After some convincing from his friend, Aditya Tiwari went to see a private mental health practitioner in his hometown of Jabalpur in Madhya Pradesh. But, unfortunately, the session did not go well. “He first thought that I had a concern regarding my flamboyance, and he said that I would get well,” says the 23-year-old poet and activist. Tiwari tried to explain, but, to his utter disappointment, the professional could not even understand his experiences as a queer individual.
The professional ended up prescribing him sleeping and mood-elevating pills after their first meeting. While the pills helped Tiwari initially, the sessions did not: the professional made no efforts to address concerns that stemmed from the isolation and harassment he faced in his day to day life. ("For queer people, finding comfort and friendship in a small town is almost impossible," says Tiwari.) When he saw no improvement, he stopped the treatment after a few months.
Unfortunately, Tiwari's experiences are similar to many other queer people who are struggling with their mental health and struggle to access it. Additionally, they are often left disappointed when they actually seek it. According to a 2021 study in the Indian Journal of Endocrinology and Metabolism that explored predictors of suicide ideation, attempt, and risk in gender incongruent --transgender and other non-cisgender-- adults, more than 25 per cent of the study candidates reported a past suicide attempt and 19.26 per cent seriously considering suicide. Another study on the psychological wellbeing of middle-aged and older queer men in India from 2020 found out that issues of ageism and internalised homophobia can lead to worse mental health outcomes among this population.
The campaign slogan for the World Mental Health Day 2021 (October 10) is 'Mental health care for all: let's make it a reality.' Queer activists and mental health professionals are also advocating for changes in the healthcare paradigm that would consider the unique mental health concerns of queer individuals in India.
One of the biggest issues most queer people face is finding mental health professionals who can understand their experiences. "Many queer people may live their relationships in a far more imaginative way than the cis-het conjugal idea of couples. If a therapist doesn't get that, they are likely to pathologise you, or they will try to use their very limited heterosexual frames to understand you. That's one more place where you feel dejected and misunderstood." says KP, who goes by the pronoun they. KP who works with the Centre for Health and Mental Health in the School of Social Work at the Tata Institute of Social Sciences (TISS), Mumbai, has worked in the mental health space for two decades.
Also read: An Instagram archive of queer love
Ideally, professionals must adopt a life-course approach to mental health, says KP. This approach recognises the stress in queer people's lives from the time they start grappling with their identity and lasts throughout the life span. "People who do not fit in the cisgender heteronormative way of living will have to deal with things as soon as they know they do not fit in," says KP, adding that the stressors start from family interactions. "Families are the first institution that tells you what makes you a girl and a boy, what makes you respectable, heterosexual, marriageable, good character man or woman," they say.
These stressors continue all through a queer person's life. KP takes the example of queer folks who want to check into a paid facility for older people: "They deal with the same question about whether I want to go to a men's facility or a women's facility. Where will I fit in, where would I feel safe, could I check in with my partner and say that they are my partner or 'friend'?"
The one thing that could help is queer affirmative counselling or therapy, says KP. According to them, it is a mode of learning or gathering information and knowledge of queer experiences and being aware of the history of damages done by mental health disciplines to this community. It also requires empathy for the lived experiences and minority stress faced by queer people as well as a critical perspective of heteronormativity, cisgenderism, and social institutions behind the privileges enjoyed by cis-het people.
Though queer affirmative therapy practices have gained some traction in recent years, it is not available to many."When it comes to medical education, things are not being taught in an affirmative manner, or in a way that is affirming of different gender identities and sexualities," says Delhi-based queer affirmative counselling practitioner and psychotherapist Neeraj Kumar. Kumar is associated with queer feminist resource group Nazariya and is the founder of the Unsound Project.
Kumar also speaks of the divide between private and public mental healthcare in the country. They say that the former is only accessible to those who can afford it financially and have some awareness about it. As for the psychiatric departments in public hospitals, they say that some of their clients who sought help there had to deal with “homo-negative interventions.” In this regard, NGOs and queer support groups are filling in some of the gaps, adds Kumar.
For effective change, Kumar also advocates for the full implementation of the progressive Mental Healthcare Act 2017. The Act clearly mentions that there should be no discrimination in mental healthcare on the basis of gender, sex, and sexual orientation. The Act provides for a redressal mechanism for those who are aggrieved by the decision of a mental health establishment and whose rights have been violated. “If you have experiences particularly around pathologisation or attempts made to cure you, then being able to make complaints to mental health review boards is important. People who are seeking help should know about these redressal mechanisms,” says KP.
Additionally, as both Kumar and KP point out, it is important to look at queer mental health from a psycho-social perspective i.e. looking at the influence of both psychological factors and the existing social environment on a person’s mental health. "We can not just look at a person or a body just symptomatically. We need to look at the emotional journey. Even in the healing spaces, we need to look at how all the identities come together for the individual—not just queer, but also, disability and the identity of Dalit or Bahujan or Adivasi or Kashmiri or a Muslim minority," says Kumar.
As for Tiwari, he says that he is afraid of seeking mental health support again after his bad experiences earlier. "If I find someone [therapist or professional] in the future who is reasonable and who would understand me, I will go for it."