Mental health isn’t just in the mind

Written by Dr. Shivangi Shankar

As we discuss mental health on October 10 or during mental health awareness month(May), we offer individualistic and medical solutions and coping mechanisms are highlighted. However, we forget that much of the distress people are under is due to more tangible problems they face daily. Even when there are biological or psychological issues involved, these aggravate pre-existing social vulnerabilities.

Is it only a problem with the individual’s coping mechanism that leads to a decline in mental health? Is mental health limited to a lack of mental illness? Can mental health then improve in the silo of a therapist or psychiatrist’s office? 

A 2014 document by the WHO states: “Mental health and many common mental disorders are shaped to a great extent by the social, economic, and physical environments in which people live.”

For instance, a therapist cannot change the fact that someone doesn’t have food to eat and a psychiatrist cannot erase the trauma a person from a marginalised caste or from a marginalised sexual orientation or gender identity goes through everywhere. People with chronic illness and disability cannot be counselled out of their disappointment at a system that refuses to improve access. Similarly, carers cannot be asked to simply “cope” with the lacunae in the system that lead to running from hospital door to door to seek basic care for loved ones, the associated loss of wages, the physical strain, and so on. A farmer cannot survive on catharsis alone and a student’s resilience is not detached from the education system that stresses on marks and places them in debt. A healthcare worker cannot just “stay positive” when they are constantly expected to work multiple shifts with little to no rest. Several of the responses to these conditions are physiological, it would be strange if people were not responsive at all to these stressors!

Even within the health service system, it is difficult to even reach the therapist/ psychiatrist’s office. Helplines that are often floated on social media are often functional for limited hours, if at all. Is it feasible to expect people’s depressive/ suicidal episodes to time themselves according to working hours? Despite the push that mental health has received in recent years, these remain inaccessible to all. Alongside, there is still much to be said about the quality of care available- be it in terms of privacy or in terms of the lack of understanding of lived realities of marginalised groups. In such cases, the safe space itself becomes a place for perpetuating and at times even aggravating one’s stressors.

This is not to say that psychological and psychiatric interventions don’t work. They do have a role and can be a boon to many people. These conversations must be had and it is important for people to be able to navigate these stresses they face- counselling and medication can help with that, i.e. it is necessary though not sufficient. 

There is no one size fits all answer to mental health, which makes it that much more tedious for the individual suffering. The impact of discrimination, stigma, poverty, malnutrition, unemployment, etc is now being acknowledged with respect to mental health. If preventable stresses are being placed on people, it is imperative to look at the ways those can be addressed.

For instance, if a group is more vulnerable to suicide their problems must be addressed instead of placing the onus just on an individual. If people are unable to support themselves financially, making them dependent on an abuser, it is essential to create support systems for such people to be able to protect themselves. If substance abuse is on the rise, it is essential to look at both- the factors leading to the substance abuse in the individual as well as the factors enabling preying on vulnerable individuals. Many of these don’t fall into clear-cut medical diagnoses at their core. This does not negate their relevance to one’s mental health.

It would be a start to acknowledge the stressors in one’s environment. This process can be facilitated by a therapist/ counsellor/ psychiatrist or even a friend. It is not necessary that one suffer to a certain level or fit into an ICD or DSM criteria to seek help. Healthcare workers, too, must be attuned to their role in people’s mental health- not only psychiatrists, most healthcare workers meet people when they are at their most vulnerable. It is also important to remember that healthcare worker does not mean only doctors; nurses, counsellors, physiotherapists, ASHAs are each uniquely placed to help a person who requires mental health support. It would be helpful to have a system in place to at least refer to a social worker/therapist or even a helpline in times of need. Several helplines have come up recently to address mental health crises. It would be ideal if these could run 24×7 but they are a very essential start. 

Mental health is largely affected by (and affects), the body, the environment, one’s entire life, and society. So, mental health support can come in many shapes and sizes. It can be in the form of care, it can be in the form of listening, it can be in the form of helping someone access legal/financial aid, it can be in the form accompanying someone to the hospital, it can be in the form of accepting someone’s truth, it can be in the form of sharing job opportunities if asked and it can be in the form of advocating for the rights of a marginalised group. It can be in the form of voting with the knowledge of everything that can affect people’s (mental) health. In all of these ways, what is most important is to look at what people need. 

Mental health (and mental health support) is, very often, not just in the mind. It takes a village to maintain it!

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