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India’s Mental Healthcare System Is Biased Against Women. Period.

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Popular culture often misleads us into believing that mental health is more of an individual issue than anything else. But is that really the case? What if I were to tell you that mental health is a social issue; that to address mental health issues is to address patriarchy, sexism, casteism and class discrimination as well?

The truth is that mental health is a privilege, one that is often denied to women, especially if they hail from marginalised communities all because of patriarchy.

It’s 2021 but mental health still remains a taboo topic in India. According to the National Mental Health Survey undertaken by National Institute of Mental Health and Neurosciences (NIMHANS) in 2016, mental disorders affect more than 14% of the Indian population, 10% of which require immediate intervention.

However, the number of people who are able to seek help is much lower, caused mainly by the stigma surrounding mental illness, lack of awareness and the paucity of available and affordable resources. 

Representational image.

The Men in Mental Health

In a country which has long been governed by patriarchal norms, the diagnosis and treatment of mental health issues too, remains highly gendered.

The problems faced by women: stringent gender norms, sexual harassment, domestic violence, restricted access to basic resources such as education and lack of financial and social freedom, are widely different than those faced by men.

These structural issues restrict the individual space of young women, thereby stunting their emotional growth and often lead to poor mental health. A study concluded that women are twice more likely than men to suffer from major depressive episodes.

And it’s not just depression either. Various studies have come to the conclusion that more women suffer from common mental disorders, with gender differences being observed in the course of the disorder, frequency of psychotic symptoms and long term outcomes. 

Common sense would suggest putting more focus to tackle this gender bias but real life paints a grim picture. For centuries, medical professionals have written away symptoms of mental illness in women as hysteria, a very convenient explanation that continues to haunt psychiatry. 

In fact, hysteria was thought to be exclusive to women and recommendations for cure included herbs, sex or even sexual abstinence.

A visit to the therapist takes a lot of courage, especially for women whose distress is often ignored or assumed to be just stress. But their struggle to get a correct diagnosis doesn’t just end there; doctors too sometimes do not take their symptoms and complaints seriously until it’s too late.

Caste + Class = Catastrophe

The Constitution of India may have done away with the caste system, but casteism has somehow managed to survive. A simple Google search turns up tens of articles about the caste based violence still practiced in India.

Consequently, casteism becomes an important factor in the current mental health epidemic in the country. Years of discrimination and inter-generational trauma culminate in a lower economic and social standing for these marginalised communities, making them all the more susceptible to mental illnesses, while simultaneously making it harder to access resources.

Women from these marginalised communities not only have to deal with casteism, but also the sexism running rampant in their own families. 

Women from the transgender community have their own woes to count, especially when they belong to lower castes. Their own struggle with gender dysphoria is worsened by social exclusion from society and a highly restricted access to resources and opportunities due to social stigma.

Representational image.

Mental health professionals in our country have a very poor understanding of gender themselves and fail to provide the support that they should be able to.

The problem with the nation’s mental health framework is that it perceives mental health from an upper-caste, upper-class point of view. In a society where a Brahmin man is at the top of the ladder, a poor trans Dalit woman runs the risk of being oppressed to the highest degree.

Studies indicate that women from rural communities or from lower social backgrounds find local healers such as ojhas more accessible while men, in general, find it easier to access modern mental-health care systems.

However, even this gendered access does not benefit people from lower castes. The culture-blindness of psychiatry has given birth to mental health professionals insensitive to caste-based structural oppression.

Neither are they trained to take socio-economic realities and political histories into account during treatment. Such a de-contextualised approach to mental health obscures the necessity of addressing the social and economic causes of mental distress. 

On Making Mental Health Inclusive

It is a sad reality that not enough research has been done to figure out the perfect way to navigate caste, class and gender in mental health. The existing policies put forward to reduce this treatment gap remain redundant.

The crux of the issue centers on the individualisation of mental distress which doesn’t really work in the Indian context. The need of the hour, thus, is to sensitise mental health professionals towards the systemic oppression faced by these communities, especially women and their various social locations and develop effective measures to deal with the same.

Such resources must also be made easily accessible to different communities. Blue Dawn, a mental health support group for Bahujans, is a flag bearer in facilitating professionals to those in need and paves the way for others to follow.

The psychometric tests used for evaluation too, do not factor in the social and political landscape of India, and must be developed keeping in mind the unique problems that plague the subcontinent. 

Women from these marginalised communities not only have to deal with casteism, but also the sexism running rampant in their own families. Representational image.

Mental health is a human rights issue, and it is critical that psychiatry as a discipline becomes more inclusive and welcoming towards vulnerable communities. The need is no longer individual self-awareness but to create safe spaces for vital dialogues to take place.

Women have been grossly misunderstood and sometimes even erased in India’s mental health discourse and the world at large. Such stereotypes, appropriations and wrong diagnosis can assume dangerous proportions with the already entrenched patriarchy.

What becomes crucial is a gender sensitive process that not only understands structural factors but also takes remedial steps to eliminate them.

It is only when mental ailments begin to be treated as physical ailments that the burden of mental distress can be alleviated from the citizens.

The author is part of the current batch of the Writer’s Training Program
Featured image is for representational purposes only.
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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.

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.

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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 Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’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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