Troubled Waters - MHI




Troubled Waters

Tales of Woe from the Kerala Coast

Dr. Manoj Kumar and Dr. Meena Nair


illustrator’s bio

Amreeta Banerjee

Alice A. Barwa completed her MA in Education from Dr. B.R. Ambedkar Univerity, Delhi (AUD), in 2022, and is from the Oraon Adivasi community, a native of Chhotanagpur Plateau, Chhattisgarh. She has been an advocate for Adivasi rights and voices as a member of an Adivasi youth collective @TheAdivasiPost, and has been an Adivasi youth representative at UN Climate Change Conference in Glasgow, Scotland, in 2021. Her research interests include education, culture, sociology, and linguistics.

The implications of climate change have not been lost on mental health professions. In May 2021, the Royal College of Psychiatrists in the UK called for international cooperation and urgent action by declaring a climate and ecological emergency. A survey conducted by the college found that as many of the UK public (84 percent) believe that climate and ecological emergencies will affect mental health in the next decade as they believe that unemployment (83 percent) and COVID-19 (84 percent) will. More interestingly, 60 percent of the respondents said that the climate and ecological emergencies are affecting their mental health now and will continue to do so in the future. Dr. Adrian James, President of the Royal College of Psychiatrists, said, “The climate and ecological emergency is a mental health emergency. Our mental health is entwined with the health of our natural world.”

Nowhere is this more starkly borne out than in Kerala. The past few years have seen Kerala being battered by torrential rains resulting in large-scale flooding. Cloudbursts causing landslides in the mountains of the Western Ghats have become more common. Farming, which has always depended on predictable weather patterns, has suffered as the previous patterns have become undependable. Needless to say, environmental degradation and climate change have come to the fore as yet another social determinant of mental ill-health. In the UK, flooding, which is the most common disaster, has been shown to be associated with anxiety, depression, and post-traumatic stress disorder (PTSD) in survivors and a similar picture has been reported in India as well. 

The big question is, like with all other social determinants of mental health, can we act to mitigate the effects of climate change?

This piece focusses on the work that MHAT (Mental Health Action Trust) has undertaken amongst a vulnerable group affected by climate change in Kerala. MHAT has been active in the field of community mental health for almost a decade-and-a-half, providing free, comprehensive community-based mental health services to people from socio-economically disadvantaged backgrounds. As we became aware of the disproportionate effects of climate change on certain communities, we decided to shift our focus to where we felt it is needed the most. We began to work amongst the fishing communities of coastal and inland Kerala. We were particularly interested in the problems faced by the women from these communities

Coastal communities

Globally, it is estimated that about 10-40 percent of the population lives along the coast, depending on the definitions. According to the National Centre for Coastal Research (NCCR), about a third of India’s coastline has deteriorated in the last 26 years.  At 590 kilometres, Kerala’s coastline is India’s sixth longest. For centuries, coastal communities have worked the seas, fishing and engaging in related maritime activities. This way of life is now threatened by climate change. Large-scale mechanised deep-sea trawling has resulted in severe depletion of fishing stock, affecting small-time fisher folk disproportionately. Depleting fish catches have pushed fishing communities into debt and poverty. The alarming ecological devastation of the oceans has caused governments to step in and restrict fishing activities. The unpredictability of weather has limited the days that people can venture out to sea. On shore, fishing-related activities that the rest of the community, particularly the women, depended on for a livelihood have come to a standstill. Rising sea levels and land erosion have led to the loss of homes. Subsequent displacement and unsatisfactory relocation have become major problems. Add to this the implications of the COVID-19 pandemic, and the cup of misery is full and overflowing. 

The full impact of the economic and social aspects of the COVID-19 pandemic on coastal communities is not yet known. Social distancing policies, lockdowns often enforced using drone surveillance, the fear of becoming sick, compulsory isolation and quarantine, and the resulting loss of livelihood and income have all added to the community’s woes. The longer-term impacts of these are unknown still. Do the above-mentioned developments hold well for the local communities? We dug deeper to find out.

Focus Group Discussions (FGDs) and key informant interviews

We held a series of recorded focus group discussions and interviews with women to understand the mental health issues faced by the coastal population. We were unprepared for the stories that emerged and found several themes repeating in the various groups. 

(Translated from the original Malayalam):

On coping with poverty

“We have been really affected by natural calamities in recent years and then in the last one-and-a-half years by the COVID pandemic. We are totally shattered now economically. Currently, we have no work. No income. We have tried several ways to earn a living through fisheries. But we have had to stop due to a series of issues related to that sector.”

“We lost our (sewing) machines in the last sea erosion and floods. We live only 50-150 metres away from the sea. Now we go to the harbour for work, but we get only a day or two of work in a week. At times, we collect fish from there, dry them, and sell them. But that only gets us very nominal amounts of money.”

“It’s entirely my headache, in addition to all the other issues. I am really fed up. We have no money to support even our children’s education. Some have switched over to catering activity.”

On displacement

“The sea wall is damaged and useless, hence there is no consolation; the sea will reach our kitchen any time, that is the situation. Since 2018, the situation has been very grave, but the issues started from (Cyclone) Ockhi and even after the tsunami.”

“Houses are getting destroyed due to the regular sea floods. We have no money to do proper maintenance, too. And we are facing the threat of evacuation also. The thought of displacement itself is driving us mad. We are in real tension.”

On loss

“We are ready to work and earn income for our family. We really loved the work we were doing. But our lives are shattered due to the climate issues and the Corona pandemic.”

“We lost all our documents. I was crying incessantly. Even before we could react, the sea would come inside our house. I was exhausted crying, thinking we will lose everything. What to do, isn’t saving our lives the most important thing?”

On the fishermen

“Our men are under stress and are totally hopeless. They have practically zero earnings. We are all under great stress.”

“Our husbands have no work now. They have got one or two days of work at the most all these months. They are also very disheartened and dull.”

“My husband is so dull these days. He will go to the sea and just come back without any catch some days. He comes home, just lies down on the floor, eats nothing, and won’t speak either. I am afraid he will attempt suicide. I try to console him but I am also disheartened. My father-in-law is having a loss of memory and he just goes out and gets lost at times. At times, he becomes violent, too. We don’t know what to do. There are other cases as well in this locality.”

On stress

“Regular flooding due to sea level rise, strong sea waves, and regular cyclonic attacks have made our minds so unstable. When the skies darken, so do our minds. The sea has become totally unpredictable.”

“We are suffering from constant headaches. Numbness in the head, burning, sometimes behind the head, sometimes on the top, icy sensation, backache, bleeding. Bleeding is very irregular these days. We are suffering from tension.”

“If it rains, I can’t sleep; thinking of the loans, I can’t sleep.”

“Our children are also disheartened and we are facing issues related to them also. We need outside support to deal with our children.” 

The FGDs gave the women a chance for mental and emotional venting. The fisherwomen, generally assumed to be resilient physically and mentally, presented a different picture when they were given an opportunity to share. In the majority of cases, the women, the beneficiaries of a specific benefit program from a government department, were the only source of income for their families. 

The FGDs revealed that the women are under extreme stress, which is manifesting as physical pain and symptoms — headache, back pain, excessive bleeding, loss of sleep, anxiety, dullness, loss of interest in continuing work even when no other choice exists, loss of hope, expressions of sorrow and anger, and ultimately, suicidal thoughts. At the end of the FGDs, many of them openly opined that they really needed mental health support. Many requested immediate help, too. 
At three places where the FGDs were held, the women pointed out the increasing rate of suicides in the area. In their words, the coastal societies are “on the verge of an explosion”. At one location, the women said that one in three households had had an incidence of suicide in the past two years. The women requested counselling and de-addiction treatment for their men and children, too, especially the adolescents. They want to move forward with their activities but at the same time, they seemed hopeless as well. The endless struggle has made them tired, both physically and mentally, they said. A few requested access to counselling services and a few broke down crying during the sessions. 


The FGDs confirmed that the fishing communities in Kerala are in urgent need of mental health support. 

Following the FGDs, we were able to set up 12 centres aimed at these communities with the support of Mariwala Health Initiative. The MHAT model is based on identifying local partners and working together with them in identifying beneficiaries and providing mental health care. Once identified, the local volunteers ensure continuity of care and act as care workers linking with the MHAT team. Weekly clinics are held in each area by a multi-disciplinary team from MHAT and domiciliary care is provided as well. The entire service, including medications, counselling, and other psychosocial interventions, is provided free of cost. Telemedicine (telepsychiatry) plays an important role here as does a task-sharing model. 


The MHAT model has evolved into a social developmental one, wherein the starting point is the whole community rather than the sick individual. Unless social development happens in tandem, isolated mental health initiatives will remain incomplete. Working together with partner agencies involved in social development work is important. Livelihood activities, supplementing education in schools, working with youth and women’s groups, looking after the physical health needs of the population, and dealing with substance use – all come under the social development ambit.


Climate change is here to stay. The resulting mental health impact is only going to get worse. Both mental and substance use disorders are significantly prevalent in coastal communities and demand immediate attention. Social developmental problems and mental ill-health are inextricably intertwined and need to be addressed together.

Cite this Article View all References


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E : Locating Adivasi Self within Environmental Jus...