Narratives are the most powerful tools of our age. Each week, I deconstruct the dominant ones behind the success or failure of businesses, leaders and governments
Good Morning Dear Reader,
This week, writing coach Chip Scanlan compiled a useful list in his newsletter, Chip’s Writing Lessons.
He called it the ‘10 paradoxes of writing life’.
The fourth point, in particular, is a crucial lesson on narratives for writers and non-writers alike:
The power of a story comes from what’s not in it. Powerful writing demonstrates what Ernest Hemingway referred to as the “iceberg” effect: What is below the surface—the interviews, drafts, false starts—is the hidden source of strength. We write best from an abundance of material.
I would go so far as to say that omission is what differentiates a story from its primary raw material—information.
Advertisements, for instance, are often stories designed to omit everything about a product that the company does not want you to know—like, sugar being bad for health; or the polluting effect of traditional cars; or fast fashion’s exploitative labour practices. Narratives built for other purposes may choose to make different omissions.
However, every story (ideally) needs the storyteller to pick a single strand of thought or a combination of thought and emotion to tie together the information they want to include. What information isn’t included, is discarded. The result is a coherent narrative—and a story with a core argument that brings seemingly disparate pieces of information together.
Which brings me to another paradox that Scanlan includes in his list.
To tell a story of 1,000 words (or 100,000), you must be able to tell it in one word. Every story needs a single dominant message—a theme, defined as “meaning in a word.”
As we wrap up 2021, the second year of living under the shadow of a global pandemic, let’s look at an aspect of mental health treatment in India that is routinely omitted from the dominant narrative.
And the one phrase that captures the larger story for me.
Insurers aren’t really supporting mental health
A couple of things happened this week that put the spotlight on the recent state of mental health among Indians.
On Saturday, The Printwrote that 2021 was the year when mental health cases exploded in small-town India. And most of those affected don’t have access to professional help—many district hospitals in the hinterlands don’t even have a dedicated psychiatrist.
During the first wave, people who faced financial crunches, adjustment issues with the lockdown and interpersonal problems approached us, says Dr Ishanya Raj, a clinical psychologist at Motilal Nehru Divisional Hospital, Prayagraj. As a result, many mental health professionals came together and started tele-counselling. Central and state governments also started helpline numbers. “But the second wave was devastating. Patients had to be stopped from committing suicide. Many of the people approaching OPDs at district hospitals were desperate for help,” Raj says.
Which brings me to the second thing.
On Monday, the not-for-profit Suicide Prevention India Foundation (SPIF) and Wikimedia Foundation partnered to create a repository of mental health-related imagery. Their year-long initiative starts from this month and aims to leverage these visuals to reframe the narrative around mental health in India. The goal is to increase awareness, reduce stigma, bust myths, and encourage help-seeking.
Because there’s a fundamental problem at the heart of the mental health question in India—as we at The Kenwrote three years ago.
Conservative government estimates claim that nearly 15% of India’s adults are in need of active interventions for one or more mental health issues. And while this huge market of potential patients awaits these interventions, the supply side of the equation is horribly skewed due to a limited number of trained psychologists and psychiatrists. Access to mental health treatment is severely limited in the country, according to the World Health Organisation, with a treatment gap of up to 95.7% for depression.
There’s a twist, though. Because even when there is access to treatment, the stigma around mental health has prevented Indians from seeking care.
But Juno, and other startups such as HealthEminds and ePsyClinic which began with similar marketplace-based models, have been forced to rethink their approach entirely, scale down considerably, or become bootstrapped, respectively. They underestimated just how ingrained the stigma dogging mental illness is. Indians are still reluctant to take the plunge and get diagnosed, find a professional therapist, and open up to a stranger, however qualified. At least not en masse. Not yet.
A digital cure for India’s mental health crisis, The Ken
But a lot has changed over the last two years of the pandemic. Stigma and taboo are being replaced by awareness, and a desire to seek help has been normalised to some extent.
A survey conducted by non-profit LiveLoveLaugh on the knowledge, attitudes, and practices (KAPs) related to mental health found that 92% of those surveyed say they would seek treatment, and support a person seeking treatment, for mental illness. A significant jump from 54% in 2018. Similarly, 65% of respondents believe that individuals with mental illness could hold jobs and lead stable, healthy lives—more than double the 32% recorded in 2018.
A cofounder of a mental health treatment mobile app in India also told The Ken that app downloads, therapy sessions, and corporate partners have increased by about 10X during 2020 and the first half of 2021.
And money is following the growth in consumption. Indian mental health apps Wysa and Inner Hour raised US$5.5 million and US$5.2 million, respectively, in Series A funding rounds earlier this year.
That is not all. In 2020, the Supreme Court issued a notice to the central government asking it to direct insurance companies to provide medical insurance coverage for the treatment of mental illness. After all, a large number of Indians can afford such treatment only if their health insurance finances it.
All of the above have become an intrinsic part of the grand narrative—that mental health treatment is the new normal in post-pandemic India. It looks like a good, compelling story, doesn't it? The ‘problem’ is on its way to getting resolved.
There are 19 emails in my inbox under the mental health label that I received over the last eight months. Each of those are from companies providing mental health treatment and management options to their employees. And they all celebrate the recent progress.
But something crucial is being omitted from this mainstream narrative: A majority of health insurance policies issued by Indian insurers still do not cover the treatment of mental illnesses.
Last Wednesday, a The New Indian Express report summarised this concern.
“Earlier, insurance companies used to reject claims stating that suicide, alcohol and substance use, psychosomatic disorders, etc were excepted. However, the new Mental Health Care Act clearly stipulates that there should not be such distinction. The insurance companies are yet to follow this, citing that mental illnesses cannot be assessed using an external factor, like a laboratory cross-checking…,” says Dr Arun B Nair, psychiatrist from Thiruvananthapuram.
He added that there are two types of classifications to diagnose mental illness—International Classification of Diseases of WHO and American Psychiatric Associations’ Diagnostic and Statistical Manual. The psychiatrists diagnose the illness on the basis of these two classifications. So, the insurance agencies will have to hire an expert psychiatrist to determine mental health issues, unlike in the cases of other illnesses where a junior doctor can determine the type of illness. The cost of hiring an expert and the least chances of denying the claims might be discouraging the agencies to give reimbursement in the cases of patients with mental health issues, Dr Arun said.
Which brings us back to the first narrative lesson we learned this Friday: Omissions maketh the story.
The second lesson was that we must be able to tell a story in just a couple of words. For me, those words would be ‘silver lining’. Because despite mental health treatment still not being financed adequately, the pandemic has accelerated public awareness and increased the willingness to seek professional help.
But unless insurers start putting money behind the solution, access will remain limited to the few who can afford it.
Share this edition
That’s it for this week. Please let me know what you think about this edition by writing to [email protected].
Today is also the last publishing day of the year for The Ken. But expect more amazing newsletters and stories from the first week of January.
If you’d like to share this issue, here’s a link. You can also just hit the easy-share buttons below.
Have a very merry Christmas and a wonderful new year! And take care of your mental health over the holidays.
Yours,
Ruhi
Narratives are the most powerful tools of our age. Each week, I deconstruct the dominant ones behind the success or failure of businesses, leaders and governments
Enter the email address that you’d like us to send this payment link to. This could be your HR, finance representative, or anyone from your organization. A copy of this email will be sent to the team’s admin as well.
Email Sent Successfully
Corporate pricing applies to teams of 5 or more members only.
Thank you. We have received your request to post comments. You’ll hear from us soon.
Are you sure? Your subscription will expire at the end of your current subscription period.
The Ken has added you as a partner. Read The Ken as a couple. Sign in to get started.
T
The Ken has added you as a partner. Read The Ken as a couple. Sign up to get started.
Having your name allows us to address you personally in emails and on our website. That’s all, nothing else.
T
The Ken has added you as a partner. Read The Ken as a couple.
The Ken’s stories are available only for paid subscribers. As a partner, you can now access The Ken subscription. For free. Just activate your account to get started.
T
The Ken has added you as a partner. Read The Ken as a couple.
The Ken’s stories are available only for paid subscribers. As a partner, you can now access The Ken subscription. For free. Just activate your account to get started.
By registering, you will be signed-up for a free account with The Ken
Sharp, original, insightful, analytical
Alert
Our anti-piracy system has flagged your account for suspicious activity and has temporarily paused your account. This may happen due to a number of reasons.
If you think that this was done in error, please get in touch with us at [email protected].
Are you sure?
You will be changing your registered email address to access your account. All email newsletters will be delivered to the new email ID.
As a part of the Learning and Development program at Myntra-Jabong, you have complete access to 300+ original daily stories over the next year, 500+ previously published stories and our comment sections. Also, do keep an eye out for our exclusive subscriber-only iOS and Android apps which will be rolled out for you shortly.
Happy Reading!
By continuing to browse our site you agree to our use of cookies to improve our performance and enhance your user experience.
