This post has been self-published on Youth Ki Awaaz by India Development Review (IDR). Just like them, anyone can publish on Youth Ki Awaaz.

Four Ways To Ensure Sensitive Mental Healthcare For All: A Guide

More from India Development Review (IDR)

Written by: Amalina Kohli DaveRaj Mariwala

The history of mental healthcare is closely intertwined with human rights violations, incarceration and a lack of patient-centred approaches. A ‘community-centric’ approach has often been offered as an alternative to this, but what does that really mean in the context of mental healthcare?

Tracing The Heritage Of Mental Health

The history of modern psychiatry and psychology is firmly rooted in spaces called ‘asylums’, or mental hospitals. The idea of earmarking a space for the containment of distress saw institutions providing treatment or incarceration of those deemed ‘insane’ or unmanageable by their families in an attempt to protect social order.

However, since the definitions of ‘normal’, ‘abnormal’ and ‘insane’ were based on existing social norms, those sent to asylums often included the poor, sex workers, unmarried pregnant women, dissenters, people with physical disabilities or epilepsy, and those deemed immoral.

This confinement, and thereby silencing, of individuals in asylums was often used as a social disciplining tool. Such spaces were not run by trained doctors or experts, but largely priests, physicians and even entrepreneurs. Custody often meant violent restraint with chains, straitjackets and other forms of coercion to prevent ‘antisocial behaviour’ or self-harm. The underlying concept was of having separate spaces to ‘cure’ persons not conforming to societal standards of behaviour, including non-participation in the economy.

With this, we saw the advent of an alternative approach. ‘Moral treatment’ in the 19th century advocated that patients would benefit from being treated humanely and like ‘regular people’. Patients were expected to follow social norms, eat and talk politely, and perform basic tasks. Restraining methods and physical punishment were relied on less widely.

Shift To Community Mental Health

In the 1950s, ideas around deinstitutionalisation began to gain popularity. Facilitated by lower government budgets, the rise of psychopharmacology and protests against human rights abuse, asylums were slowly replaced by community mental health.

The confinement, and thereby silencing, of individuals in asylums, was often used as a social disciplining tool. | Picture courtesy: Unsplash

Community mental health is a decentralised system of mental healthcare. When envisioned, it was based on the premise that those who required psychiatric treatment would enjoy a better quality of life and have better chances of recovery if they were treated in their own communities. Ideally, it is an accessible and responsive local framework, based in a variety of community settings that use referrals to link users to a range of social services.

Coinciding with activism from user-survivors,1 this community care narrative rings with notes of liberation, human rights and ethical user-centred care. However, many lived experiences of community mental health testify to certain critical gaps.

1. A vague definition of ‘community’

Today, our notions of ‘community’ are themselves vague. Is community something that is found in public spaces, families, neighbourhoods or workspaces?

As practised, community mental health is reflected mainly in day-care centres, community clinics or services, and health workers. Actual social support networks that allow users to access employment opportunities, housing, physical healthcare or even caregiver support are often missing. Years of exclusion and stigma, with mental illness popularly associated with violence and danger, means that living within mainstream communities has been difficult for many. For example, while public perception is that persons with mental illness perpetuate violent crimes, research shows they are more likely to be victims of such crimes.

Community or public spaces can, then, be hostile environments, perpetuating violence, discrimination and stigma. The legacy of marking, removing and confining those who disrupt social norms means that expressing distress, or one’s gender, class or non-conforming behaviour may lead to exclusion from public transport, workspaces or neighbourhoods. Public spaces can prove especially hard to negotiate for those who transgress as a result of their gender, sexuality or other marginalisations — which often have a domino effect on the transgressor’s access to education, employment and healthcare services.

Take, for example, public spaces that are segregated on the basis of gender (such as public toilets and reserved seats on public transport). Gender-segregated spaces are especially difficult for trans or gender non-conforming persons to occupy, and often result in them facing discrimination or violence. Similarly, public spaces often cater to upper caste bodies. This influences community care settings — when, for example, we see segregation in seating arrangements for Dalits in self-help groups.

2. A lack of resources

There is a lack of spaces that specialise in a range of mental health interventions. This, combined with limited public mental health services, funding, welfare schemes as well as a lack of linkages to livelihood and housing reinforce a cycle of deprivation. The poor are significantly more likely to experience mental health problems and conversely, those with mental health problems are more likely to slide into poverty. Combined with the carceral justice system, this has resulted in many persons with mental illness being homeless or in jail. Inclusion of persons with mental illness as a vulnerable group who require development assistance is, therefore, essential.

Mental Healthcare For All

We must be cautious not to replicate, in community spaces, the old, top-down, biomedical approaches and power hierarchies of the asylum. Here’s a few ways in which we can do so.

1. Centre the individual and their narrative

Mental healthcare is often a combination of diagnosis and prescription, while an individual’s own understanding of their distress is sidelined. Often, these solutions are not just biomedical and prescriptive; they remove the human element of mental health entirely — that mental health (or illness, or distress) is experienced by a person and that their unique location is the lens through which they experience the world. A lot of mental health discourse is top-down or expert-led, and discusses people and communities without their involvement or input.

Representative image.

For example, diagnosing a queer person with anxiety without taking into consideration their particular experience of structural marginalisation is reductive and a band-aid on a larger systemic problem. Centering the person’s narrative would allow us to engage with and challenge a society that is queerphobic, while understanding the ways in which heteronormativity operationalises as privilege for cishet people at the cost of others.

2. Look beyond physical spaces as sites for care

An online support group for people with disabilities is, for instance, an abstract space — a possible alternative to a physical space with limited accessibility. Art therapy, to use another example, is abstract in that it often exists outside both designated clinical spaces and mainstream biomedical practice. Peer support networks are abstract spaces too, because they use identity as a location of community.

Such spaces can challenge the linear, ableist, and sometimes, carceral approaches to mental healthcare. They can counter the belief that an officially designated and controlled space is necessary to provide support and care.

3. Move away from a recovery-focused approach

In the mainstream sphere, for mental illness/distress that is either chronic, lifelong or recurring, the approach typically consists of three steps: diagnosis, prognosis and intervention. As such, intervention is meant to correct an inherent deficit or ‘abnormality’, thereby leading to ‘recovery’. There is no conception of what mental healthcare might mean outside of these rigid parameters.

To move away from this approach, we would have to look at mental health as a series of practices, associations, coalitions, support networks and systems that collectively contribute to a person’s well-being. Doing so will also create room for an individual seeking care to express what they see as ideal outcomes for themselves and make decisions about what kind of support best suits their needs.

people carrying lgbt flag at a pride

4. Recognise identity as a factor for mental distress

Being cognisant of different identities is critical to understanding where and how communities come together. Several community-based civil rights movements come from shared identity spaces, often with shared lived experiences and marginalisations. Given this, we need to acknowledge identity as a site where distress and conflicts can occur (be it due to lack of resources, discrimination or historical disenfranchisement). We also need to look at these sites of identity as spaces where individuals seek solidarity, form support networks, engage in advocacy and share dissent.

Whether persons come from queer/trans identities, marginalised caste or religious identities, or communities formed through shared experiences of chronic illness or disability, these identities sharply reveal how broader power equations may affect mental health, well-being and access to mental health resources. In addition, perceiving mental health and distress in terms of privilege and oppression helps challenge existing channels of support to examine how some people have less access than others.

While the idea of community mental health may lead to closure of asylums, the heritage and legacy of these institutions are still often carried forward. Since public spaces, institutions, communities and families will continue to reinforce discrimination and violence based on caste, class, gender, sexuality, ability or religion, we need to challenge the one-dimensional idea of community and redefine care.

Note: This article was originally published on India Development Review.


About the authors: 

Amalina Kohli Dave is a neurodivergent queer feminist activist. While her day job is book and historical document conservation, she has an academic background in gender and queer theory, and is inspired by a disability rights/crip theory paradigm. She has spoken about her lived experiences as a user-survivor at the intersection of queerness and mental illness on various platforms, including in community-led spaces. She is guest faculty at Mariwala Health Initiative’s (MHI) course on Queer Affirmative Counseling Practice and is on the advisory board of MHI.

Raj Mariwala is the director of Mariwala Health Initiative (MHI), and has an educational background in Business Economics and International Relations. Previous work experience includes livelihood-related work at Mercy Corps International. Currently, Raj serves on the advisory board of Global Mental Health Action Network as well as on the advisory board for the Lancet Commission on Stigma and Discrimination. In line with other interests, Raj is also a board member of Parcham, a non-profit that serves adolescent girls through sports.

You must be to comment.

More from India Development Review (IDR)

Similar Posts



By rrajeevsingh_

Wondering what to write about?

Here are some topics to get you started

Share your details to download the report.

We promise not to spam or send irrelevant information.

Share your details to download the report.

We promise not to spam or send irrelevant information.

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.

Read more about his campaign.

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.

Read more about her campaign. 

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.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

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.

Read more about the campaign here.

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.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

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.

Share your details to download the report.

We promise not to spam or send irrelevant information.

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.

Sign up for the Youth Ki Awaaz Prime Ministerial Brief below