Why there is a need to provide mental health services to marginalised groups
The current narrative on mental health tends to be overtly biomedical with too much focus on the individual
Persons from marginalised communities and groups face discrimination and violence in their daily lives. This has serious impacts on their mental health. Therefore, there is a need to view mental health from a developmental lens and understand how a person’s identity (their gender, sexuality, religion, caste, age, geography and class) affects their interaction with the environment and their mental wellbeing.
The current narrative on mental health tends to be overtly biomedical with too much focus on the individual. This narrative pins mental health down to individual genetics, biology, environment and experiences. It is essential to consider social and economic determinants of mental health, that is, conditions in which people spend their childhoods, working lives, and later years. While these determinants may have received attention in academia, certain clinical practices, and community-led interventions, they have not been taken into account while designing mental health services and policies at scale.
There is enough research to show that COVID impacted the mental health of marginalised communities disproportionately – women experienced more domestic violence, school drop out numbers increased for children in both rural and urban areas and suicide among daily wage earners increased.
Mental health of marginalised communities such as daily wage earners, persons with disabilities, women, children, Dalits, Adivasis and people living in conflict areas therefore need focused attention from providers and policymakers of mental health services. Since the mental health issues among marginalized communities are caused due to external, sociopolitical factors, individual counselling may not reduce distress as the causes have not been holistically addressed.
A psychosocial approach to mental health care provision includes enhancing access to education, legal aid, public distribution systems, housing, healthcare and other social entitlements. A psychosocial approach to mental health moves away from addressing only the ‘treatment gap’ (which identifies the number of psychiatrists per 1 lakh people as a measurement of access to mental health care) to a holistic care approach–one that covers the overall needs of the individual.
Marginalised groups find it harder to access services: women who experience domestic violence find it that health services are non responsive to their experience of violence, persons from LGBTQIA+ communities face discrimination in accessing legal services and in the legal system, persons from marginalised religions have difficulty in finding housing accommodation and students in remote areas don’t have access to quality education. Therefore, working on mental health issues of marginalised communities means centering social interventions and building strong referral systems.
Mental health support for marginalised communities involves understanding the unique stressors that the community experiences, and designing interventions accordingly. These interventions are therefore best led by people from the community who have a deep understanding of the context and have similar lived experiences.
Mental health needs to be given a priority within the government by firstly providing adequate budgetary allocations, and secondly, providing services not just through the primary health center but also integrating mental health service delivery within all the health programmes, for example, maternal health, SRHR, TB, HIV/AIDs, etc. Most importantly, there is a need to have strong referral systems for social benefits if these mental health services are to deliver the impact of reaching marginalised communities and effectively addressing their mental health.
The author is CEO of Mariwala Health Initiative. Views are personal.
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