The anthropogenic activities involving lead, mercury, PCBs etc prevailing in the country have been reviewed and compiled and presented at the World Congress of Mental Health (World Federation for Mental health), November 2-5, 2017 being held at New Delhi.

1. Anthropogenic Activities Involving Risk of Adverse
Impacts on Mental Health in India
By
Dr R S Mahwar, Environmental Adviser
Former Additional Director, Central Pollution Control Board
(Ministry of Environment, Forest & Climate Change), Govt. of India, Delhi
World Congress for Mental Health
November 2-5, 2017 , New Delhi

2. Traceability of Mental Health Impacts to Anthropogenic
Contaminants
 Anthropogenic (caused by humans or their activities).
 Needs of modern life styles.
 Emission of Contaminants.
 Impact of contaminants on all life forms.
 Impact of contaminants on human health.
 Contaminants having Impact on Mental Health (CIMH).
 Human exposure to CIMH.
 CIMH exposure history needs in mental health treatments.
 Questionnaire for obtaining CIMH exposure history.
 Identification and confirmation of CIMH exposure.

3. Contaminants having Impact on Mental Health (CIMH)
 Lead
 Mercury
 Persistent Organic Pollutants (POPs) : Resistant to environmental
degradation & bio-accumulate.
 POPs
• Twelve POPs ( also known as “The Dirty Dozen” )
• Pesticides (8): aldrin, dieldrin, chlordane, DDT,, endrin, heptachlor, mirex,
toxaphene.
• Industrial chemicals (2): Polychlorinated biphenyls (PCBs ) & Hexachloro
benzene (HCB).
• Unintended By-products (2) : Dioxins and Furans.

4. Health Impacts of Contaminants
 Lead
• Poor development/damage of the brain/nervous system(children).
• High blood pressure and kidney damage (Adults).
• No known level of lead exposure that is considered safe (WHO).
 Mercury
• Toxic to the central and peripheral nervous systems.
• Harmful to the digestive & immune systems, lungs and kidneys.
• Tremors , shaking, trembling.
• Numbness in the feet, hands, tongue and around the lips.
• Cognitive and motor dysfunction.
• Headache.
• Insomnia.
• Memory loss, neuromuscular effects.

5. Health Impacts of Contaminants
 Persistent Organic Pollutants (POPs)
• Neurobehavioral impairment.
• Endocrine disruption.
• Genotoxicity and increased birth defects.
• Short-term memory and spatial learning effects.
• Long-term effects on intellectual function.
• Increased cancer risk.
• Reproductive disorders
• Alteration of the immune system.

6. Lead Contaminated Environments
 Mining of Minerals.
 Metallurgical industries/Processes.
 Coal handling and Coal Power plants.
 Lead Acid battery manufacturing.
 Lead Acid battery/Lead Scrap Recycling.
 Lead Soldering.
 Lead Die casting.
 Lead Based paint/chemicals manufacturing/Spray Paining.
 Automobile Manufacturing.
 Metal surface treatments (Pickling/Electroplating/Galvanizing).
 Other heat treatment processes (shop floor) involving use of lead.

7. Used Lead Acid Battery Recycling

8. Lead Levels in Blood (Whole)
 NIOSH (US EPA)
• <60 µg/dL
 CPCB-India
• 10 µg/dL
• Persons with blood lead levels greater than 42 µg/dL to be shifted to non-
lead activity areas.
• Given special medical treatments.
• Not to be brought back in the same environment till the lead levels are
restored to the acceptable level of 10- micrograms /dl in the blood.

9. Mercury Contaminated Environments
 Occupational Exposure
• Mining of Minerals.
• Metallurgical industries/Processes.
• Coal Gasifiers.
• Coal based boilers
• Manufacturing, operation, maintenance and disposal of Button cells,
Switches, Relays, CFLs Thermometers, sphygmomanometer, etc.
• Production/use of Pesticides, biocides and topical antiseptics.
• Waste Incinerators.
• Cement clinker production.
• Production of cosmetics.

10. Coal Handling

11. Mercury Contaminated Environments (contd.)
 Non Occupational Exposure
• Fish consumption.
• Folk medicine/herbal remedies/cosmetics
• Fluorescent light bulbs.
• Religious practices (use in temples, sindoor etc.
• Broken thermometers & electrical switches.
 Take-Home Exposure
• Transport of metallic or inorganic mercury on shoes, clothes, skin, hair,
and tools into the workers homes or automobiles.
• Exposure to mercury in the children of take-home workers.
• Mercury found in clothes were storage and washing machines.
 Dental fillings and associated activities exposure.

12. Mercury Levels in Blood/Urine
 Urine (US EPA)
• <50 µg/L : No clinical or sub-clinical effects are expected.
• 50-100 µg/L : Some subclinical minimal effects observed.
• 100 -130 µg/L : Increased risk of subclinical and neuropsychiatric effects.
• > 130 µg/L : Increased probability of symptoms and signs of toxicity.
• > 200 µg/L : Reversible effects may progress to impairment.
 Blood (US EPA)
• 15 µg/L : No clinical or sub-clinical effects are expected.
 ACGIH * Biological Exposure Indices for Healthy workers
• Total inorganic mercury in urine (pre-shift): (35 μg/g creatinine).
• Total inorganic mercury in blood (end of shift or workweek): (15 μg/L).
(* The American Conference of Governmental Industrial Hygienists)

13. POPs Contaminated Environments
 PCBs
• Organic Chemical Industries.
• Paints Industries.
• Electrical equipment management and disposal.
• Re-refining transformer/lubricating oils
• Waste Incineration.
• Food (mainly fish), soil water and air.
 Pesticides
• Pesticide Industries.
• Agricultural Applications.
• Air/water/soil.
• Food.

14. Pesticide Industry

15. POPs Contaminated Environments
 Dioxin/Furans
• Waste incineration.
• Fuel combustion/burning.
• Metallurgical industry (sinter production, electric arc steel, secondary
lead, copper, aluminum).
• Mobile sources (mainly due to additives with chlorine).
• Open burning of wastes.

16. POPs Levels in Humans
 Dioxins
• Tolerable intake
 1 to 4 pg/kg body weight/day (WHO)
 PCBs
• Average concentration of total PCBs in human milk.
 0.5 to 1.5 mg/kg fat

17. CIMH Exposure History Needs in Mental Health Treatment
 Similarity in CIMH Impacts and Mental Problems
• Numbness in the feet and hands.
• Insomnia
• Tremors
• Unusual movements of body party.
• Memory loss, neuromuscular effects.
• Cognitive and motor dysfunction.
• Fatigue/Headache
 Risk of CIMH impacts mistaken as the usual stress induced problems.
 Treatment for mental ailments may be ineffective or aggravate the
problem.

18. Questionnaire for Obtaining CIMH Exposure History
Q-1 Working Environment Type (To be marked)
■ Mining ■ Metallurgy. ■......... ■........ ■......... ■
■........... ■.............. ■.......... ■........ ■........ ■........ ■ Others (to be described) ..
Q-2 Contaminant Exposure type (To be marked)
■ Lead ■ Mercury ■ Pesticides ■ Organic Chemicals (To be specified)...
Q-3 Total working hours Per day..............
Q-4 Number of years working in the same environment....
Q-5 Working Environment During the last 5 years.....
Q-6 Personal Protective Equipment used while on duty ....( Yes/No)
Q-7 Type of PPE Used (To be marked)
■ Gas Mask ■ Hand gloves ■ ......... ■.........
■......... ■........ ■......... ■ Others... (to be recorded).

19. Questionnaire* for CIMH History
Q-08 Change of clothes/shoes before and after the duty......... ( Yes/No)
Q-09 Taking bath after duty and change of clothes for going home.. (Yes/No)
Q-10 Change of clothes after returning home .. ...(Yes/No)
Q-11 Clothes washed separately .... ( Yes/No)
Q-12 Long leaves (more than two weeks at a stretch) taken in last one year...
Q-13 The persistence of the problem while on leave .... ( yes/No)
Q-14 Any similar symptoms before joining the present job... (Yes/No)
Q-15 Any other person in same job in the family or staying with..( Yes/No)
Q-16 Any of the family member having any chronic disease .. (Yes/No)
* In case of college students working in the laboratories the
questionnaire to be completed accordingly. And in case of children the
questionnaire will be relevant if any of the family member is working in an
environment involving exposure to CIMH.

20. Identification and Confirmation of CIMH Exposure
 Review of the CIMPH History
 Further investigations in case of suspected CIMH exposure
 Blood /Urine tests for suspected contaminants
 Patient to be advised to take all precautions for preventing further
impacts or even to change the job depending upon the gravity of his/her
condition.
 Further treatments based on the findings
 Special Attention – The contaminants whose impacts on the human body
may also result into phobias
• POPs are carcinogenic and the long term exposures may lead to cancers
• Long tern effects of Arsenic specially skin lesions and hard patches on the
palms and soles of the feet
• Long term effect of Selenium (redness or even blood coming out of nails)

21. Thank
You