By Malika Noor Mehta
Artwork by Kanika Dhankher
At its core, Justice indicates fairness and equity. The fair and equitable treatment of individuals, no matter their caste, class, creed, gender, sexual orientation, race, ethnicity or nationality. Justice relies upon a system or an individual’s beliefs in impartiality and reason.
So the question is: what does justice mean in the realm of mental health?
Is justice in mental health about providing all people access to quality mental healthcare? Is it about psycho-education and the equal dissemination of mental health knowledge? Is it about rallying governments around the cause of mental health and ensuring that robust mental health policies are drafted and implemented? Is it about securing private investment in mental healthcare? Is justice about realizing an individual’s need for care, or is it about systemic changes that ensure equal access for as many as possible? The answer is all of the above. And more.
Access to Mental Health
First and foremost, justice in mental health is about access to quality mental healthcare services. This should be a fundamental human right. Seeking out a mental health professional when you are feeling depressed or anxious should be as simple as seeing a medical doctor when you have a fever. Yet, access to quality mental healthcare is not that easy in India.
An incredible 197 million Indians suffer from mental health conditions, but there is a 95% gap between this number and those who actually receive mental healthcare. In India today, there are only 0.07 psychologists and 0.3 psychiatrists for every 100,000 people. This dearth of services and professionals ensures that only those who have the ability to pay for services gain access to them.
This disparity is further solidified by the correlation between socioeconomic class and exposure to information; a person will only seek mental health help if they know that such services exist and if they know where to search for them. Such knowledge often depends on the environment to which an individual lives, the people that the individual meets, and the educational resources to which the individual has access.
As a concept, ‘access to mental healthcare’ is further complicated by the difference between equal access versus equitable access. The distinction is critical. Equality would indicate that all groups of people are given the same opportunities and resources. Equity, however, recognizes the differences in needs and circumstances and allocates the necessary opportunities or resources required to allow for equal outcomes. The nuance between the two forms of resource allocation is important when thinking about access in the realm of mental health.
Consider this: in order to tackle the severe scarcity of mental health professionals in India, the government recruits international psychiatrists and psychologists, and places them in mental health clinics in Mumbai and Delhi. The government states that anyone can seek help from these professionals. Equality of access might allow us to stop here. Equity, however, demands that we dig deeper into this proposed solution.
First and foremost, will these professionals charge their patients, or is care subsidized or free? Secondly, since these professionals reside in urban metros, how will people from rural parts of India reach them? What if these rural dwellers cannot afford to travel long distances to see these professionals? Third, will these professionals be able to treat all types of mental health illnesses, and distinguish care depending on the client’s specific requirements? Finally, how will information about the existence of these professionals reach the ears and eyes of people across India? What modes of communication will be employed? In which languages?
These questions only graze the surface of the equity versus equality dilemma in the realm of access to mental health services. They do, however, demonstrate that mental health justice is a complex and winding road. This road is further complicated by the stigma that permeates the mental health arena in India.
Stigma and Mental Health
Stigma inevitably hinders justice for those who struggle with mental health issues. In India, 62% of people describe those who suffer from mental health disorders as “crazy,” “mad,” or “stupid.” 43% of Indians state that they feel anger towards people who discuss their mental health conditions openly. 28% say that they viscerally hate those who struggle with mental health concerns. While these data points are deeply distressing, they are not entirely surprising.
Until the COVID-19 pandemic disrupted the world, mental health was not openly discussed. The intangible and often invisible nature of the mental health conditions stoked societal anxieties that those who claimed to have mental health issues were somehow unstable, irrational or unpredictable. A lack of research and data around mental health conditions only fanned these flames of fear.
Furthermore, difficulties in measuring the impact of psychological interventions meant that only a few individuals and institutions truly spent time and effort brainstorming and creating these interventions in the first place; funding for such research was scarce, no doubt. Invariably, the mental health arena remained shrouded in stigma, which meant that those with mental illnesses often suffered silently and alone. Unjust and unfair, to say the least. While the pandemic has brought conversations about mental health to the forefront, stigma remains a critical issue, one that is not easily tackled.
Justice in the realm of mental health must address the issue of stigma head-on. Whether through policy changes – the Mental Care Act of 2017 makes moves in this direction – or through robust psycho-education programs that are integrated into public school curricula, de-stigmatizing discussions about mental illnesses will allow those who need help to get help. This, in turn, will allow those who struggle with mental health conditions to stand up for themselves, speak out about their experiences, and fight for their basic right to be seen, heard and respected.
Justice is never simple, and it is never easily achieved. In the realm of mental health, securing justice is a fight that is fought at the grassroots level as well as in the halls of government and corporate offices. When leaders in the private and public sectors align interests and recognize that the health of institutions (or countries) is inherently tied to the wellbeing of the individual, we might just take that first step forward in this struggle of mental health justice. It is a slow process, but we are on our way.
About the author:
Malika Noor Mehta is a mental health entrepreneur. Before the pandemic, she was engaged in creating a fellowship program that placed mental health counsellors in low-cost schools in Mumbai. Her interest in mental health stems from her teaching experience at Teach for India and her time in Jordan and Greece, creating trauma-sensitive education programs for Syrian refugees. She holds a Master in Public Policy from the Harvard Kennedy School of Government. In her free time, she loves to write and take photographs.