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Section 2 - Access and Equity

India is one of the largest and fastest-growing markets for digital consumers, with approximately 700 million internet users across the country in 2020 and a projected growth to over 974 million users by 2025 (Keelery, 2020). Of those online, the majority connect using mobile devices and mobile internet, accounting for 73 percent of India’s total web traffic (Keelery, 2020). This rapid proliferation of digital access is helping to close the digital divide, with the potenal for full connectivity by 2025 (MGI-Digital, 2019). Moreover, it is reported that, in 2019, 294 million Indians engaged in social media, with the average user spending approximately 17 hours on the platforms each week, which is more time than users in China and the U.S. spend (MGI-Digital, 2019).

These stats are nothing short of astounding. With a country as digitally connected as India, it is reasonable to question the role of technology in helping individuals navigate issues such as loneliness and mental illness. By the numbers, India’s mobile penetration “effectively [is] an already paid for and developed health communications technology infrastructure through which a substantial proportion of India's future mental health services may be delivered” (Yellowlees and Chan, 2014). This includes the use of telemedicine and stand-alone mobile health applications for meditation, medical management, and interventions. For instance, Snapchat, in collaboration with the Mariwala Health Initiative and non-profit Manas Foundation, recently launched the “Here for You” campaign to provide resources to its users in India who are experiencing feelings of stress and anxiety during the pandemic (Gulfnews, 2020). As another example, in October 2020, Facebook launched Emotional Health, a resource center focused on delivering access to knowledge on baseline mental health conditions as well as crisis hotlines for suicide and other mental health conditions. In February 2021, the company will launch an updated set of content specifically for India in partnership with It’s OK to Talk; Live, Love, Laugh Foundation; and iCALL / Tata Institute of Social Sciences. Despite an increase in the number of people connecting to the internet, access remains one of the largest hurdles to care. According to reports from 2018, for every one million people in India, there were only three psychiatrists, and even fewer psychologists, available for treatment or counseling (Vivek N.D., 2019).

It comes as no surprise then that the discourse around the role technology plays is in its ability to connect and bridge the gap, par-ticularly among rural communities, which comprise approximately 66 percent of the country’s total population (World Bank, 2019) and where mental health resources are limited. Experts consider the proliferation of digital technologies as one avenue to realize the as-pirations of India’s National Health Policy, which aims to attain the highest possible level of health and well-being for all at all ages and universal access to good quality health care services at little to no cost (Singh, 2017). Yet, the challenge is not just in connecting the next one billion users, but guiding the design of technology and its potential influence on an individual’s mental and psychological state. This includes, as experts highlighted, the ability of technology to facilitate deeper meaningful connections with others, as well as provide a space for self-actualization.

Experts from India were also quick to delineate the differences between social media and tech in general, suggesting that research not conflate the two. As Sairee Chahal, Founder and CEO of Sheroes, points out, “Currently, the whole therapy ecosystem is segmented and only available to certain pockets of society. Tech makes this easier, more available, and simpler.” Sugata Srinivasaraju, a bilingual journalist, author, and columnist, highlighted that social media, on the other hand, “creates a binary world made of one-dimensional choices and assumptions about your life. It creates ‘approval gangs,’ not actual communities.” While these critiques reiterate previous discussions, it remains unclear whether there is a causal link between the effects of technology, particularly social media, on feelings of loneliness. Specific to India, a 2017 study on patterns of Facebook use in post-graduate students in the southern part of the country found that loneliness correlated with the severity of problematic use of Facebook (Shettar, et al., 2017). While studies such as this are necessary to understanding effects of technology on loneliness, there is a clear imperative for further study, investment, and collaboration between industry and researchers. However, in contrast to our discussions with experts from the U.S. and UK, the tone during these dialogues in India leaned more toward optimism, especially for the role technology can play in facilitating access to mental health resources and aid. Neha Kirpal, co-founder of Innerhour, points out, “To be able to own and talk about things, to find communities both online and offline, is a function of both vocabulary and connection but also about safety. Why can’t we explore those spaces on a tech-platform? And if so, then what are the opportunities.”

In addition to access, concerns around equity and inclusion were again key discussion points. As several experts commented, the priority for most Indians is to address basic needs, such as putting food on the table, not the individual issues of mental health. Noted above, loneliness remains less socially accepted in India and is interpreted by some to be a concern only of the elite. “The pandemic has taught us that the people who suffer most are those who suffer from social inequity. In tech and in social media, there is a huge amount of people for whom the problem is not loneliness, not that there isn’t enough connectedness. The problem is with social inequity,” emphasized Alok Sarin, Psychiatrist at Sitaram Bhartiya Hospital. Again, we invoke the question, whose loneliness matters—only this time, we apply it to the systematic and discriminatory structures within India.

Shrinidhi Deshmukh, Program Associate of Disability & Mental Health at the Raintree Foundation, summarized it best:

Is loneliness a product of the systems around us, which can be exclusionary to so many people? And if loneliness is also about skills, for example understanding how to deal with concerns around mental health and how to cope, then are these skills also built as a part of or as a result of access to the privileges that we have?

Access to the technology, services, resources, and experts is only part of the equation. To truly serve those in need, lifting the burden of systematic discrimination is critical and requires further attention by a variety of stakeholders, including private industry, government, civil society, practitioners, etc. The experience of loneliness may not be clearly defined or even fully recognized throughout India, but efforts to connect its prevalence, associated risk factors, and potential psychiatric comorbidities should be pursued in earnest. Most importantly, this pursuit must be centered on the most vulnerable populations in order to develop equitable and inclusive interventions.

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