal, PhD is the founder and director of Kaan Pete Roi.