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People from marginalized communities and groups face discrimination and violence in their daily lives. This has serious impacts on your mental health. Therefore, it is necessary to view mental health from a developmental perspective 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 well-being. .
The current mental health narrative tends to be overtly biomedical and overly focused on the individual. This narrative attributes mental health to genetics, biology, the environment, and individual experiences. It is essential to consider the social and economic determinants of mental health, that is, the conditions in which people spend their childhood, working life 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 when designing mental health services and policies at scale.
There is enough research to show that COVID disproportionately impacted the mental health of underserved communities: women suffered more domestic violence, the number of school dropouts increased for children in rural and urban areas Y suicide among day laborers increased.
Therefore, the mental health of marginalized communities, such as day laborers, people with disabilities, women, children, Dalits, Adivasis and people living in conflict zones, needs special attention from providers and policy makers of mental health services. Since mental health problems among marginalized communities are due to external sociopolitical factors, individual counseling may not reduce distress as the causes have not been comprehensively addressed.
A psychosocial approach to the provision of mental health care includes improving access to education, legal assistance, public distribution systems, housing, health care, and other social rights. A psychosocial approach to mental health moves away from just addressing the “treatment gap” (identifying the number of psychiatrists per 1 lakh people as a measure of access to mental health care) to a holistic care approach, that covers the general needs of the individual.
Marginalized groups find it more difficult to access services: women experiencing domestic violence find that health services are unresponsive to their experience of violence, people from LGBTQIA+ communities face discrimination in accessing legal services and in the legal system, people of marginalized religions have difficulty finding housing, and students in remote areas do not have access to quality education. Therefore, working on mental health issues in underserved communities means targeting social interventions and building strong referral systems.
Mental health support for underserved communities involves understanding the unique stressors the community experiences and designing interventions accordingly. Therefore, these interventions are best led by people in the community who have a deep understanding of the context and have similar lived experiences.
Mental health should be given a priority within the government, firstly by providing adequate budget allocations and secondly by providing services not only through the primary health facility, but also by integrating mental health service delivery within all health programmes, eg maternal health, SRHR. , TB, HIV/AIDS, etc. Most importantly, there is a need for robust referral systems for social benefits if these mental health services are to have the impact of reaching underserved communities and effectively addressing their mental health.
The author is executive director of the Mariwala Health Initiative. Views are personal.
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