When Mental Health Becomes a Privilege: Understanding the Hidden Impact of Social Inequality
~ Jia Chopra, Intern
Conversations about mental health have become more prevalent than ever in recent years. Many individuals are vocal and open about their struggles with anxiety, depression, stress and seeking therapy. But, is the discussion around mental health complete when it is silent on a very important fact: who actually has access to the treatments available for them?
For many in India, a person’s mental health is not only determined by personal events and experiences, but also the social context into which one is born. Factors like poverty, discrimination, illiteracy, and the availability of resources can significantly influence a person’s mental well-being, and his ability to access treatment and support. Caste-based discrimination, among them, has long since affected not only economic prospects but also the mental health of scores of Indians.
Being subjected to prolonged and ongoing discrimination can indeed become the underlying cause of constant stress. The psychological impact of being unfairly treated, judged, and excluded based on an arbitrary social category (caste) invariably makes individuals fear, doubt, get ashamed or angered and helpless. It doesn’t always need to be as blatant as it might seem, even passive forms of discrimination that have occurred throughout life span take their mental toll, resulting in persistent states of low moods, anxiety, low self esteem and chronic stress.
Yet, the individuals or families most devastated by these issues were, for the most part, excluded from accessing formal mental health support. Professional therapy in the form of counselling and medications for mental disorders is often inaccessible to the majority because: A therapist’s cost of service is too high, there are too few psychiatric and psychologists to treat too many patients; there are very limited mental health professionals in the rural parts of the country, services often provided only in English or the more “dominant” languages in the region, and last but not the least, severe stigmatization in the society as seeking mental healthcare support is always perceived as a stigma or an admission of some mental deformity. For most families facing poverty, day-to-day survival becomes their absolute priority which overshadows the expense of counselling, regardless of the person’s mental turmoil.
Therefore a pernicious cycle emerges. Suffering continues in silence as accessible mental healthcare services are practically unavailable or simply too costly. These issues eventually impact schooling, job prospects, relationships and even physical health. As they continue for generations, it leads to internalizing a belief that emotional ailments are just a burden, a personal failure or simply a part of life that simply needs to be endured.
The second important problem is, of course, the stigma. In families and communities where conversations regarding mental health are almost unheard of, a person experiencing chronic depression, anxiety, or trauma will likely mistake or dismiss his or her sufferings as personal weakness, or mere bad fortune, but hardly ever as a treatable condition. Where, and to whom one can turn to for help without facing judgment then? Without awareness no amount of available services, no matter how excellent the facilities, can work.
It is critical to bear in mind that not all persons who belong to the same caste or social groups will have the same life experiences. Multiple identity categories such as socioeconomic status, gender, education, support networks etc, can combine to create differential experiences. Acknowledging the significance of caste-based discrimination does not imply suggesting that all members of marginalized castes will experience poor mental health at certain stages of their lives. It denotes however that their probability of distress might be higher and their ability to access support lower as a result of the social structures at play in society.
Thus, achieving improved mental health in India demands more than merely advising people to “talk”. It also needs to make adequate services affordable and readily accessible to everyone regardless of his or her locality or social standing, in accessible local languages and with culturally sensitive therapists and counsellors, complemented by strong government backing, public awareness campaigns, in-school mental-health educational programmes, community-based counselling initiatives etc.
No matter the socioeconomic status or background or whereabouts anyone finds himself or herself, everyone must deserve an adequate platform and support to be heard, and cared for with dignity and compassion. Building healthier societies requires paying as much attention to the individual as to the socio-ecological factors that influence well-being.
