Mental Health in India: Gaps in mental health care for India’s LGBTQ+ community
There are no special provisions for mental health for India’s sexual minorities, considering that they are often more likely to be economically marginalised, and may need more support. Sadaf Vidha explores the gaps and possible silver linings.
The ‘Mental Health in India’ series on The Chakkar will look at various gaps in conversation regarding mental health issues in the country, from the effects of history, to current cultural speed-bumps, solutions for coherent policies for the future, and much more.
As a turbulent year came to an end, it was clear that the trauma of the pandemic further highlighted the reality of mental health concerns in India. COVID-19 and the subsequent lockdowns have unequally affected different sections of citizens, but nearly everyone in the nation has felt the stress of these times.
A story from Down To Earth earlier this year underscored, through heartfelt first-hand accounts, how this year has been particularly difficult for queer and trans people in India, in relation to their mental health and beyond. Even before the pandemic, queer and trans people struggled with access to the health care systems in India. A paper by Shamayeta Bhattacharya and Debarchana Ghosh suggests:
“Results clearly indicate that there is a pressing need to address both physical and mental health among gender-diverse communities by not only improving awareness of their healthcare rights but by also removing social and structural barriers to health programs, increasing targeted health interventions, grassroot level activism, and government advocacy.”
In fact, a recent article on Go Mag discovered that trans men face often face mistreatment within the medical community, and hormone treatment is not considered “essential” by the doctors.
The curricula of medicine and psychiatry hardly mentions the concerns of queer and trans people, and if it does, then it does so, only as an abnormality… Doctors, psychiatrists and therapists continue to be biased and even openly provide conversion therapy.
Unfortunately, the gap in the health care system also spills over to the mental health care space. To begin with, the Mental Health Act of 2017, while taking many progressive and positive steps ahead of previous mental health legislations, is still very clinical and medical in nature. There remain several loopholes in not just leaving out prevention and awareness, but also in execution of the various aspects of the law. For example, many states do not yet have their State Mental Health Authorities in place, and the rules for the application of the Act only came out in 2020—three years after the law. Additionally, the Act leaves much to be desired on the front of the rights of people who go to mental health practitioners in private practice, in regulating licensure and life-long education and also with the topic of insurance cover for mental health costs, other than psychiatric admission.
If the law does not make space for queer and trans people, then it is quite logical that the mental health space will also follow suit. A piece on mental health care for the queer community in India on gaysi suggests:
The political circumstances have proven to be particularly discouraging to the queer community in India, most prominently witnessed by the passing of the discriminatory Transgender Persons (Protection of Rights) Act, 2019. With requirements like a having district magistrate to identify one’s gender and undergoing a sex reassessment surgery as proof to change preferred gender, the Act which is only increasing the oppression and violence faced by trans people, has resulted in widespread anguish along with resistance amongst the community. In such an environment, minority stress faced by trans people is worsened, posing greater risks to developing mental health challenges. The stigma associated with being both queer and having a mental illness puts the whole community at danger of not being connected to accessible and equitable mental health care services in the country.
While the mental health act protects the rights of sexual minorities on paper, we do not see the integration with other laws which continue to be homonegative and transnegative. Further, there are no special provisions for mental health for queer and trans people, considering that they are more likely to be economically marginalised and may need support in accessing the services. In fact, the curricula of medicine and psychiatry hardly mentions the concerns of queer and trans people, and if it does, then it does so, only as an abnormality. With this sort of education, is it surprising that doctors, psychiatrists and therapists continue to be biased and even openly provide conversion therapy?
Research has suggested that there are unique life stressors associated with being queer/trans. Jagruti R. Wandrekar and Advaita S. Nigudkar write, “Financial debt was a predictor of depression in one study. The rates of depression were higher for those who had faced negative reactions when coming out.” Therefore, unique life stressors continue to effect queer and trans people, while the health and mental health infrastructures fail to accommodate them adequately.
All is not lost, however. Independent practitioners and NGOs are doing their bit to bridge the gap both by intervening as well as advocating with the government to push for better laws and fulfilment of rights. There are already crowdsourced and verified lists of queer affirmative mental health practitioners and gynaecologists doing the rounds in India. Nazariya, a prominent LGBT organization, had organised free mental health workshops for the LGBT population in 2017, partnering with the TARSHI publication.
In writing about the outcome of these workshops, TARSHI say,
Several participants emphasised that they considered the personal to be political; while doing so allowed them to take greater ownership of their identities and their politics, it also constantly highlighted ways in which their surroundings were in conflict with them, whether that be having to stay in the closet, keeping a queer relationship a secret, or the pressure to ‘pass’ as someone conforming to heteronormative standards. Participants stressed that politicising one’s identity made it extremely hard to find a safe space to just ‘be’ or to disengage.
Therefore, activism which is a safe space and an empowerment tool, can also add to burnout and therefore, lead to mental health distress.
2020 has also been the year of online support groups and many prominent mental health organisations have opened their doors to queer and trans populations. This is an encouraging sign. Group support and therapy is quite a helpful model, illustrated by the success of the SAAHAS group. As can be gleaned, the aspect of peer support, safe space and inclusivity contributed the most to the wellbeing that participants were able to experience because of the group.
However, NGOs and for-profits neither have the reach nor the funds available to the government. Therefore, the future of safe and accessible mental health for everyone lies in more helpful laws, amendment to existing laws and swifter implementation with fewer loopholes. If this year has taught us anything, it is that mental health is an “essential”, and not a luxury, and it is about time we demand it as a right from our government.
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Sadaf Vidha (she/her) is a therapist and researcher with five years of experience. She is interested in cross-disciplinary understanding of human behavior at the intersections of mental health, sociology, social justice and economics. In her free time, she likes to read, paint, bake and play with her cats. You can find her on Instagram: @shrinkfemale and Twitter: @randomwhiz.
