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“Mental Illness And Poverty Are Intricate Parts Of A Vicious Cycle”

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by Ara Johannes:

In the last few years, we have seen a flurry of media articles, tweet-a-thons, Facebook posts, and hashtags making the rounds in the run up to World Mental Health Day—calling for attention to an issue that seems to have reached an inflection point. Campaigns such as #SpeakYourMind, #NotAshamed, and #ItsOkToTalk address mental health stigma by broadcasting personal anecdotes from those with lived experiences of mental health conditions.

Yet, mental health still occupies a minuscule share (0.06 per cent) of budgetary allocations to health in India, reflective of global budgetary trends (under two per cent). The reluctance to appropriately budget for mental health stems partly from a failure to see mental health as a development issue, and an inability to join the dots between mental health and social conditions of poverty.

“Mental illness and poverty are intricate parts of a vicious cycle.”

We intuitively understand that living on the streets, being unemployed for extended periods, not knowing where one’s next meal is coming from, the constant threat of eviction or violence, or social exclusion on account of caste, gender, or sexual identity, would distress anyone. Mental distress, in turn, impacts the ability to hold a job or complete education, inhibits participation in social and family activities, decreases productivity, and diminishes resources within families.

It isn’t surprising then that those living with mental health conditions might simultaneously grapple with unemployment, low education, food insecurity, inadequate housing, and financial stress. Mental illness and poverty are thus intricate parts of a vicious cycle: poverty increases the risk of mental health conditions, and conversely, those living with mental health conditions are more likely to drift into poverty.

Within this self-fortifying cycle of mental illness and poverty, certain groups emerge more vulnerable than others. Social hierarchies—of gender, sexual orientation, economic status, ability, and caste—exclude, discriminate against, marginalise, and isolate certain groups and individuals. Consequently, we find that marginalised groups that hold lower positions within these social hierarchies experience greater levels of mental distress than those who hold more advantaged or higher positions.

According to data from the National Crime Records Bureau, 2014, people from Scheduled Tribes had the highest suicide rate 1 at 10.4, followed by Dalits at 9.4. In less than a decade, more than 25 Dalit students in India have died by suicide due to caste discrimination and institutional casteism in educational institutions such as the University of Hyderabad, AIIMS, and IIT. The Banyan—a Chennai-based mental health organisation that provides comprehensive services for people with mental illness living in poverty and homelessness—noted through their research that one in every three homeless individuals suffers from a mental illness.

Similarly, LGBTQIA+ individuals face unique life stressors such as familial violence, discrimination, and violence in public spaces and institutions, contributing to a significant impact on their mental health. The global suicide rate among trans or non-binary gender persons ranges from 32 to 50 per cent, significantly higher than the average global suicide rate.

hand pressing voting machine-illustration-mental health
Social hierarchies—of gender, sexual orientation, economic status, ability, and caste—exclude, discriminate against, marginalise, and isolate certain groups and individuals. | Photo courtesy: ReFrame Issue No. 2/Studio Kohl

We are surrounded by such examples of how mental health coexists with social, economic, and environmental conditions. In fact, mental health cuts across and influences several Sustainable Development Goals (SDGs)—all of which will remain unattainable unless mental health is integrated into development programmes. For instance, let’s take SDG-3: Ensure healthy lives and promote well-being for all at all ages. There is a high level of comorbidity between mental illness and physical illness that underlines why health services need to be provided in an integrated manner.

For example, maternal depression has been shown to increase the risk of poor infant nutrition, stunting, and diarrheal disease. If we want to influence better health outcomes for infants, we must ensure that pregnant women or mothers of infants are routinely screened for mental health conditions and provided with appropriate care and treatment. Similarly, depression has been shown to adversely affect adherence to antiretroviral medication among those living with HIV/AIDS. Again, to influence better health outcomes, mental health care and treatment should be integrated within HIV/AIDS programmes.

Mental health clearly cannot be addressed in isolation. The WHO’s Comprehensive Mental Health Action Plan (2013–2020) advocates for ‘mainstreaming mental health interventions into health, poverty reduction, development policies, strategies and interventions’. Fostering linkages between mental health service providers and allied service providers—for livelihoods, health, education, legal support, and government welfare schemes—is important.

At Mariwala Health Initiative (MHI), one way in which we facilitate this is through a school-based mental health justice programme that addresses psychosocial distress within the education system. This is especially pertinent among vulnerable communities that face mental distress due to multiple axes of marginalisation. This programme aims to equip educational spaces better to enhance mental well-being among marginalised and vulnerable youth.

“We need to take a closer look at how the intersections of poverty, casteism, misogyny, and other forms of violence impact mental health.”

Another example of integrating mental health within development programs is our disaster-related psychosocial programme. Despite evidence of the impact that disasters have on mental health, disaster response approaches traditionally have not included mental health services, and tend to focus solely on immediate humanitarian needs (protection, water, sanitation, shelter, food, and health).

Consequently, while disaster-related distress is highly prevalent in affected communities, those experiencing such distress usually have no recourse. If we were to integrate mental health within a disaster-response programme, we would, for instance, consider how overcrowding and lack of privacy and safety in disaster relief camps increase distress for vulnerable groups such as women and children. We would draw on a community’s inherent resources—which might include how people have dealt with adversity previously, and traditional solidarities that provide mutual support. In situations of disaster, these networks and mechanisms for psychosocial wellbeing and mental health may face undue strain or break down, making it even more imperative to revive them.

These examples of how mental health can be integrated within education and disaster-response programmes hold true for other sectors as well. We need to locate mental health within economic, environmental, sociocultural, and political contexts. We also need to take a closer at how the intersections of poverty, casteism, misogyny, and other forms of violence impact mental health and include it as a key ingredient across development programmes.

  1. Suicide rate refers to the number of suicides per population of one lakh.

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This article was originally published on India Development Review.


About the author: Ara JohannesAra Johannes is a communications manager at Mariwala Health Initiative. She has a Masters in Health and Non-Profit Communications from Johns Hopkins University and a Bachelors in Anthropology from the University of Kansas. Ara has over a decade of work experience in communications for development organisations—across sectors including maternal and child health, women’s rights, and strategic philanthropy. She is passionate about using communications to illustrate stories of transformation, giving voice to those on the margins, and rallying people to a common purpose.

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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.

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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.

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.

Find out more about the campaign here.

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She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

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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.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

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
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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