India spends 1% on its health budget, which looks gracious in comparison to the margin of what is expended on mental health being less than 0.5% (Chadha, 2020). Pre-COVID 150 million people required active interventions, but 80% of these people did not receive it despite experiencing the symptoms for over 12 months (Kamath, 2016). The current narrative of suicide in India 2020 centres around a male celebrity when there have been numerous records of farmer suicides all over the country throughout months due to issues of loans and debts (Sharma, 2018). This shows that dialogue around mental health for specific individuals is not a part of the conventional discussion. Thus the reach of the movement is restricted to only a few. This reach is also extended when a one-off incident such as the death of a celebrity by suicide emerges. When the lack of portrayal of marginal voicing occurs, the general narrative homogenizes each person’s struggles by already assuming their experience (Layes, 2019). Thereby feeding the idea of inclusivity tends to remain cloaked with exclusivity.
The dominant discourse around mental health topics barely discuss or de-stigmatize issues faced by minorities; instead, they continue to elaborate on already amplified voices. Many mental health organizations have taken the agency away from communities in order to make it a product and created a structure of knowledge based on mainstream ideas of what is acceptable or not. It is also essential to look at questions like, why does the death of a person with mental illness from a tribal community draw attention towards their wellness and not inclusive care for Adivasis? Also, why do the experiences of the LGBTQIA+ community matter ‘only’ during the pride month? Or why does body shaming by others reduce with the existence of an eating disorder and not considering another’s wellbeing? Why is the death of one celebrity by suicide more critical than a thousand farmer suicides? Why is it that we fail to look at the system in which a person is placed before dumping the whole onus of distress on the said person? What does this say about the prevailing conversation around mental health?
Most distresses experienced by people are placed within one’s physique, and for the larger part are treated to be something ‘within’ the individual. By this explanation, all deficits reside in the person, including the ideas of oppression and violence too. If an individual is oppressed, they are the ones who ‘invite’ the suffering by being weaker than the rest. When an individual experiences violence at the hands of another, they must not be strong enough to fight back. These ideas fail to look at a person engaging with the structure of marginalization and an embodiment of lived experiences of discrimination. There is a greater inclination for the mental health field to ignore the macro system while continuing to push the change in said person. Taking an example of a neurodivergent person, if all the deficits are located in the self, then the institution of mental health fails to look at how it is propagating an ableist world. Thus, a neuro-divergent person functioning in a neurotypical world is expected to operate just like any typical member. At the same time, the mental health field fails to acknowledge the structures forcing the divergent to ‘cope’ as opposed to examining the relationship between self and world (Mariwala Health Initiative, 2020).
Another aspect that then emerges from this is ‘victim-blaming’ which further stigmatizes the person and diminishes their ability to seek help from an already suppressing system. One cannot say that individuals who died by suicide ‘died because of themselves’ to minimize the effects of an oppressive system. When such criticisms are not looked at in defence against the mental health field, it ends up ignoring the levels of marginalization experienced by the person in addition to reinforcing those marginalizations.
Mariwala Health Initiative (2020) talks about LGBTQ+ people who are bullied, harassed, in addition to being exposed to conversion therapy. Many experience it at the hands of mental health professionals like clinical psychologists. Queer and disabled have been asked to volunteer their time in areas of mental health which are monetizing their marginalization. The ‘participatory’ initiatives focus more on service delivery/ lip service rather than activating a more significant change and make some individuals feel like “unpaid community professionals” (Dodds et al., 2011). Money is being made on such narratives, especially during the time of this pandemic. The wellness industry is incorporating ‘exotic’ Indian cities in their treatment approaches, where they offer meditation and yoga. This is no way negates the healing effects of yoga and/or meditation, but the access to such alternative means of treatment is limited to those who can ‘afford’ it. Some claim that these tools may be a method of pacifying individuals part of a capitalistic society to accept the inequalities that accompany it (Layes, 2019).
Some also claim that the increase in the wellness industry along with large scale surge of homelessness, loneliness, competition and comparison as well as inequalities is not a coincidence. “In this neoliberal economy, productivity is the prime concern, more than anything, and competition, the main driver” (Layes, 2019). When the main driver becomes a competition, the individual begins to value productivity over everything else willing to put a price tag on most things. In a capitalistic atmosphere, the individual works for the employer disregarding the levels of exploitation attached to it. One must then either suffer at the hands of an employer or devalue themselves by entertaining anxious thoughts while being unemployed. These capitalist notions of productivity, growth, and progress take an ableist view for individuals who do not fit in the category of ‘normal’ standards which largely include persons suffering from mental health and other disabilities. Thus, only able bodies can succeed in an unequal structure despite the top being attainable for any person regardless of their gender, social standing or economic status. When such a person fails to attain the absolute best in a success-driven society, there is only one person to blame thereby- themselves. These become the members of the community “who are unable to keep up with the pace of productivity, experience isolation, depression, humiliation, inaccessibility” (Layes, 2019).
With the advent of support converting itself on the online platform, the same discourses continue to be advanced. The mental health system needs to take into consideration the gaps that already exist in it rather than just priding in the fact that it can shift through different modalities of reach effectively. Disillusioning ourselves that the stigma attached to mental ‘illness’ can be reduced just by outreach to a more significant number of people is ill-informed. It only amplifies the fact that a few webinars conducted for a mainstream population in a mainstream language does bare minimum for treatment accessibility (Mariwala Health Initiative, 2020).
What can you do?
The first step that can be taken is to challenge the dominant narratives which have been prevalent since the longest. You can take up space as much as learn to give it too, hence making spaces and learning about the experiences of those on margins instead of assuming their narratives can be uplifting.
While using any approach, adding socio-political questions to them such as, (Layes, 2019) “In an individualistic neoliberal approach which (now) successfully privatizes social problems such as mental illness” it is essential to question who does this approach benefit most? Is it the most appropriate tool to address the individual in question and their problem? What may be the social standing of the person and how it may be affecting him or her?
Bottom-up approach as mentioned in “seven strategies: comprehensive community participation, motivating local communities, expanding learning opportunities, improving local resource management, replicating human development, increasing communication and interchange, and localizing financial access” (Blanchard, 1988). Practitioners in the field perceive from the social development theory, engage in community-wide discussions, create and improve opportunities to learn as well as aid community development through empowerment by knowledge (Larrison, 1998). A bottom-up approach can initiate a collaboration between community participants and professionals in the field, which ideally leads to a partnership, not leadership.
People also re-evaluate detaching mental health from the rest of the socio-political structure as it consequently “blocks the path of collective understanding and action against inequalities and building of solidarity” (Layes, 2019) It perpetuates the functioning of businesses as usual. It limits the critique of the structure of inequalities. If this is opposed, victim-blaming may reduce with a decline in force inflicted upon individuals to regulate their emotions despite facing injustice in the power structure.
There is a paucity of mental health experts in addition to limited institutional care in India (Kamath, 2016). Another solution could be deinstitutionalization, which brings focus to community care with mental health services located in the society which can integrate individuals with mental health issues as well as disabilities. With the presence of more members with mental illness within the community, an increase in awareness can be seen which has been found to decrease the life expectancy gap between those who have a mental illness and others who do not (Westman et al., 2012).
Constitute a National Commission of Mental Health with people from mental health, public health, social sciences and judiciary to “oversee, facilitate support and monitor and review mental health policies” (Kamath, 2016)
Streamlining of finances with more investment around the seriousness of accessibility of mental health services
“Redirect the agenda to public health and revamp the mental health information system to prioritize mental health” (Kamath, 2016)
To challenge present work ethics which revolve around productivity and hyper-consumerist culture wherein an individual is reprimanded for not contributing equally ignoring the possibility of them being rendered “dysfunctional” or “traumatized” by the environment.