“If we don't talk, other people will talk on our behalf,” shares Garima, who identifies as a disabled agender person highlighting the need for sharing experiences and connecting with people to navigate mental health challenges. 

For the longest time, the discussions around mental health and mental illnesses have been brushed under the carpet, only to surface in hushed conversations and with stigmas attached. The COVID -19 pandemic brought focus on this silent pandemic, and it was not surprising, given how it created a "new normal," leaving a widening trail of devastation and grief across the globe. 

In 2020, cases of major depressive disorder were estimated to have increased by more than 27% globally and cases of anxiety disorders by more than 25%, adding to the 1 billion people who were already living with a mental disorder. 

The recently released Human Development Report ‘Uncertain times, unsettled lives: Shaping our future in a transforming world’ highlights that mental health issues are the leading cause of disability globally. Yet, of those who need mental health attention or treatment, only about 10 percent receive it. On average, countries spend less than 2 percent of their healthcare budgets on mental health. 

As the world returns to normal, mental health remains a concern. It weighs on human development in many ways, especially for marginalized communities, such as LGBTQIA+ or people living with HIV (PLHIV). Research worldwide has shown that these communities face more mental health issues because of the stigma, prejudice, and discrimination for being different. 

The post-pandemic world offers us an opportunity to rekindle our efforts to protect and improve mental health. It is aligned with the theme for World Mental Health Day 2022, 'Making Mental Health and Well Being a Global Priority.' 

Here are five ways to ensure that our responses to mental health are inclusive and leave no one behind.  

1. Understanding the psychosocial determinants of mental health 

Gender, sexuality, religion, income, education, etc., contribute to one’s lived experiences and, thus, mental health. For communities like PLHIV and LGBTQIA+, many of these psychosocial determinants are marred by stigma and discrimination, thus significantly impacting their mental health and well-being.  

To achieve mental health for all, it is necessary to understand how these determinants impact mental health and address them through a multipronged psychosocial approach. UNDP is working on developing psychosocial support modules with government stakeholders like NIMHANS. These modules will train mental healthcare providers and frontline workers to counsel the communities on these social determinants and raise awareness on linkages to social protection schemes, jobs, and livelihoods where needed.  

2. Providing services to reach the furthest behind first 

Despite the Indian Mental Healthcare Act 2017 suggesting a rights-based approach to managing mental health, the lack of accessible and affordable mental health services remains one of the biggest hurdles  

The World Mental Health report 2022 notes, “Mental health needs are high, but responses are insufficient and inadequate.” Large-scale studies in India suggest that only 5 out of 100 people with mental health problems receive regular treatment suggesting a high treatment gap.   

This is even more concerning for PLHIV and LGBTQIA+ communities, who already face numerous barriers in seeking healthcare, adhering to treatment, and continuing care due to stigma, discrimination and other social issues they face because of their identities.  

The recent NACO Guidelines on HIV Care and Treatment 2021 has recognized this issue and recommended mental health screening and treatment at various stages of antiretroviral therapy (ART). Similar integration needs to happen across the healthcare system.   

Community-based organizations (CBOs) working among marginalized communities can also be considered to increase mental health services outreach. A wellness centre in such settings can provide a holistic package of services through referrals and linkages to general healthcare, educational schemes, scholarships, skilling development schemes, etc., along with mental healthcare, in an enabling environment. 

3. Keeping community at the heart of research, policy, and programme 

For LGBTQIA+ and PLHIV to have access to and reap the benefits, their voices must be heard and lived experiences considered while designing the programmes. People from marginalised communities best know their challenges, and they can and should be able to lead research and advocacy efforts for themselves.  

4. Making affordability a priority 

There is a need to increase the availability of affordable mental health care services for marginalized communities. Usually, out-of-pocket expenditures on mental health services like medicines, investigations, psychotherapy, counselling, etc., are high, and insurance coverage for mental health care, even though mandated by law limited. While the government can ensure services at an affordable rate, private mental health providers can ensure affordability of services by offering sliding scale models for payments - charging people only what they can afford to pay, determined by their incomes.   

Free helplines and crowdsourced lists of affordable therapists can be another starting point to help people access mental health services. 

ASHAs or Accredited Social Health Activists can also be engaged to provide mental health services. During the COVID-19 pandemic, ASHAs did an incredible job of reaching everyone, everywhere, with information and vaccination. Engagement of ASHAs can ensure communities get access to mental health services closer home.  

5. Make services affirmative of diverse identities 

Sensitizing and empowering mental health service providers on the specific needs of people living in marginalized communities can increase their health-seeking behaviour.  

The Queer Affirmative Counseling Practice (ACP) training by Mariwala Health Initiative is one significant effort in building capacity to respond to the mental health and well-being needs of the LGBTQIA+ community. Blue Dawn is another initiative that links persons from Scheduled Castes, Scheduled Tribes, Other Backward Classes, Nomadic Tribes, and Decriminalised Notified Tribes across religions to affordable mental health services and sponsors.  

In addition, we need more representation of marginalized communities in the health professionals' workforce, as this further builds trust and comfort. 

UNDP is working with SANGATH – a not-for-profit organization – to develop a roadmap to make medical education Trans affirmative so that the communities can access health services free from stigma and discrimination. 

Authors:  

Sangath iHEAR team - Aiswarya S (they/she), Harikeerthan Raghuram (he/him), and Anant Bhan (he/him). 

Chiranjeev Bhattacharjya (he/him), National Programme Manager-Health Systems Strengthening, UNDP India