Mental health and ill-mental health in particular are not foreign concepts to us. Over the last few decades, mental health has been ousted from the toxic pedestal of taboo and has made significant strides towards being normalized. As encouraging as it is, the fruits of de-stigmatization of mental health has not been experienced equally across all sections of society. Disparity does not just exist in the attitude towards mental health, but also in the risk of suffering a mental illness.
People living through financial hardship are more likely to suffer a mental illness. However, they are also less likely to have it diagnosed thanks to the stigma surrounding mental health. Stigma is undoubtedly a large part of why people shy away from seeking help, but the availability of financial resources is a bigger hurdle than it is given credit for.
The stress surrounding debts or of merely putting food on the table can take a major toll on those belonging to the lower socioeconomic strata of society. A survey conducted in 2017 proved that children and adolescents too are not spared this fate. It was said that children who lived in lower income households were 2 to 3 times more likely to develop mental health issues. This is a direct result of the mental burden economic hardships can place on an individual living under financially insecure circumstances.
Racial, Ethnic and Caste-based Inequity
In a country as diverse as India, limiting mental health inequality to economics would be greatly insufficient. With the varying cultures, castes, religions and tribes comes the added layer of the disproportionately disadvantaged minority groups. For a country that boasts of having a rich cultural heritage, the social privileges the majority are allowed is disturbing. This unequal playing field is reflected in the predisposition of mental illness in minorities. A study conducted in 2020 revealed that SC and Muslim respondents had worse mental health when compared to upper-caste Hindu respondents. Yet another worrying phenomenon is that historically disadvantaged castes, typically overlapping with low-income communities, have a 40% higher rate of depression than the national average.
This compounded with the lack of easy accessibility to mental health diagnosis and therapy; as well as the gaps in self-reporting mental health issues paint a grim picture.
Racial and ethnic minorities all around the world too are no strangers to these disparities. Among adults with diagnosis-based need for mental health or substance abuse care, 37.6% of Whites, but only 22.4% of Latinos and 25.0% of African Americans, receive treatment. This too constitutes a small sliver of the many injustices ethnic minorities are forced to endure. Let history set the example. Since the very dawn of the healthcare system, people belonging to black, Hispanic and other racial minorities have been illtreated, abused and gaslighted by medical practitioners.
A study done on the racial and ethnic disparities in mental health recorded a participant saying,
“I felt that because of my race that I wasn’t serviced as well as a Caucasian person was. The attitude that you would get. Information wasn’t given to me as it would have [been given to] a Caucasian. The attitude made me feel like I was less important. Even during the sessions (therapy sessions), my therapist’s attitude was rough and insensitive. I could come to the reception desk and they would be real nonchalant and someone of Caucasian colour would come behind me and they’d be like, “Hi, how was your day?”
Privilege, Therapists and Lack of Context
A vital yet often ignored aspect of therapy is the ability to validate a client’s or patient’s experience. The majority of mental health professionals in India are cisgender heterosexual able-bodied upper-caste Hindus, and in other parts of the world, a slightly different yet equally privileged group. As a result, there is a discrepancy in their perception of a client’s trauma and the reality of it.
Owing to their relatively privileged life, most therapists don’t rationalize certain minority specific issues in the context of racial, caste discrimination or as ableism, homophobia, dysphoria, etc. This could potentially invalidate the client’s experience. This phenomenon is a painful reflection of the decades of erasure minorities have had to endure and swallow.
In the comment section of a YouTube video on disability and mental health, a commentor said’
“I cannot move around on my own and spend most of my life on the chair through the winter when operating a wheelchair is extremely difficult even when out and about because of snow. It makes me feel very dependent. There are so many emotions that come and go with physical disability, and many people in wheelchairs are suffering with mental health issues that therapists (at least in my area) are not familiar with, or do not know how to approach or unknowingly disregard.”
LGBTQ+ Community and Mental Health
The relationship the LGBTQIA+ community has with mental health or rather mental health diagnosis and treatment is especially fraught. Not until 1987 did homosexuality completely fall out of the DSM. The wounds of being considered an “abnormality” are still raw. Around 1 in 8 LGBTQ+ people have experienced unequal treatment from healthcare staff because of their sexual or gender identity. As a consequence, 1 in 7 have avoided treatment for fear of being discriminated.
An account given by a trans youth said that a counsellor once told them,
“If you are ever going to pass as female, you need to do something about your face and your voice.”
In research done by the Trevor Project a trans youth was reported saying,
“The therapist I was previously going to would frequently use my deadname. She would apologize too, but then do it again. These “accidents”- as she called them- were the reasons why I had to change therapist.”
In recent times though, a silver lining in the form of digital therapy has emerged. “These online spaces are important to people for finding community and support, and for exploring their identity before they come out to family or people at school, which are often very stressful environments,” Oliver Haimson says. “We see this over and over again in our studies as well,” says Birkett. “Youth prefer to reach out digitally. It’s just where they feel most comfortable going.”
This hesitance or even fear of being discriminated against or hate crimed is unfortunately only part of the larger picture. People from the LGBTQ+ community are at a higher risk of experiencing poor mental health. A study conducted by Stonewall showed that half of the LGBTQ+ people part of the study had experienced depression and nearly 3 in 5 had experienced anxiety.
Looking to the Future
The research done in areas that could allow us to explore the truth of the silent battles many social minorities have had to fight is lacking. The studies and testimonies available are conducted primarily by those within the community. The dearth of research done in this area is a sorry indication of the importance minority mental health is allotted in the public conscience, more specifically in the minds of the masses.
The first step towards bridging the gaps in mental health and social inequality is listening to people. Lending a patient ear to the problems that have gone under the radar of recognition for far too long. Rarely does public discourse acknowledge that the circumstances in which people were born and raised profoundly impact mental health and the accessibility to mental health professionals.
People are multifaceted, focusing on one aspect of their identity often comes at the expense of erasing others. So, as important as learning about marginalized communities is; it is crucial to not limit our understanding of their experiences. A full, all-encompassing understanding can only be achieved if we were to make an active effort to adopt an intersectional approach in order to better mental health practices and accessibility.
About the writer: Bhargavi Barnabas is a Content writer, English literature student, researches and writes on feminism, mental health, and LGBTQIA+ issues, she is also a Bouncbk user.
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