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What do freedom and power structures have to do with mental health? A lot

Those who are not included in the economic, social, political and cultural mainstream are at higher risk of experiencing mental illness and substance abuse

There are many pieces to solving the mental health crisis at a societal level (Photo: Tumisu/Pixabay)
There are many pieces to solving the mental health crisis at a societal level (Photo: Tumisu/Pixabay)

During my early interactions with people to assimilate them on the various aspects of mental health, I would stress on the need to understand that only when we get the ‘health’ angle of mental health can we begin to seek curative solutions to the issue.

But over seven years, as the mental healthcare space unfolded in many ways in front of me, I woke up to the fact that I was not entirely correct.

Indeed, we need to find curative solutions to mental health issues and there are several challenges to it. We would, however, be wrong to not notice the complex web of issues that mental healthcare is about. Finding lasting and sustainable solutions require us to take into account all of these perspectives.

The bio-psycho-social model of mental health explains the three possible reasons why someone could possibly experience a mental health condition. The first being genetics and the second psychological, which is about our emotions. The third reason is environmental. All kinds of environment that we are exposed to can be a contributing factor to our mental health, wellbeing and illness.

Interestingly, of the three reasons, the one we can influence most in the preventive space is our environment. Because, most often, we can choose our environment. What if we cannot influence our environment? Therein lies the key point I want to bring up in this column.

It’s time we look at mental healthcare, or more particularly, mental illness, from the perspective of ‘power’. Several research studies tell us that the less members of a community have the freedom, power and choice to lead a good quality life, the more they are at the risk of experiencing mental illness. The more their social environment is influenced by factors beyond their control, greater the chance of mental illness among them.

Marginalized groups—those who are not included in the economic, social, political and cultural mainstream—the world over are at higher risk of experiencing mental illness and substance abuse than others.

The National Alliance of Mental Illness (NAMI) in the US estimates that persons from the LGBTQIA+ community are three times more likely to have a mental health condition. They are four times at risk of having thoughts of suicide or attempting suicide. They are also at greater risk of substance abuse than the rest of the population.

Children in conflict with the law and those who come in touch with the juvenile justice system in India have a higher prevalence of mental health conditions and substance abuse than others.

During the first three months of lockdown and the pandemic, Indian women filed more complaints of domestic violence than recorded in a similar period in the last 10 years.

Several other vulnerable groupse—conomically weaker populations, migrants, homeless, displaced population, women at workplaces in several sectors, children, those regularly experiencing natural disasters –are exposed to adverse social, economic and cultural environments that increases their risk of mental illness.

Well, this may sound obvious. But the fact remains that there’s very little done to address this challenge of mental healthcare. It is also important that we do not just understand this from a curative angle but also find solutions that are preventive. In many social environments, it would help a great deal to accept these learnings and apply solutions that identify vulnerable (read, at risk) population and implement preventive measures.

The issue here may look macro and one would expect the key responsible agencies to be the government and other influencers. This may not be entirely true. We as individuals can be effective change agents in addressing this problem. To begin with, we must understand and accept this perspective of mental health. In our respective spaces that we could influence, we should be able to identify those members who are more vulnerable and affect a positive change in their social environment.

To give an example, children are often mute victims of domestic violence. They are powerless. The impact of domestic violence on their mental health is not immediately observed. Very little is done to address the emotional health of children who are exposed to domestic violence.

At our workplaces, it would help to identify vulnerable co-workers who may find the work environment toxic, and therefore, impacting their mental health adversely. Reach out to them and the decision makers to bring about a change in their work environment. Leaders must proactively ensure that the social and cultural construct of the workplace is not taking away from the vulnerable sections of the workforce their freedom, power and right to dignity.

Even as we speak about the environment as a potential trigger for mental health conditions, we must also recognize that our social environment often makes those with existing mental health conditions even more vulnerable. At our homes, neighborhoods, communities and workplaces, they find themselves powerless to seek their right to live a life of dignity and inclusion. We as individuals, and collectively as communities, have a responsibility to change this situation.

Acknowledging the direct link between ‘power’ and mental health conditions and seeing a role for ourselves would be the right way to start affecting a change. Failing to do so would result in solutions that are not effective, inclusive, sustainable and lasting.

FundaMental Truth is a series on mental healthcare by Manoj Chandran, Founding CEO of White Swan Foundation, a not-for-profit organization that offers knowledge-led solutions in the area of mental health

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