Vidhi Writes: How Accessible is Mental Health Services for Indian Women

Studies have shown that prior to the pandemic and even during it, women were more susceptible to anxiety and depression. However, women are less likely to avail mental health services compared to men. Moreover, certain mental illnesses such as post-partum depression found amongst pregnant women are often not part of the discourse of mental health in India. This creates a ‘treatment gap’ between men and women that is not remedied by law or policy for mental health in India.

By Sakshi Pawar, 5 Nov 2021

The intersection between gender and mental health

The World Health Organisation (WHO) defines mental health as the “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” This is supplemented by the WHO’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The definition provides that mental health is an important subset of health. A mere absence of mental illness is not sufficient to ensure the mental health of an individual.

Both definitions clearly imply that the community or the environment play a role in the mental health of an individual. Gender, therefore, plays a significant role in a person’s mental health. It determines the difference in power and control that men and women have over their social position in society.

For example, the gender of a person and the consequent societal and economic pressures can determine the kind of mental illness that may afflict a person. Reports have shown that women are more likely to have anxiety and depression disorders than men, who are likely to have addiction-related disorders. This difference is because women are more often subject to income inequality, gender-based violence and a subordinate social status which takes away their autonomy to make decisions in the face of severe events. This often leads to anxiety and depression in women.

In addition to this, gender also plays a role in the addressal and treatment of mental illnesses and the accessing of resources to ensure mental wellbeing.

Mental health of women in India

A report by the Lancet in 2021, which had conducted studies in USA and UK, showed that during the pandemic, women were at a higher risk of becoming distressed or having severe mental illnesses. A report in India further supplemented this to show that women had suffered a drastic increase in mental health problems.

This statistic seemingly contradicted other data that could affect mental health or serve as an indicator for it, such as the mortality rate during COVID-19, which was noticeably higher for men (all over India and more recently seen in Maharashtra, for example). Men also accessed mental health resources, such as helplines, more often than women in India during the pandemic.

However, the pandemic’s disproportionate effect on women can be attributed to greater female employment in sectors that suffered the most, for instance, tea pickers in Assam saw an increase in mental health problems after they became unemployed or were forced to work under unfair terms for their labour. Women were burdened additionally with caring for their families and children who were also continuously at home, more women suffered from domestic violence, and girls formed the higher portion of school dropouts which affected their mental health.

Additionally, women in India suffer from ‘treatment gap’, as they perceive more stigma and also have difficulty in accessing mental health services compared to men. Therefore, the information on people accessing mental health services in India may not accurately reflect the number of the women suffering from mental problems in India.

This corresponds with research on mental health conducted before the pandemic, as an article in the Indian Journal of Psychiatry in 2015 had stated that women were at a greater risk of having anxiety and depression and were more susceptible to mental health problems. However, the lack of access to resources for these women and perceived stigma had prevented the accurate reporting and understanding of mental health of women in India.

Particularly, one of the mental health concerns facing women in India is post-partum depression and other related issues during pregnancy. India’s National Mental Health Survey in 2016 stated that 20% of the people affected by depression in India were new or expectant mothers.

What are the current laws and policies?

The legislative and policy frameworks set by The Mental Healthcare Act, 2017 (MHA 2017) and the National Mental Health Programme, 1982 (NMHP) are currently used to address mental health problems in India.

The enactment of MHA 2017 paves the way for a rights-based framework for patients with mental illnesses in India. However, the MHA 2017 guarantees a statutory right to easily accessible and affordable treatment for ‘mental illnesses’ only. Mental illnesses are defined under MHA 2017 as a “substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs”. It therefore does not cover a wide range of mental health services such as counselling for mental health problems that do not reach the threshold of ‘mental illnesses’ as defined under MHA 2017.

MHA 2017 is still a progressive legislation as compared to its predecessor, the Mental Healthcare Act, 1987 which emphasised more on the institutionalisation of persons with mental illnesses and did not provide for their rights in detail.

Some of the provisions of MHA 2017 that emphasise on the rights of women with mental illnesses are:

An order of the Supreme Court in September 2021 however reveals that mental healthcare facilities are failing to comply with many of these provisions. There are reports of mothers being denied access to their children, forced tonsuring of women’s hair under the garb of preventing lice infections and no access to sanitary pads for menstruation. The Supreme Court ordered the Ministry of Social Justice and Empowerment to raise these concerns with each state government and provide an affidavit on changes made to remedy the violations by December 2021.

The NMHP, which is the second prong of this framework, works at the grassroot level to ensure access to community mental health services and mental healthcare facilities by increasing the workforce of psychiatrists and persons equipped to counsel for mental health problems. The scope of NMHP is broader than that of MHA 2017 and has been vital in ensuring access to mental health services in rural areas during the pandemic, especially when mental health services were facing disruptions elsewhere in the world. However, not all districts have utilised the money provided under the NMPH or have implemented provisions of the NMHP. Additionally, problems such as post-partum depression and mental health of pregnant women are often overlooked even by the NMHP, despite the fact that they can be easily identified by community mental health workers. This leaves a lacuna for certain required mental health services for women in India.

Our take

These problems can be addressed in a threefold manner. First, the implementation of the provisions of MHA 2017 must be ensured. This will prevent the humiliation of women and ensures their basic rights to safety and hygiene while they are accessing mental healthcare services. Many states in India have still not created the authorities and boards mentioned within MHA 2017. These statutory authorities are empowered to deal with the violation of provisions of MHA 2017 and their absence prevents the effective redressal of violation of women’s rights.

Second, all districts should prepare a district mental healthcare plan which can ensure the utilisation of the budget provided under the NMHP. This allows the district the ability to allocate workers to address issues of stigma preventing women from accessing mental health services or counselling. Third, it also affords an opportunity for districts to ensure that the health care providers are sensitized to and can address issues pertaining to mental health problems of pregnant women, which remains an overlooked aspect of mental health for women in India.

This piece has been authored by Vidhi Centre for Legal Policy’s research fellow, Sakshi Pawar. All views are personal to the author.