In this guest article, Rajvi Mariwala, Director, Mariwala Health Initiative, highlights the need for an informed and holistic approach towards building mental health awareness, the need for integration of patients' views and emotions in the recovery process, and the need to develop and scale community-based interventions for capacity building.
Most articles on mental health in India quote statistics to shed light on the sheer magnitude of the issue, ranging from numbers of persons with a particular mental health issue to the ‘treatment gap’ i.e. lack of supply of mental health professionals (MHPs). The numbers frame the dominant approach toward mental health, which is that demand for mental health services outstrips supply of qualified experts i.e. psychiatrists or psychologists. These practices are top-down, based on an expert diagnosing a solely bio-medical illness that may require medication. Apart from a scarcity of MHPs, there’s a paucity of information on the type of MHPs one can consider for different issues as well as lacunae in policy.
Need for a paradigm shift
To tackle the mental health crisis in this country, there needs to be a paradigm shift in how we view mental health. Critical to raising awareness around mental health is the idea that mental health needs to be viewed as psychosocial rather than a pathologised condition. This means that one must question a narrow definition of mental health and instead see it as a spectrum, ranging from well-being to a common or severe mental health disorder. It also necessitates an intersectional approach, indicating systemic and structural barriers all contribute to an individual's mental health.
Many studies have shown that marginalised communities are more susceptible to mental health stressors. Hence, mental health needs to be understood keeping in mind structural inequalities across caste, class, ability, gender and sexuality
There is pervasive stigma and silence surrounding mental health issues which affects awareness, access, provision and, efficacy of mental health services. Many individuals living with mental health are labelled when unable to pass as ‘normal’ and can be invisibilised and isolated within their families, schools and most public institutions.
Human rights issue
For those who can access professional support, there is lack of not just informed consent, but also, knowledge about options and their rights. This puts the sector of mental health squarely in the realm of being a fundamental human rights issue, not just in terms of access, but also in terms of lack of focus on the user. Thus, efforts at awareness and access have to be mindful of not just systemic oppressions but also centre agency and consent of persons with mental health issues or disabilities.
This means that individuals must have a say in their health care, not just doctors who enforce a certain authoritative, and impersonal, recovery model. The focus should also be on social environments; on how to embrace people with a variety of mental health needs.
Policy changes required
Policy changes are required in all public institutions, ranging from mental health institutions to educational systems and curricula, work spaces, and public spaces. These challenges can be addressed by approaching mental health as an ecosystem involving multiple stakeholders, challenging systemic barriers and privileging the voices and concerns of those with a variety of mental health concerns.
We need to build a network to improve access and a multi-pronged strategy that devises interventions for people at multiple levels of grassroots, programming, advocacy, and, policy making
The Mariwala Health Initiative (MHI) uses such an approach as a cornerstone and aspires to create a holistic and universally accessible mental health ecosystem by funding mental health organizations that work on innovative, community-based interventions targeting the most marginalized of populations. We hope to enable a wider and deeper awareness of mental health concerns and support quality services as well as ongoing research. MHI is also looking at mental health as an asset by working towards capacity building for individuals, organizations, communities, and institutions through training, network building, and knowledge sharing.
Focus on marginalised communities
Currently, our focus is on community-based interventions that are based within marginalised communities and where services are not delivered by just experts but also by trained individuals from within the community. This service delivery mechanism not only builds capacity within certain groups but also builds agency and resilience within communities.
Building agency and resilience is key here and the partner organizations of Mariwala Health Initiative use these practices and frameworks in their work with communities and at-risk populations, as well as facilitating access to government social welfare schemes.
We believe that mental health touches individuals, families, livelihoods and communities and this must be taken into account when countering stigma, accessibility and policy. As we continue to push for awareness, access to services amongst marginalised communities, we endeavour to break the silence and change the conversation around mental health in new, challenging and radical ways.
Picture Credit: LBB