By Sadaf Vidha and Prateek Sharma:
A recently developed survey is out to record people’s experiences with bigoted and unethical mental health professionals.
At a time when we can write the longest review for the purchase of a hairpin, there exists the dark and vague world of unmonitored mental health care.
A newly established Mental Health Care Act suggests the briefest idea of what we call a people-centric approach, but the sector still remains highly unregulated from different perspectives. One such perspective involves professionalism, ethics and the progressive outlook mental health professionals are genuinely expected to have. This issue has been spoken of very rarely in India but is now gaining the attention it needs.
Keeping this in focus, we have developed a survey that intends to collect the experiences of people who have undergone therapy or any mental health treatment in order to determine the prevalence of social discrimination and unethical qualities in practitioners.
As those working in the field of mental health, we are aware that ethical issues are rampant, but as feminists, we have also realised that a spectrum of attitudes directed towards gender, sexuality and lifestyle choices do not get recognized, at times even by the person experiencing it.
Sexist “advice”: “You’re 31, you should be married and settled. Living like this is what causes the anxiety.”
Women have been hearing these phrases for the longest time, but coming from a therapist, its effect drives a deeper conflict. Sexism and misogyny have no place in therapy, and statements polluted by them can have a wider scope ranging from marital status and blaming “non-traditional” relationships to slut shaming and fat shaming.
Colluding with family members: This happens when the professional, without any independent analysis of their own, just takes the word of family members to be correct. This has been used quite often in the past to dump men and women that the family did not want to care for. One big problem was men taking the help of psychiatrists to label their wives as “insane” for divorce proceedings. Sometimes, instances of abuse coming from the family are also protected by professionals for the sake of sanctity.
Homo/transphobia: While ventures offering ‘conversion therapies’ have reduced in the community, general homophobia and transphobia continue to prevail and the LGBTQ+ community is on the receiving end. Because India is not a country friendly enough for a person to comprehend their sexuality, it is accompanied by stress, for which people often seek help. As soon as the trust is shattered by a remark that indirectly points a finger at someone’s orientation or persona, what was once known as help turns into hatred.
Gender roles imposition: There is very little awareness about how ‘giving advice’ has no place in therapy, since the person seeking therapy needs to regain the ability to make decisions that are productive for them. When gender norms and societal roles become a part of therapy, they tend to do more harm than we think. “What an ideal wife/husband/mother/father/child SHOULD do” always collaborates with personal and traditional beliefs.
Lack of structure and transparency: There is no clarity given in the number of sessions/visits required. Often, the medication, its effects, and side-effects are not a part of informed consent. There are times when psychiatrists don’t speak of more affordable versions of these medications, which later becomes a huge problem for the patient. Therapy and medication go hand in hand but sometimes psychiatrists often leave out non-medical interventions like psycho-social rehabilitation, which actually has a vital role in healing.
Medical malpractice: Much has been written on the institutional problems surrounding mental health. This includes bad conditions of mental health institutions, patients kept in an unclean way without much activity, wrong diagnoses, forceful Electroconvulsive Therapies (ECTs), patient deaths, forceful admission and medication, ECTs without anaesthesia, or ECTs when not required and so on.
God complex in practitioners: As much as a therapist (or the client) is free to have any religious beliefs, their imposition has no place in the work therapists do. The ‘former Vastu consultant’, the ‘chakra healer’, are some of the examples you must have come across.For something that is scientific and human at the same time, the imposition of such beliefs without caring much about the worldview or specific experiences of the client causes major problems.
Lack of therapeutic skills: Some basic skills are required when in a therapeutic relationship with someone undergoing mental health issues. These include critical thinking, trustworthiness, reflective listening, respecting the client’s anatomy and having the client’s best interests at heart. This also implies working on your own issues so that they don’t get transferred to the client.
There could be numerous reasons as to why these anomalies exist in the first place. Be it the lack of awareness, a licensing body or an ethics committee, the notion remains that they do exist and need to be addressed. To do that we would like to hear from you.
The survey takes an in-depth look into people’s experience with mental health care, examining different aspects of ethics and determining the existence of judgmental behaviour based on how discrimination and bigotry against minorities operate in India. Being detailed in approach, it also prioritises ease of use for the respondent in terms of filling in, and prioritises the experiences of gender and sexual minorities.
Domains like gender-based discrimination, sexuality, confidentiality, listening skills, attitude towards suicide, abuse and irrational areas like trivialisation of someone’s misery are extensively covered in the form.
Towards the end, it asks the respondent (with negative experiences) to articulate their experience(s) in a few words, since narration has always been a helpful source of qualitative data.
The survey form is designed in a way that positive experiences can be recorded as well. We believe that it is equally important to bring to light the existence of a progressive and ethical mental healthcare practice.
The analytics that went behind building the questionnaire enables the person to avoid questions that do not resonate with the kind of experience they had, and at the same time point out what qualities they liked or did not like in the professional they visited.
Research has always been a productive approach towards making important decisions for both society and one’s own life. By doing this, we are not only attempting to help people be more informed about progressive mental health care, but also to highlight a sensitive concern that the society remains unaware of.
The collected data will be analysed and the results will be published as a paper.