Why the Mental Health Discourse in India Needs to Focus on Social Realities

In 2019, nearly 381 Indians died by suicide every day, out of these, roughly 31 deaths were of farmers and others dependent on agriculture. While suicide is often seen as a mental health issue, can the suicide of a farmer due to economic reasons be classified the same way as that of an urban youth possibly living with mental health challenges? 

To deal with the growing rate of challenges like suicide, recommendations have been made by researchers to the Indian government to improve access to mental healthcare and support. However, mental health does not exist in a silo but is strongly influenced by factors like an individual’s quality of life, health and social standing. Thus, the lens through which interventions are currently being designed and implemented for such a heterogeneous population also raises pertinent questions for the current mental health landscape. 

Sudarshan R Kottai, clinical psychologist and assistant professor of psychology, Jain University in Bengaluru spoke to Re:Set about why decolonizing mental health is crucial for India and why the system needs to be more patient-centric as opposed to revolving around providers. 

This interview has been edited for length and clarity. 

In your latest paper, you discussed why the mental health help currently extended to people such as migrant workers who suffered during COVID-19 lockdown was inefficient, could you please elaborate?

The issue that I find problematic with mainstream mental health discourse, which is led by state and government-run mental health institutions like…NIMHANS in India, is that it is completely divorced from social realities. It doesn’t look at power structures [like casteism], it doesn’t speak against the oppressors who actually cause social suffering. 

With the case of farmer protests happening now…many mental health professionals have written about farmer suicides. But, there are no mental health professionals speaking against the government, the state policies on agriculture and the need to reform those so that mental health [of farmers] will organically evolve. The oppressors [in this case] are the state and the corporates [that will benefit from the policies the farmers are protesting against.]

For example, when migrant workers’ issues happened, mental health [organizations], professionals and systems sprung into action to provide mental health services. The government put out a notification asking NIMHANS, CIP, LGBRIMH, the three premier mental health institutions of the country, to provide counseling. Yes, there is severe distress…amongst that population, but they cannot be reframed only as mental health issues as they are structural issues also.

This whole lot of social suffering, difficulty, distress, disability caused by structures and [people in power] gets reframed as mental health problems to be treated and to be intervened by professional experts.

India has a high rate of farmer suicide which is often linked to agrarian distress but is viewed as a mental health problem. Photo courtesy: Pexels

Research has shown that as a result of COVID-19, India could see a larger mental health crisis, where does decolonizing mental health care fit into this?

[When it comes to] decolonizing mental health, I think the training, education, research, the whole knowledge production itself is [seen as by those in the field as] something scientific, objective and value-neutral. But, you cannot have healthcare without linking it with the community and without hearing their voices. 

When I was in Assam, being trained as a clinical psychologist, there used to be so many [workers] who were dubbed as “Bangladeshi” because they had long beards or the women wore burqa. [When they visit the mental health institution] what happened is immediately, they were dubbed as psychosomatic and given the diagnosis of anxiety, depression and were given free medication such as anxiolytics or anti-depressants, by the institution. Sometimes the psychiatrist after giving this, [send them] for psychotherapy and cognitive behavioural therapy. So, [I later understood] that they are stateless, being chased by police, chased by people, suffering from discrimination and they don’t get employment. Even if they do get employed, they aren’t paid, they are abused. 

[Which is why] we need structural competency training which [has been studied by] by Jonathan Metzl. It evolved in the U.S. in terms of racism, but when we come to India, there should be focus on casteism which is very much prevalent. [This kind of training is important when it comes to decolonizing mental health because] at least there will be a language for you to speak about caste.

Currently, in education for mental health professionals, are concepts like systemic oppression, social justice a part of curriculums, included in practice? How do you think this should be expanded?

We should focus on qualitative research, [currently in psychology and psychiatry] most of the research is quantitative. [Through statistical analysis] you’re trying to number the mind, but no psychologist is going to the field, staying there and understanding the ecosystem or the ecology. Not being trained in qualitative research is a big problem. 

The United Nations has also acknowledged that mental health should move to a development discourse…human rights discourse. Mental health professionals should collaborate [with anthropologists, social scientists, and others to better understand social context]. These collaborations would show the facets of the same problem [from different perspectives]. The biggest failure of mental health systems has been that they never got involved in politics or advocated for human rights-based transformative change.  

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