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The Grave Reality Of Indian Women Experiencing Mental Health Issues

Representation image. Source: Getty

Shakti is a 42-year-old woman. She has two kids and speaks English fluently. While narrating her story however, she seems apprehensive. She nervously bites the end of her dupatta as she tells me about the domestic abuse she has faced and how she was thrown out of her house and forced to live on the streets.

Her schizophrenic mother was left by her father. She also describes a few episodes of childhood abuse and poverty.

Three years later she was picked up by the police and sent to a mental health hospital. After her rehabilitation, she joined Tarasha. Tarasha is a unique initiative started by TISS (Tata Institute of Social Sciences) in Mumbai to support women suffering from mental health disorders.

However, stigma and exclusion remains. She is not able to meet her two sons and she hides that she is on medication for schizophrenia, even from closed ones.

Shakti’s case, the stigma and the exclusion characterise the general case of people suffering from mental health disorders in the country. Such people are living on Indian streets ravaged by poverty and helplessness. In a country like India, the male to female ratio of mental health disorder is quite low compared to rich countries where it is 3:1 (in India it is 1.5:1).

According to a study conducted by the National Institute of Mental Health and Neurosciences, 1 in 40 and 1 in 20 people are suffering from depression in India. Another aspect is the existing infrastructure and workforce in India to address this health challenge. There are just about 40 mental institutions (out of which only nine are equipped to provide treatment for children) and fewer than 26,000 beds available for a nation comprising 1.50 billion people. The WHO report on the Mental Health Atlas reveals that there are just three psychiatrists, and an even lesser number of psychologists for every million people in India, which is 18 times lesser than the commonwealth norm of 5.6 psychiatrists per 100,000 people.

There are two main factors which women in India have to face. The first one is stigmatisation of mental health disorder. In India, it is of utmost importance that women do not bring shame to the family. If they are associated with any mental health disorder, then they are shunned. They are considered a disgrace to the family and made to feel as if they are not able to perform their expected roles.

Once a woman acts ‘abnormally’, she is very likely to be stigmatised. But how does an affected woman act then? In this regard, Renu Addlakha argues that, “one outcome of this gender-based differential access to mental health services is the higher rates of female utilisation of magico-religious systems, such as temple healing, native healers, exorcists and faith healers”.

The second factor is exclusion. There are women like Shakti who have lived on the streets and some who spend their whole lives there.

This grave ground reality of Indian women experiencing a mental health disorder is quite alarming. The number of suicides is increasing and it is a major concern whether India will be able to meet the UN sustainable goals objective to reduce suicides by 10%. There is no active suicide prevention policy by the government of India.

However, a proper legislation is present. A bill was passed in 2017 came into effect on 2018 which replaced the old law. According to the old law, Mental Health Act (1987), the review processes or appeal processes for mentally ill patients were far from realistic. The Mental Health Care Bill (2017) was introduced in the light of the provisions made under the United Nations Convention on the Rights of Persons with Disability (UNCRPD). The old law did little good in doing away with stigmatisation and exclusion. The new law decriminalises suicide, allows mentally ill patients to pick their caretaker and decide the course of their treatment. A person with mental illness shall not be subjected to electroconvulsive therapy (ECT) therapy without the use of muscle relaxants and anaesthesia. Furthermore, ECT therapy will not be performed for minors. Another highlight of this Act is to protect the rights of a person with mental illness. The Government is advised to set up a Central Health Authority at national and State Health Authority at state level.  The Section 2 (r) defines the term “mental illness” as a substantial disorder of thinking, which grossly impairs judgement, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life and includes mental conditions associated with the abuse of alcohol and drugs.

Therefore, there is a lot of work which has been done on paper. However, the ground reality continues to be pitch dark. Only 1% of India’s health annual budget is given to mental health and issues. There is inadequate architecture, thus, there is a need to reallocate the health budget.

Image via Getty

Also there is ignorance about the mental health condition. Due to this the advance directive of choosing one’s medical treatment is quite difficult and long. The Bill also does not take into account factors such as poverty, the immediate environment of the individuals and other socio-cultural factors which affect an individual’s mental health. 

According to research the Suicide helplines in India are quite inefficient. Most of them don’t work 24/7. If you google “suicide helpline in India” the contact number of one NGO’s helpline will flash on your screen. However if you call it, it never works. Such is the state of most helplines in India. There are many reports on the state of National Helplines by NGOs. However, there is no official helpline in the country.

Thus there is a need to revise the funding, and work to eliminate stigma, exclusion and achieve Sustainable Development Goal. We also need to focus on educating people and children especially in economically backward areas. If stigma persists, then there will be no effect of the good infrastructure and funding.

According to a recent survey – “Respondents were asked about their feelings towards people with mental illness. While there exists widespread sympathy towards sufferers, with more than 75% of participants stating they would always feel sympathetic towards them, they also exhibit feelings of fear (14% would always be fearful), hatred (28% feel hatred sometimes or always), and anger (43% feel angry sometimes or always) towards people with mental illness. More than a quarter admitted that they would always be ‘indifferent’ towards people with mental illness.”

We need more groups like Tarasha and more policies like Gatekeeper started by NIMHANS India . According to this policy, more than 500 people are trained to deal with Suicide Prevention. There must be a training programme like Gatekeeper in schools and offices to deal with this silent, yet deadly epidemic. This is because most of the time, families that should be peers to a suffering individual, do not know how the patient must be treated, they lack basic empathy.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

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A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
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