Radhika Sharma is a trained psychiatric social worker from Mumbai who works as coordinator for Seher, a psychotherapeutic service wing of Bapu Trust, which is also an advocacy agency for rights within the mental health sector. As a part of her work, Radhika has developed keen interest to establish linkages in the micro level service delivery as well as the macro level politics of the mental health sector in the current scenario. She can be reached at radhikainsaan@gmail.com.
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A number of international agreements and documents have attempted to make mental health a visible issue in many ways and through various platforms. The World Health Organization’s Ottawa Charter for Health Promotion (1986) or the 1981 WHO report on the social dimensions of mental health are examples and instances of this effort. However, being a mental health practitioner, the reality I still grapple with is that mental health still stands on the margins of both the health sector and the larger development sector.
It pinches me that in spite of having glaring statistics of the extent to which psychosocial disabilities are amounting and can in future amount to the Global Burden of Disease (GBD), we still choose to label mental health as a luxury issue. “Roti, kapda, makaan” (food, clothing, shelter) as the older Hindi cinema would call it used to traditionally be the “real” concerns. After immense lobbying and advocacy, health has also felt included. The recent additions are disaster management and HIV/AIDS. I am in no way hinting that these are issues that don’t need to be engaged with. All I am saying is that let us at least start acknowledging and accepting issues like mental health as “issue enough” and requiring an immense amount of work at the preventive, promotive and curative levels. While we should try and place mental health in the larger development politics, let us be mindful of the rights-based framework that has to inform work in the mental health sector.
Projections show that psychiatric and neurological conditions could increase their share of the total global burden of disease from 10.5% in the year 1990 to 15% in 2020. It is estimated that by the year 2020, unipolar depression will be the second most defining cause of disability burden in the world. In 1990, it was ranked fourth of fifteen leading causes. The question I really want to pose to the readers is: can we still afford to treat mental health as a luxury? By treating or branding it a luxury issue, we end up turning our backs to the same, which has serious implications at advocacy, policy as well as implementation levels. We are talking here of millions and millions of people worldwide whose functionality is going to be grossly affected by psychiatric and neurological conditions they would be experiencing.
When we begin tracing gender on such a challenging terrain, the task at hand just becomes even more complicated. By gender, I would specially want to imply both the material and symbolic position that women occupy in the social strata along with the experiences that condition their lives.
A report published in 2000 by WHO conceptualizes gender as a powerful structural determinant of mental health that interacts with other structural determinants (including age, family structure, education, occupation, income and social support), and with a wide variety of behavioral determinants of mental health. Understood as a social construct, gender must be included as a determinant of mental health because of its explanatory power in relation to differences in outcome between men and women vis-à-vis differential stressors, resulting disability, different service requirements etc. This leads us to the evidence that the mental health of women is a complex construct of various factors mentioned above and not merely about the “hormones that they secrete” and the “babies they give birth to”.
A recent comprehensive review on gender differences in the epidemiology of affective disorders found that women predominated over men in lifetime prevalence rates of major depression in all the general population studies conducted so far. At the cost of being repetitive, I must reiterate that Murray and Lopez estimate that by the year 2020, unipolar depression will be the second most defining cause of disability burden in the world. In the light of this data, can we guess who will largely comprise of the disability? Of course women!
We thus see how women’s mental health – which is so greatly hidden – needs to be identified and treated as a significant public health issue in our current times. This is an even greater concern in India where mental health services (specially the non-bio-medical ones) are very scarce anyway and a significant proportion of those available do not consider gender as an important determinant of their work.
Talking about women’s mental health is of exceptional importance if at all we desire to facilitate the control women, or other individuals (or members of their communities and families) have over the factors that influence their mental health and overall quality of life. This will help us as a society to construct a system that will improve women’s mental health and its outcomes. Till then, it is a daily struggle from the margins of the margins, towards the center and mainstream.
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References:
- ‘The Global Burden of Disease’, C. J. L. Murray and A. D. Lopez by the World Health Organization, Geneva, 1996.
- ‘Gender Diffère in the Epidemiology of Affective Disorders and Schizophrenia’, M. Piccinelli and F. Gomez Homen by the World Health Organization, Geneva, 1997.
- Women’s Mental Health in India (Art), Aparna Joshi, 2007.
- ‘Women’s Mental Health: An Evidence Based Review’ by the World Health Organization, Geneva, 2000.
- http://www.who.int/mediacentre/factsheets/fs248/en/index.html
- National Family Health Survey 3.
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