ReFrame, a journal by the Mariwala Health Initiative is a platform to challenge existing norms and explore diverse voices within the mental health space — expanding horizons

for who gets to participate in such conversations in an effort REFRAME to firmly ground mental health in a contextual, intersectional, right-based, intersectoral framework. It is envisioned as a tool for mental health practitioners, advocates, activists, scholars, students, experts, funders, government officials and non-profit ISSUE NO. 3 SEPTEMBER 2020 organizations — and those from closely allied sectors.

Beyond Clinical Contexts THE MARIWALA HEALTH INITIATIVE JOURNAL

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Beyond Clinical Message from the Founder Contexts Despite decades of advocacy for affordable and accessible quality services in the sector, the gaps in mental health care have only increased – for want of funds, besides a lack of political will and social awareness, among other reasons. As we all continue to grapple with the COVID-19 pandemic, and people around the world experience heightened levels of distress, compounded by stressors related to food, livelihood, shelter, safety, and basic survival, it is clear that we are ill-equipped to deal with this mental health crisis.

We strongly believe that during such a crisis, funders can actively facilitate the work of their partners

ISSUE NO through instituting changes in procedures related to disbursement, approval, and reporting. Some SEPTEMBER 2020 of the measures that MHI has taken in this regard have included enabling our partners to repurpose funds for COVID-related work, extending grant allotment periods, and minimizing reporting formalities. THE MARIALA HEALTH We have also funded technology upgrades for our partner iCall, a national helpline that provides free INITIATIVE JOURNAL counseling services, enabling their counselors to work from home during the pandemic.

COVID-19 is not just a public health issue but also one of livelihoods, food, security, shelter, and justice. At MHI we believe that mental health is a development issue, and that distress calls for both mental health care and material responses, and so our COVID relief fund has striven to provide food, shelter, medicine – thereby supporting marginalized communities: migrant workers, daily wage labourers, persons with disabilities, homeless persons, persons from the Adivasi/Tribal/Dalit communities, persons living with HIV/AIDS, sex workers, widows, orphans, and persons belonging to the LGBTQ EDITORIAL TEAM SPECIAL THANKS CONTENT ARNING Mentions community. Ara Johannes Devanshi Vaid of suicide, domestic violence, caste-based violence, alcohol Anam Mittra Saisha Manan substance use, ableism Over the last 6 months, we have funded 23 grassroots, community-based organizations across 18 Priti Sridhar ableist violence, child seual Raj Mariwala PHOTOS / IMAGES / ILLUSTRATIONS abuse, homicide, heteroseism, states. With stronger links to communities on the ground, we hope to work, over the next few years, Smriti Nevatia Siddhesh Gautam pg 19 cisseism, abusive relation- not only on mental health advocacy but on structural and systemic responses to issues of economic ships, lynchings and religious Aravani Art Project pg 31 insecurity and instability arising from COVID. DESIGN & PRODUCTION violence, seual violence, Shrujana Shridhar pg 59 seism, death penalty, natural Studio Kohl disasters and disaster-related studioohlcom PRINTED BY losses In the case of material Our commitment to funding mental health intensifies each year. We have grown from having 8 Print Palace being triggering or upsetting, partners last year to 19 as of today – expanding into new regions, and funding new interventions TYPEFACES 022 2687 2276 you can reach out to iCall at that align with our values. Today, more than ever, we are seeing how mental health intersects with 9152987821 or icalltissedu Playfair Display by Claus Eggers Srensen and influences other areas of development, including education, health, social justice, livelihoods, Roboto by Christian Robertson PUBLICATION DATE employment, among others. Therefore, I urge decision-makers in the CSR space, as well as September 2020 ICONS institutional donors and philanthropists, to explore how they might integrate components of mental Courtesy The Noun Project PAPER health care within existing development programs that they fund or implement. Institution by Popular Printed on Munen Polar Rough Community by Adrien Couet CREATIVE COMMONS Thank you! Government by u Luc Fist by Maim Kuliov Attribution-NonCommercial- ShareAlike 4.0 International Medical by Aybige RECYCLABLE CC BY-NC-SA 4.0

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Little did we know that the theme we chose for ReFrame this year – mental health beyond clinical be used to grapple with the heritage of psy-disciplines. Talwar talks of using therapy to dismantle contexts – would take on a special significance due to the global pandemic. With accessing mental oppression, Joshi and Maneckshaw of queering therapy, Nair elaborates on the subversive health care in institutional settings becoming a more risky proposition than usual, much of therapy possibilities of peer counseling, Jena examines the role of neoliberalism in MH, while Mathias et al and clinical practice have shifted to phone or video. In the opinion of many influential voices in outline resilience in rural MH. the field of mental health, the COVID disaster has led to more discussions on MH, reflecting a The second section, ‘Contexts’, explores the counter-narratives that come from lived experiences, reduction in stigma but also an expanded mental health crisis. such as Chatterjee’s piece on native queer subcultures, Jadhav’s on song and customs as agents I believe India, and many other parts of the world, were in an active state of MH crisis even before of MH in slums, and Khalid’s on the importance of vulnerability in rebuilding therapeutic spaces. the pandemic. Whether in Hong Kong, France, Lebanon, USA, Sudan, Chile, UK or India, civil rights The other pieces in this section inform us about the power of poetry, palliative care, and MH care movements had been protesting against inequality, political repression, human rights violations, centering the deaf community, or address issues around MH in toxic workspaces, legal settings, restrictions on labour unions, climate change, the usurpation of land rights, and the erosion of and over phonelines. democracy. Such dissent was and continues to be met with clampdowns, surveillance, violence, What does challenging traditional mental health legacies look like in practice? The third section, incarceration – and a further attrition of rights. These traumatic and turbulent experiences can and ‘Engage’, brings us on-ground examples: teachers in Darjeeling as agents of change; relooking do spark severe distress. In India, the new citizenship laws, the state-sanctioned violence against at spaces of child and adolescent care in Sri Lanka; psychosocial support in drought-hit farming students inside university campuses, and the Delhi riots have resulted in widespread uncertainty, communities. On the other hand, Atal writes of looking at support beyond geographically defined fear, and other stressors, with severe psychosocial consequences. communities, while Chakraborty and Kaikobad speak of how body-based approaches to MH may Stigma and discrimination of various kinds have arisen or continued during the pandemic: offer a powerful counter-narrative. the attacks on frontline health workers, no matter their expertise; the scapegoating of entire Although I began on a note of surprise at the relevance of this year’s theme, it is important to clarify communities, as in the instance of Tablighi Jamaat; using Covid to propagate transphobia; the that most of the articles are not COVID-specific. This, one may hope, serves to underline the long- common use of racist terms like “Chinese virus” to target persons from North East India. The term importance of their ideas and concerns – even as some of the solutions being proposed in discourse on suicide has also been problematic, especially in mainstream media, which have the here-and-now (outside the frame of this journal) involve technology, artificial intelligence, or largely failed to address the pervasiveness of ableism and of discrimination against persons with applications to address MH issues. Many such apps, with their focus on diagnosis and intervention, mental illness. combine a biomedical approach to MH, neoliberal capitalism and digital surveillance in startling Using the clinical heritage of asylums, MH is still being weaponized – most clearly, in the case of measure. The start-up culture, along with an overriding focus on cost reduction, has meant Dr Sudhakar Rao, a Dalit doctor who was incarcerated in a mental hospital after protesting the outcomes that range from re-traumatization, and inappropriate chats from text-based counseling shortage of N95 masks for doctors. The emphasis on the “normality” of feeling anxiety during volunteers, to sharing data with platforms like Google and Facebook without clear disclosure COVID, of deciding what is normal or abnormal, is still rooted in psy-disciplines – while the self- clauses in privacy policies. Many online platforms allow users to engage with hashtags, and to care, routine and meditation, so widely prescribed, maintains a problematic, neoliberal focus on explore ideas and articulate experiences around mental health. There is much to unpack here, the individual. with the digital divide affecting the accessibility of such spaces even as the subversive potential of virtual community-building might help in the endeavour of setting up socially just systems of care. There is no doubt that the mental health crisis is intensifying with rising unemployment, economic hardship, lack of food security, domestic violence, and interrupted education for many – making it amply clear that MH is also located within economic, environmental, sociocultural, and political contexts. And recognizing how intersections of poverty, casteism, misogyny, and other forms of violence impact MH impels us to affirm that advocacy for mental health is part of advocating for rights and social justice. This also means engaging with the clinical heritage of psy-disciplines as it mirrors dominant narratives and actively propagates structural inequalities. In accordance, then, with this year’s theme of looking beyond clinical contexts, the journal is divided into three sections. ‘Re-vision’, the first section, reflects on frameworks and constructs that can RAJ MARIWALA RE-VISION

They call it ‘depression’, while you call it survival from oppression. They will feed you pills to cure social ills. Medicate injustice. Remember they once labelled runaway slaves as mentally ill for desiring freedom. SANAH AHSAN Poet, Psychologist Words from 'Decolonising Distress' @sanah_ahsan RE-VISION

Beyond Clinical Contexts Re-Vision Clinical Legacies and Counter-Narratives 3 Creating Safe Spaces within Legal Settings 55 Therapy as a Tool in Dismantling Oppression 13 Mental Health Helplines 58 Resilient Practices for Mental Health in Rural and Urban Uttarakhand 18 Mental Stress: The Toiling Class in Slums 61 The Neoliberal Project: Mental Health and Marginality in India 21 Queer Possibilities 25 Engage ‘I Get You’ 28 Teachers as Agents of Change 67 A Home Away from Home 72 Contexts An Approach to Dance Movement Therapy (DMT) 75 Relocating Mental Health Conversations to Native Queer Subcultures in India 33 Communities of Practice and Women’s Mental Health 79 Rebuilding Therapeutic Spaces 38 Seeding Wellbeing in Drought-Prone Regions 82 What Kind of Interventions Do We Need Now? 41 Making Your Days Matter, To The Very End 44 Partners 85 'Knife of Insight' 47 101 An Invisible Intersection: Mental Healthcare for the Deaf Community 51 Glossary & References

We aim to highlight a variety of topics and voices but will not be able to be exhaustive in our material. The views expressed in ReFrame are those of the contributors and not necessarily those of Mariwala Health Initiative. Articles are accepted in good faith and every effort is made to ensure accuracy. RE-VISION

Re-Vision HOW do we have DIFFERENT CONVERSATIONS about MENTAL HEALTH? What are the ways in which we can COMPLICATE clinical or community based mental health frameworks? How do we look beyond the binary of clinical and community? How do we understand power relations between lived experience or expert in these spaces? And how do they learn from each other to SUBVERT or CHALLENGE in a way that shifts the focus from the INDIVIDUAL to the COLLECTIVE, to STRUCTURES and SYSTEMS?

Constructs Frameworks Power Structures

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HUMAN RIGHTS

SEGREGATION HUMAN RIGHTS ABUSES NORMS

Clinical Legacies and The ISOLATION Counter-Narratives Asylum

To move from oppression in The history of modern psy-disciplines 1247 is firmly rooted in the spaces called psy-disciplines, we must look toward Bethlem Royal Hospital (or Bedlam) was founded “asylums”, or mental hospitals.2 The idea in London for the confinement of persons of earmarking space for the containment histories and marginalised BY Amalina Kohli Dave, considered “mad”. of distress saw both public and private Raj Mariwala communities institutions providing treatment or Asylums soon became common in Germany, incarceration of those deemed “insane” or France, the Netherlands and Spain. unmanageable by their families.3 Those sent, thus, to asylums included the poor, The fields of knowledge associated tracing the heritage of mental health sex workers, unmarried pregnant women, 1400 with mental health have come On the basis of social norms, dissenters, people with physical disabilities under scrutiny for human rights psychiatry solidified the creation Establishment of for-profit asylums but also or epilepsy, and those deemed immoral.4 violations, incarceration, their lack of a normal/abnormal, which is charity/religious institutions that were asylums, of patient-centered approaches what many experience as stigma prisons, or workhouses, for “lunatics”, “criminal and emphasis on productivity, today. Psychiatry also enabled the lunatics” and “pauper lunatics” respectively. besides ethical concerns around idea of segregation as safety for This confinement, and thereby silencing, of pharmacology. Although social communities and societies — and in individuals in asylums was often used as a social inclusion and community MH are the tracing the legacy we can see that the disciplining tool. proposed panacea for oppression intention was never to define illness by psy-disciplines, we may neither but to protect social order. Such spaces were not run by trained doctors or validly imagine “community” as experts, but largely by priests, physicians, even a caring monolith, nor presume entrepreneurs.5 that mainstream communities The power relations between patients and do not reflect clinical heritage. Psychiatric "Milestones" Clinical Legacy caretakers or “experts” in these spaces were To explore ways of moving away clearly demarcated and strictly enforced. from replicating the prevalent The Asylum Segregation, Human Rights Abuses, oppression, we must look at the Norms, Isolation history of psychiatry and learn from 1700 marginalized communities.1 Defining 'Normal' Treatments, Men in Power, Science and 'Mad' Custody often meant violent restraint with chains, straitjackets, and other forms of coercion, to Building Diagnoses Sociopolitics, Laws, Classifications prevent “antisocial behaviour”, or self-harm.6 The underlying concept was of separate spaces Morality, Profit-Making Normalisation, Industry, Lack of to “cure” persons not conforming to societal and Pharma Government Responsibility standards of behaviour, including non-participation in the economy.

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Defining TREATMENTS MEN IN POWER SCIENCE Building SOCIOPOLITICS LAWS CLASSIFICATIONS 'Normal' Diagnoses and 'Mad' 1795 1800 Asylums allowed for the study of In 1883, German Emil Kraepelin, who behaviour that was seen as “abnormal” or The colonialist propagation of the system saw the is often called a pioneer of psychiatry, In an attempt to undertake an “intensive study unproductive, of distress and madness, first asylums in present-day India established in published ‘Compendium der Psychiatrie’, of insanity”, Jean Etienne Dominique Esquirol as individual, personal phenomena. It Calcutta, Kilpauk, and Munger.8 a classification of mental illnesses based founded an asylum in Paris. was in these spaces that the building of on his clinical observations of patients in psychiatric knowledge began, and the self- German asylums. His mirroring of socio- fashioned experts in charge experimented 1800 political prejudices is evident in his theories 1805 with and enforced treatments to cure about the genetics of psychiatric disorders Treatments using seclusion and punishment were He published as a book called “The passions incarcerated persons.7 In this way, asylums in Jewish people; he also proclaimed linked to stereotypes of mental illness as violent considered as causes, symptoms and means of gave birth to psychiatry, which soon had that both, opponents of World War I and and dangerous, requiring exclusion.9 cure in cases of insanity". the monopoly on the definitions of both socialists, were mentally ill.11 “normal” and “mad”. By the late Victorian period, theories around the biological and hereditary nature of madness were 1838 becoming popular.10 Esquirol drafted the ‘Law of June 30th’, the first of This biological/medical framing of the discourse its kind on the rights of the mentally ill.12 contributed to the idea of psychiatry as neutral, objective, and scientific. This French law was later used as the basis for similar laws in many other countries.

1858 Britain introduced the Lunacy Act for establishing asylums and admitting inmates, with the Inspector General of Police in charge.13

1883 Introduction of the terms schizophrenia, manic- depressive psychosis, paranoia. Kraepelin’s classification system: the basis for the Diagnostic and Statistical Manual of Mental Disorders, and the International Classification of Diseases.14

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NORMALISATION INDUSTRY

Morality, LACK OF GOVERNMENT RESPONSIBILITY Profit- making and

1850 community mental health networks are often missing. Years of We may understand these histories Pharma One of the premises of exclusion and stigma, with mental of exclusion and incarceration of The scope of psychiatry broadened to include deinstitutionalization, and the illness popularly associated with people with mental illness, and the The 19th century also saw the advent of milder disorders – such as ‘nerves’, ‘neuroses’, subsequent shift to community violence and danger, mean that living perception that people who are an alternative approach. “Moral treatment” ‘English maladies’ – not requiring confinement to MH, is that people can recover within mainstream communities unproductive, or queer, are threats advocated that patients would benefit from asylums. from illness when support services has, for many, been vexed. (While to the social order, as a kind of being treated humanely and like “regular Large public hospitals were built in many parts of function in tandem with the public perception is that persons “moral panic”: "A condition, episode, people”. Patients were expected to follow the Western world – providing treatment, work, sustenance and stability of families, with mental illness perpetuate violent person or group of persons emerges social norms, eat and talk politely, and and housing for patients. social networks, and communities.21 crimes, research shows they are more to become defined as a threat to perform basic tasks.15 The focus was on Coinciding with activism from likely to be victims of such crimes.24) societal values and interests; its the individual, in whom rational behaviour As stigma around “insanity” increased, the affluent user-survivors of mental health, the nature is presented in a stylized was encouraged using rules and rewards, began sending family members to asylums abroad legacies, and passing as normal deinstitutionalization narrative rings and stereotypical fashion by the supervision and punishment.16 Restraining or sanatoriums in spa towns.17 Community or public spaces can, with notes of liberation, human rights, mass media; the moral barricades methods and physical punishment were then, be hostile, perpetuating and ethical user-centered care.22 are manned by editors, bishops, relied on less widely. violence, discrimination, and stigma. politicians and other right-thinking 1920 However, many lived experiences The legacy of marking, removing, people; socially accredited experts of community MH testify to critical confining those who disrupt social Lucrative private clinics and facilities began to pronounce their diagnoses and gaps. The lack of specialized MH norms means that expressing appear, both for “curable” patients and for those solutions; ways of coping are spaces, and abdication by, or limited distress, or one’s gender, class or institutionalized for longer periods. evolved or (more often) resorted discharge of duties and funds from non-conforming behaviour, may to; the condition then disappears, With overcrowding, poor funding, and methods government apparatuses have lead to exclusion in public transport, submerges or deteriorates and like electro-convulsive therapy (ECT) and insulin meant minimal housing support, workspaces, neighbourhoods. becomes more visible.27" In this treatment,18 asylums remained violent spaces of employment assistance and other Attempts to “pass” or look “normal” context, the influence of mainstream incarceration. safety nets. Combined with the can be difficult, due to markers such morality on psychiatric treatment, carceral justice system, this has as twitching caused by medication, which then encourages “passing”, resulted in many persons with mental different time patterns because of is not surprising. Moral panic may 1950 illness being homeless, or in jail.23 lack of work, unconventional dress.25 stay in collective memory or have Public spaces can prove especially Idea of deinstitutionalization — better chances of Further, notions of “community” are long-term legal, social, political hard to negotiate for those who recovery and quality of life, if patients were treated themselves vague. Is community to repercussions. The gay or trans transgress as a result of their gender, in their communities (instead of asylums).19 be found in public spaces? families? panic legal defenses in America, sexuality, or other marginalizations neighbourhoods? workspaces? racially biased murders of Black men, Asylums being replaced with community mental – which often have a domino Community MH is reflected mainly and police killings of persons with health: facilitated by low government budgets, effect on the transgressor’s access in day care centers, community mental illness in public spaces are psychopharmacology, and protests against human to education, employment and MH clinics or services, and health all emblematic of an ingrained moral rights abuses.20 healthcare services.26 workers, while actual social support panic.

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Curricula Hospitals, Top-down Experts, who based on clinics, Clinical pathologisation Science/ need privilege classification institutions, Mental Mental and structural men in to access this of those in Mentally ill therapy rooms, Health Biomedical disorders Treatment Cure oppression power knowledge asylums persons tertiary care

Clinical & community Psychiatry are approached as a neat binary, but GOAL SITES

both are linked to the FOCUS POWER POWER TRAINING EMPHASIS

asylum. APPROACH AUTHORITY ! PERSONNEL TARGET GROUP TARGET Asylum POWER DYNAMIC POWER

Ranges from Support for Ranges from Ranges from Maintains Men in power "Laypersons", Derived Persons Geographical Community biomedical to mental health treatment to recovery to systemic who may from psy- with mental spaces: districts, Mental psychosocial care support privileges of need social disciplines illness/ villages, Health race, caste, networks to psychosocial neighbourhoods, gender, class, access such disability homes, primary sexuality, ability a role care centers

Studying those incarcerated in asylums meant challenges re-vision that psychiatry wasn’t based on illness but on • Task shifting echoes the clinical • Displace traditional authority (medical and community) Mental Health social hierarchy. This solidified and propagated the • Communities are unsafe spaces for structurally • Critically examine knowledge systems categories of normal and abnormal. The violence oppressed persons • Lived realities from the margins as valid sources of of the asylum/clinic is easily seen, but, when we • Access to MH in communities influenced by social location knowledge for All propose community mental health as a solution, • Who will address carceral systems & homelessness? • Look towards support and care systems in marginalised how do we account for the fact that the asylum • Provision of community MH influenced by social location communities reflected dominant narratives within communities Eg: In almost 3 of 4 villages, Dalits are denied entry to • Understand MH in terms of privilege and oppression themselves? non-Dalit homes (The Hindu) • Build systems for the margins • Is inclusion possible without intersectionality in practice?

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One must be cautious of replicating the same top-down biomedical power-hierarchies of the asylum, and obscuring them with the rhetoric of community and deinstitutionalization.

While community MH might reside and take on many meanings. At the a particular location, and uses the own experience, and make decisions of privilege and oppression also in different spaces, the influences of center of this new narrative is the shared experience and relationality as about what kind of support best suits lets us question whether the most the asylum and psychiatry operate individual – no longer the subject/ the foundation for support that fills a their needs – making for a more visible MH services and narratives in mainstream spaces as well as object of the discipline of MH, but gap in existing MH systems. holistic and inclusive space. are also the most privileged ones. In homes, hospitals, workspaces, as the narrator of their own lived challenging mainstream conceptions Such spaces can challenge the linear, identity as a site for mental health systems of transport. What, then, experience. The aim of constituting of MH, counter-narratives from the ableist, and sometimes carceral Since community-led interventions does recovery or cure look like? An counter-narratives as a specific “site” margins become a valid critique approaches in MH practice. They can hold the potential to deinstitutionalize absence of distress? Or distress is not to do away entirely with more of the power systems that may be counter the belief that an officially and diversify the field of MH, it that can't be singled out? Are there traditional understandings but to reproduced within that mainstream. designated and controlled space is is important to understand just community spaces where passing create an expanded ecosystem of necessary. They also critique the where communities come together. It is crucial to acknowledge histories, or invisibility may not be required for not just institutional frameworks, but trajectory of MH, distress, and healing Identities gain significance here: power structures, and the complicity safety? As significantly, are there MH also coalitions across disciplines, in the “legitimate spaces”, centering several community-based, civil of psy-disciplines in propounding spaces that offer counter-narratives communities, and movements. lived experience over pathology. In rights movements come from and propagating the “normal”. to legacies of the asylum? It may be helpful to think of a the mainstream sphere, for mental shared identity spaces, often While the idea of community MH challenging legacies space not only as a demarcated illness/distress that is either chronic, with shared lived experiences may lead to closures of asylums, MH has, in the past few decades, physical area, but also as abstract. lifelong, or recurring, the approach and marginalizations. We need to the violent heritage of the clinical been moving out of brick-and-mortar Which is not to suggest that it always consists of diagnosis <> acknowledge identity as a site where continues to operate in the carceral institutions, and adapting to less exists only theoretically, but rather prognosis <> intervention. The distress and conflict can occur, due systems, in public spaces hostile overtly clinical community spaces. as something allowing for various intervention is meant to correct an to lack of resources, discrimination, to the homeless, and mainstream And yet, we must be cautious not kinds of embodiment and meaning inherent deficit or “abnormality”, historical disenfranchisement; and community spaces that subscribe to replicate, in the newer sites of – not necessarily bound by the thereby leading to “recovery”. that these very sites of identity are to the clinically defined “normal”. We mental distress and care, the old walls of an institution, or by the There is no conception of what MH where individuals seek solidarity, must look to other spaces, different top-down biomedical approaches pillars of established approaches. might mean outside of these rigid form support networks, engage sites, to examine our approaches and power hierarchies of the An online support group for people parameters, but abstract spaces in advocacy and shared dissent. more critically, even as we strive to asylum, obscured by the rhetoric of with disabilities is, for instance, expand on this limited interpretation, Whether persons come from queer/ deinstitutionalize MH. To counter the Amalina Kohli Dave is a mental health community and deinstitutionalization. an abstract space – a possible letting us think about MH as a series trans identities, marginalized religious biases that were the foundation of activist and user-survivor who has One way to challenge the likely alternative to a physical space with of practices, associations, coalitions, identities, or communities formed the clinic, we must look constantly organized queer MH discussion groups, reproduction of asylum scripts is to limited accessibility. Art therapy is support networks and systems that through shared experiences of to spaces that have been engaged in and co-hosted a series of workshops engage with sites of such counter- abstract in that it often exists outside collectively contribute to a person’s chronic illness or disability, such MH support outside of the clinic, and about MH in theatre. She has also started narratives and not only shift the both, designated clinical spaces and well-being. Traditional medical identities sharply reveal how broader be guided by their value systems. ¤ support groups for people with chronic discourse from the biomedical to mainstream biomedical practice. power/authority is displaced, creating power equations may affect people’s illness. the psychosocial, but also alter Peer support networks are abstract room for an individual to express mental health and well-being, as the spatiality of MH – letting it be spaces, too, based on the intangible what they see as ideal outcomes, well as access to MH resources. Raj Mariwala is Director, Mariwala Health conceived of in multiple dimensions function of being a peer who shares articulate their interpretation of their Perceiving MH and distress in terms Initiative.

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HUMAN RIGHTS Therapy as a Tool in Dismantling Oppression

Working with the political in the personal in clinical practice BY Gitika Talwar

Can therapy align with activism to Eurocentric MH practices. Therapists3 as the relationship between dismantle the influence of oppressive must strive to understand injustice family and work), an exosystem systems, including casteism and and oppression, and be explicit about that indirectly impacts them (the heteropatriarchy? Could mental their stance against these. When MH physical environment) and a health professionals be more vocal theory meets liberation psychology, macrosystem of cultural attitudes within and beyond the clinic about therapists can influence and change and ideologies (casteism, for our anti-oppressive values in order systems that are unacceptable, as instance, or patriarchy). Revisions of to become allies in the fight for opposed to adapting to systems the model included a chronosystem liberation from oppression? This because they are typical. Within the (lifelong events, historical events). paper reflects on how therapy could framework of feminist therapy, for Oppressive ideologies maintain be a tool to fight oppression by instance, a survivor of domestic structural inequalities through their prioritizing “collective multisystemic violence is supported in seeking a influence over the macrosystem and resistance and new realities” over life free from violence. The therapist, exosystem: casteism makes it harder “individual Eurocentric symptom then, adopts an explicit position for people to access education reduction”.1 by communicating that violence is and safe livelihoods; Hindutva unacceptable, and that responsibility homogenizes neighborhoods by The Eurocentric model of mental for violence lies with the perpetrator. preventing religious minorities from health tends to be deficit-based, and living there. uses diagnostic labels to describe A liberation4 psychology framework a user who, in turn, is expected to acknowledges a multilayered Mainstream therapy, which be “treated” by an apolitical, value- ecosystem. According to Urie focuses on surviving the trauma neutral and ahistorical therapist. Bronfenbrenner who originally of the ecosystem, and prioritizes Consistent with the writings and proposed this ecological framework individualistic emotion along with activism of its founder, Latin- in the ’70s, an individual is problem-focused strategies of American social psychologist Ignacio embedded in a microsystem (family, coping, might lead to a counter- Martin-Baro,2 liberation psychology friends, work, school, and so on), productive response to oppression, runs counter to the kind of “neutrality” a mesosystem of relationships one that implicitly blames the typically adopted by mainstream within their microsystem (such victim—as with failure seen as a

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Problem focused strategies of coping, such as compensation and empowerment, also prioritize an oppressive system at the cost of those trying to survive it. BRONFENBRENNER'S ECOLOGICAL THEORY

result of not trying hard enough. would be embedded in a feedback- anxiety about failing medical school When the focus of change is limited informed framework where the due to her inability to focus on to the individual’s microsystem, therapist and user are both experts her studies.8 During our sessions therapy risks becoming a tool for who co-create healing by developing she processed how classroom chronoverse Dimension of Time people to adapt to their oppression a vision for change. The therapist is discussions about health disparities by either denying the influence of the MH expert, whereas the user is perpetuated racial stereotypes, macroverse Overarching beliefs this oppression or disengaging the expert of their own experience. and the similarity between the and values from it.5 A therapist’s silence around The therapist actively seeks racist assumptions made by her oppressive systems that impact feedback from the user about their classmates and by other healthcare exoverse Economic System + the user reflects such denial and therapeutic alliance, and facilitates professionals. While she experienced Political System + Education System disengagement while, significantly, therapy accordingly. Additionally, the rage, her professor and classmates + Government System + Religious avoiding discussion of how the therapist vocalizes a commitment upheld an “objective” (read: devoid of System therapist’s own privilege impacts the to liberatory/anti-oppressive values feelings) stance, rendering her mute mesoverse Family < > School < > therapeutic relationship. Problem- through messages within and beyond and making her question whether Peers < > Religious Affiliation < > focused strategies of coping, such as the clinic, through, say, an engaged she could succeed in medical school Workplace < > Neighbourhood compensation and empowerment, social media presence, or active if “mere class discussions” affected also prioritize an oppressive system collaboration with organizations that her in this way. Validating her rage you micro Family School Peers at the cost of those trying to survive address structural inequalities. created a safe space for her to Religious Affiliation, Workplace, it, for instance Dalits working doubly acknowledge the impact of racial In my therapeutic work I also Neighbourhood hard to get what a Savarna has by microaggressions. I invited her to micro integrate a toolkit for people of virtue of unearned caste privilege. use her feelings as feedback about color6,7, a line from which is central her values. Actively celebrating her meso I propose a liberatory therapeutic to my work: ‘The system does not family’s excitement and support framework in which the therapist get to determine your worth, dignity around her career goals, and recalling would collaborate with the user to get and humanity.’ These words serve exo her ancestors who had not had the in touch with feelings that highlight as a reminder to create space opportunities she did, added a greater how their ecosystem traumatizes between one’s self-concept and sense of meaning to her education them and how it undercuts their the messages communicated by macro and enlarged her perspective in ways sense of agency. Secondly, the oppressive systems, thus protecting that acknowledged racism but did therapist would use a strengths- oneself from internalizing oppressive chrono not center it. She articulated the based lens to celebrate resilience, messages while persevering towards hope for better discussion about and amplify the user’s efforts to liberation. health disparities, and a vision advocate for change as well as liberatory framework in action for working towards an equitable develop stamina for the process of A 23-year-old cisgender Sikh- healthcare system. We discussed sociopolitical change. Such therapy American woman presented with ways she could connect with

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RESEARCH Resilient Practices for Mental Health in Rural and Urban

professionals who shared her vision allows the celebration of joys and and might serve as role models. Our strengths associated with one’s Uttarakhand collaborative therapeutic work is community and takes it beyond focused on supporting the steps she the trauma-focused lens within takes towards a career in healthcare, which it is otherwise framed. As Building on community resources in BY Kaaren Mathias, Meenal ensuring that instances upholding Audre Lorde10 puts it, ‘Caring for Rawat, Pooja Pillai white privilege do not lead her to myself is not self-indulgence, it is crisis and disaster question her own values and dreams. self-preservation, and that is an act of political warfare.’ In the face background This article outlines key practices locations in the hilly rural district of therapy as a radical act of self-care of ideologies that prioritize the In times of adversity or crisis, such for self-care and MH as described Uttarkashi. We built on the concept of A liberatory framework could perceptions of the privileged and as the current COVID-19 pandemic, by members of communities in community asset mapping, defined make therapy more relevant to delegitimize the experiences of the global mental health has traditionally Uttarakhand state, North India, who as ‘documenting a community’s communities that are, otherwise, oppressed, entering a therapeutic focused on documentation of are disadvantaged by prevailing tangible and intangible resources, silenced by an MH framework that space that validates and even increased mental distress, and global and local social, economic and focusing on strengths as assets to pathologizes their valid response to celebrates liberation becomes a service delivery for affected persons. political structures. preserve and enhance, not deficits to oppression. For instance, a strategy radical act. ¤ However, it may be more pertinent to be remedied.’10 like mindfulness can help restore the study identify determinants of community communities fighting oppression by A qualitative study8 was carried out findings mental health, and strengthen centering their voices in the research as part of a larger MH community We summarize here the key findings existing coping strategies.1,2 Mental and development of mindfulness assessment project of the Emmanuel – seven practices for positive MH – health (MH) programs typically fail curricula.9 Correspondingly, Hospital Association that includes a with illustrative verbatim quotes. to build on available health assets,3 privileged communities could use study of factors central to recovery responding poorly to specific such emotion-focused strategies to for people with psychosocial • Spending time in nature and contexts and needs.4,5,6 By describing build their stamina for listening to, disability (PPSD).9 with animals To soothe distress, Gitika Talwar (PhD) is a Community- the resources of communities, we rather than disengaging from, the several participants sought natural Clinical Psychologist and Immigration acknowledge them as experts, active Community health workers impact of oppression. For instance, surroundings, and animals. This Advocate. In India, she worked as agents for their own health. purposively selected participants Savarna privilege continues to be required agency in contexts that a therapist and MH advocate with who were seen as thriving despite deeply embedded in the Indian “Resilience” refers to individuals’ limit freedom of movement for Bapu Trust, and as a counselor with adverse circumstances. The context (including the diaspora), and capacities to achieve wellbeing and women. Some urban participants Aanchal Trust, an LBT support group. Burans team conducted in-depth liberation from the caste system thrive despite significant adversity. described sitting on their roofs or in Subsequently, she was a Psychologist interviews, collecting data from requires Savarnas to respond to The concept merits consideration the courtyard in the mornings and with Cowlitz Tribe, serving the urban PPSD or caregivers in 8 informal feedback with readiness for change. not only in crises such as the present evenings, as well as engaging with Native American community in Seattle. urban settlements on the fringes of one, but also given the hardship-filled animals; rural participants spent Therapy can be geared towards She currently serves the student Dehradun city, and a mix of PPSD daily lives of so many in India.7 time in the fields, or going with thriving, alongside fighting community at a Washington state and other community members in 12 others to cut grass or firewood: oppression. A liberatory framework university.

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Existing assets in communities carry many implications for MH at individual, social, and environmental levels.

‘We go with 8 or 10 women and (44-year-old woman, PPSD, peri- their mental health and wellbeing: The COVID-19 era and its inevitable resilience resources too, providing Kaaren Mathias is a public health take food with us and half the day urban Dehradun) daily exercises with YouTube videos; long-tailed aftermath present a opportunities for learning and social physician, researcher, and Director of we look out at the scenery and take lingering over their morning chai. A critical opportunity for global and connection, such as the Dharavi Dairy • Contributing to the community Burans, a partnership initiative working rest and talk and half the time we caregiver with many stressors said: South Asian MH programs to set up in a Mumbai slum.19 Narratives emerged of sharing with communities for mental health cut grass. If we were feeling sad this ‘When I am feeling troubled, I take examine determinants of community resources or information, or helping One way to develop personal skills in Uttarakhand, based in Herbertpur makes us feel fresh again.’ (35-year- time to sit in the fields for a while, resilience (as was done after the others, for instance when one in MH is through co-producing Christian Hospital. She is inspired by the old woman, Uttarkashi district) and then I can come home and start 2008 tsunami in Asia), and build PPSD takes another to hospital programs to build resources resilience, strengths and collaborative work.’ (40-year-old man, carer of on ethno-cultural practices already • Social connections Several spoke and shows them how to access and resilience with community action of communities, and works for person with disability, Uttarkashi) located in communities with a view of conversation and company care. This might work individually members20 such as traditional equity in mental health in Hindi-speaking to developing grounded interventions helping them feel lighter. One or collectively – as when groups • Focus on positive thinking Some healers, ASHA workers21 – ensuring North India. and strengthening existing coping participant described her come together to discuss issues: spoke of choosing to turn away the participation of people with lived strategies.13,14 This dialogic approach telephone conversations as almost ‘This is one thing in the village that is from negative thoughts, and experience of psychosocial disability, Meenal Rawat is currently working as could increase partnerships, and vest prophylactic: ‘I also like talking to good, if someone is sick then we all actively seeking positives (“benefit- and engaging community peer Research Officer with Burans in Dehradun. agency in people who are typically people on the phone. Early in the discuss and then others will come to finding”)11 – gratitude for family support for PPSD.22,23 All initiatives of Through her research she is exploring excluded.15,16 morning, the first thing I do is call support them and will cut their grass members’ good health, for instance, this nature would, of course, require questions surrounding mental health in my mother. The entire day goes for them or take them to hospital. amid their own recent loss of implications resources and implementation at the rural hilly terrain of Uttarakhand. She well if I talk to her first thing in the We also come together for a festival employment. There was critical Existing assets in communities every level, from rural panchayats to has an MA in Public Policy & Governance morning. On days I do not talk, I feel and each household contributes and reflection around this approach: carry many implications for MH at the various concerned Ministries. from TISS, Hyderabad. Her research very burdened.’ (44-year-old woman, we all feel good.’ (30-year-old man, ‘Negative thoughts will not make individual, social, and environmental interests include mental health, disability, conclusion PPSD, peri-urban Dehradun) health worker, Uttarkashi) the problem go away.’ (60-year- levels. The Government of India must intersectionality in health care, and social Recognizing mental health assets, old woman from low-income recognize that MH is predominantly policies. • Choosing activity over despair • Practising religion Some spoke of and adapting and broadcasting settlement, peri-urban Dehradun) determined by social, economic and Work, or being active, appeared as being spiritually engaged, describing existing practices employed by environmental factors outside of the Pooja Pillai is a Project Manager with a key strategy. Meaningful work, their belief in God’s presence in discussion individuals and groups, is essential health sector, and build supportive Burans, a mental health professional household tasks and income difficult times, and practices such Practices such as these seven, to build the collective imagination of environments for MH into all working among low-resource generation ranked high in helping as daily visits to places of worship, followed by community members community MH practitioners, policy policies.17 Such an approach could communities in North India. She uses reduce negativity and sadness. as sources of solace: ‘I feel relaxed in Uttarakhand, exemplifying makers, researchers and funders, and improve equity as well as mental her biomedical science and public health Adopting regular routines was and my mind is at peace when I pray established therapies widely used ultimately to support the growth of health outcomes.18 For instance, background to lead the Burans Dehradun integral to this practice. Participants or seek God’s help. I worship for my by MH practitioners, besides newly mentally healthy communities. ¤ if street and park urban design team in their work among people with described navigating between hope, longer life and wellness.’ (57-year-old emerging ones such as seeking maximized access for low-income psychosocial disability. She is passionate hard work and despair: ‘I feel that woman, PPSD, Uttarkashi) time out in nature, are almost communities to plants, animals, and about learning more about how gender hard work is all we have. We have to undocumented in low and middle natural environments, this could and mental health interact, alongside keep our spirits up, keep believing in • Choosing to practise self-care income settings.12 enhance mental health for many. other social determinants of health. our heart, and not commit suicide. I Others talked about consciously Other urban structures could act as do think about suicide sometimes.’ pursuing activities that worked for

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HUMAN RIGHTS The Neoliberal Project: Mental Health & Marginality in India Neoliberalism has aided in the dubious re-organization of the subjective,

psychological self BY Zaphya Jena

neoliberalism as paternalism of individual-level mental illness); and late capitalism, been replaced with The increasing prevalence of mental the prescription of free psychotropic the marketization and privatization illness amongst Scheduled Tribes drugs. These frameworks involve the of health, regulating service demand (ST) has been a source of worry for “marketization” of healthcare and, with and supply. The rise of philanthro- community health workers in ST their focus on the individual, may serve capitalism, along with neoliberalism’s populations, case studies among to cast a veil over shortcomings in the ties with conservative politics, has Adivasis highlight the need for mental area of human rights.3 drastic consequences for marginalized health equity. For instance, histories of groups, with health governance marginalization have been observed1 the individual in the mental emerging as a means of social control. to have had critically adverse effects health marketplace Ramifications include scant access to on the mental health of Adivasis in Scholars drawing from Mudge’s quality health resources, languishing Wayanad district in the state of Kerala. conceptualization of neoliberalism’s public infrastructure such as sanitation “Poverty, low living standards and three interconnected spheres argue and water supply, poor nutrition, and related factors,”2 are risk factors for that neoliberalism and globalization limited health-seeking behaviour. MH, and community health workers have catalyzed widening health must attempt to address these inequities between various Drawing on the above framework, health inequalities for historically communities.4 These interconnected this piece further argues that besides disadvantaged communities. However, faces, namely the political, bureaucratic its impact in the sociopolitical, the responses of both, the health and intellectual domains, intersect economic and academic realms, community and the government, insidiously to reconfigure the delivery of neoliberalism has also aided in often involve a paternalistic form of health services. They go on to highlight the dubious reorganization of the governance that functions within how various domains of neoliberalism subjective, psychological self. This neoliberal frameworks of health: have lead to the commodification of argument becomes crucial to the individualized pathologization (where health. The role of the state as provider analysis of neoliberal ideology and its

ILLUSTRATION: SIDDHESH GAUTAM SIDDHESH ILLUSTRATION: social suffering is covered up by the veil of health as a public utility has, under involvement in psychiatric treatment,

REFRAME '20 | 22 RE-VISION

Fetishization of productivity, and how it dictates notions of normalcy and deviance, has vastly benefited the pharmaceutical industry

given how the psychopharmacological own happiness, success, and health. expropriation of tribal lands for level phenomenon removed from its above suggests), it is imperative that revolution gave birth to an obsession This reconfiguration of the self is neoliberal development, but also in sociopolitical origins. we ensure that the disenfranchised with situating mental illness within the strengthened by market forces, notably the construction of a “normal” self (as receive cognitive justice, which would individual, decontextualized from their in the intellectual realm through the opposed to mad and/or alcoholic), that Similarly, ethnographic research from involve explicitly underscoring that social reality, and how that viewpoint drug industry’s blatant sponsorship suits regional and cultural sensibilities.9 Nandigram, West Bengal,11 shows how an unjust social order contributes continues to be supported by neoliberal of motivated medical research – What transpires, then, is not just the neoliberal policies (manifested, in this to neuropsychological conditions. I ideologies that gloss over structural conferences, training seminars, colonization of psychiatric nosology case, in dispossessing villagers of their offer this criticism not to invalidate inequalities.5 branding and product placement – (the branch of medical science dealing land for the establishment of SEZs) advancements made in biomedicine, that has led to a substantial increase with the classification of diseases) are fundamentally anti-people, violently but more to highlight the kinds of Scholars have also traced how the in the number of drugs prescribed7 in Kerala, drawing as it does from causing12 displacement, a range of cognitive injustice perpetrated in biomedical discourse dominates and, worryingly, an increasingly Euro-American frameworks, but also suffering, a sense of betrayal. Euro- the name of “development”. A more health circles, supported by a market neurochemical approach to mental involves shaping models of mental American nosology might read the compassionate analysis of mental rationale that evaluates merit (and illness. health to fit into local subjectivities of ensuing symptoms as being indicative illness, therefore – while remaining notions of normalcy) based on normalcy and development. of PTSD – one of the categories that wary of certain constructions of health notions of individualized responsibility, colonization makes a have colonized our notion of the self. and personhood – is perhaps the productivity, and – eventually – comeback in mental health Philanthro-capitalism further aids in This neoliberal notion of the self- way forward for how we categorize, success. This aligns with the Psy- Categories such as post-traumatic the constructing of good health as contained self allows for the explaining diagnose and treat mental illness. ¤ disciplines’ conventional concepts of stress disorder and substance abuse a commodity, which makes a right away of poverty, violence and mental illness, in which immense value are arbitrarily appropriated and into something that depends on the discrimination in terms of “individual is placed on work and productivity. applied to mask the social suffering benevolence of the rich, perpetuating psychiatric disorders”.13 For example, one of the diagnostic brought about by neoliberal notions the lack of accountability and power criteria for alcohol use disorder in of development. For instance, asymmetries in health services.10 the way forward the DSM-V is the failure to fulfill based on physical and symbolic Non-governmental organizations, Where maximization of profit takes obligations at work, school or home, violence perpetrated on the bodies too, often rely on certain given scripts precedence, the human brain is and the inability to be a productive of marginalized caste groups in of mental illness, both while training perceived as capital. In a world where member of society similarly informs Kerala, Kottai traces how paternalistic mental health practitioners and treating the capitalistic logic of demand and the descriptions of other disorders.6 governance of mental health practices clients. Such scripts tend to emphasize supply determines the ups and downs This fetishization of productivity, and has led to the categorization of poor, treatment of the “deviant self”, and use of a volatile eco-political environment, Zaphya Jena is a graduate student how it dictates notions of normalcy displaced Adivasis as “alcoholic” and workplace productivity as a measure the onus to transform, in spite of all at the Department of Humanities and and deviance, has vastly benefited the “mad”.8 Meanwhile, funds poured into of successful recovery. Besides, when odds, is placed on the “unhealthy” Social Sciences, Indian Institute of pharmaceutical industry. Sophisticated de-addiction centers, rehabilitation the role of such NGOs includes the individual. Humans are, however, not Technology (IIT), Gandhinagar, India. With prescriptive drugs are able to modify homes, and the mechanized dispersal rehabilitation of “at-risk” populations only neuronal but political as well.14 a background in Counseling Psychology, behaviour to make it fit neoliberal of free drugs and treatment enable through counseling and psychiatric With mental illness increasingly being her research interests include the politics notions of the functional person, who narratives of “development” to modalities, “vulnerability” is understood, used as a means of social control (as of health, communal violence, and urban is seen to be in primary charge of their flourish – not only in the systematic and gets treated, as an individual- the ethnographic evidence outlined studies.

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SERVICE DELIVERY Queer Possibilities

The changing landscape of therapeutic BY Aparna Joshi, Farah practice with queer clients Maneckshaw deconstructing the counselor’s remaining cognizant that a client may harm may be a coping mechanism “expert” position know more than the counselor about for a queer client undergoing extreme The health sciences, particularly the biomedical approach as a tool to stepping away from labels and The shift away from a clinical queerness with regard to theory, distress due to their gender identity psychiatry, have had a long history pathologize queerness diagnoses approach is starkly underscored culture, or their particular concerns. or sexuality, and should be viewed of using the biomedical paradigm Toward the end of the 18th century, In queer theory and feminist studies, by the fact that a majority of my in that light. Asexuality needed be using intersectionality theory to pathologize queerness, in both medicine was no longer solely gender and sexuality are now respondents thought that the recognized as a valid identity, and Where a bio-medical paradigm Western and Indian contexts. a system of knowledges and recognized as constructed categories counselor needed to work on their not pathologized or diagnosed as looks at MH concerns as “disorders” Recently, some Indian MH methodologies to cure illnesses, but that have been naturalized and reified own biases and pre-conceived “Schizoid Personality Disorder” based caused by a neuro-anatomical community members have developed had assumed a normative posture. to establish and maintain power notions about queer people; that on some textbook definition. imbalance of chemicals in the brain, a and implemented alternative, It was used as a disciplinary power hierarchies. These approaches becoming an affirmative counselor psychosocial approach gives greater This is in line with existing literature affirmative counseling approaches to over people’s social lives by decreeing critically examine the dominant would require effort, introspection, emphasis to the social context, and that holds that counseling has working with queer clients, including what was moral and amoral, or discourses that reproduce these and constantly learning and updating this applies equally to queer clients. always been influenced by dominant a course,1 manuals2 and group “normal” and pathological.4 categories. Queer theory sees themselves on queer issues. Relying white heterosexual male culture. A therapy modules3 – indicating a sexuality and gender as inherently on clinical knowledge to play the My findings indicate that counselors’ Sexual diversity was first path- ‘sexual orientation blind’ or a “neutral” shift in how queerness is viewed by fluid, socially constructed, and “expert” was not conducive to being conceptualizations of queer ologized by the Viennese psychiatrist, perspective in counseling ignores MH practitioners, towards a more unstable.7 an effective counselor. client’s concerns included, besides Kraft Ebbing. In his ‘Psychopathia and denies the culturally unique postmodern understanding of gender consideration of their queer identities, Sexualis’ (1894), he ruled that any ‘Queer affirmative practice’ – This process of self-reflection is experiences of queer clients, and is and sexuality. other aspects of the clients’ social non-procreative sexual behaviour was developed in the West and being clearly necessary: studies conducted likely to perpetuate heterosexism.10 location as well. This perspective Such efforts notwithstanding, the abnormal; non-normative sexuality implemented in India – is an in the UK found that heterosexual helped to guide counselor recognizing dominant discourses in Indian context is widely homo- was ‘a collection of loathsome approach to counseling rooted in health care providers implicitly interventions – a client’s relatively the therapy room negative, with queer identities not diseases’.5 This trend continued in the poststructuralist assumptions preferred heterosexual individuals greater social marginalization, for Another shift from conventional included in counselor training. How, the MH community. Homosexuality of queer theory, that calls for the over queer individuals. Queer instance, could adversely affect therapeutic practice is recognizing then, have counselors working was described as a mental illness counselor's self-work, attitudes, individuals and practitioners may their access to queer resources and that therapy does not take place in with queer individuals adapted in the first and second Diagnostic knowledge, ethics, and process themselves internalize these biases. spaces. a vacuum; that the client, counselor their practice? A research study I and Statistical Manual (DSM) of the skills.8 Most counselors in my Unlearning dominant discourses and therapeutic process are all conducted for my Master’s aimed American Psychiatric Association.6 study subscribed to this approach, through careful reflection, training, Counselors spoke about using influenced by the socio-political to explore such experiences. Here, integrating it with their primary knowledge and experiences was a “queer lens” to examine their “Conversion therapy”, considered fabric, including laws and media I analyze the shift from a top-down theoretical orientations. I outline in recommended.9 clients’ concerns, which took a human rights violation by most portrayals, within which they are biomedical approach that locates this article three key components note of the minority stress faced international guidelines, is still widely The counselor’s expertise is situated. the distress within the queer client, of their practice that underscore by queer individuals. Using practised in India. Apart from the deconstructed by another practice to a psychosocial approach that the shift from a biomedical to a conventional (white, cis-heterosexual) Several counselors spoke of how fact that research has repeatedly advocated by study participants. looks critically at power hierarchies psychosocial paradigm when working psychological theory for their queer the existing political climate caused shown its impossibility, the very This was the idea that the counselor and locates such distress within the with queer clients. clients was problematized by these distress for their queer clients, intent to “cure” is a devaluing and be open to learning from their queer societal fabric. Indian counselors. For example, self- who often brought to therapy the pathologizing proposal. clients during therapy, which meant

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CAPACITY-BUILDING ‘I Get You’

Strengthening Peer Counseling within

the Queer Community BY Pooja Nair

homonegative and problematic conclusion AUTHOR’S NOTES: While several Peer counseling, as a form of care Even if one reason why peer Kolkata-based organization working comments made by politicians. The It is clear from the practices and of the participants ascribed to this and support located within collectives counseling came about is an with LBT persons reached out to Dr K processing of the client’s feelings ideas of counselors working with approach, it’s relevant to note that and communities formed around absence of mental health support Ranade, seeking help in building peer about wider political discourses was queer clients that (at least some there was some divergence in my the locus of stigmatized identities, that was affirming, the political counseling capacity. A team of four done within the therapy room. members of) the MH community results- not all the counselors I has a long history. It is a model implications of such counseling go queer-/trans-identified Mental Health have moved beyond the biomedical interviewed engaged in all three key that resists, even challenges, the beyond simply “filling gaps”. It is not Practitioners (MHPs) and trainers With regard to the law, many clients paradigm in their approach to components, or consistently engaged hold of “experts” over such matters, so much individual experiences of – Dr Ranade, Shruti Chakravarty, spoke of wanting to settle in some therapy, in order to critically examine in them in a manner that was beyond while foregrounding the needs discrimination that form the basis Pooja Nair and Gauri Shringarpure other country, with more progressive the power hierarchy implicit in their reproach. and concerns of lives lived on the of peer counseling, but the shared – worked together to devise a PSP laws, where they could live with less own “expert” positions, to recognize margins. Creating a ‘Peer Support experience of marginalization created course for interested queer-trans secrecy and shame. Counselors the role of minority stress in their Practice’ (PSP) course for queer-trans by the predominant body-gender community persons. Partnering with themselves brought up laws that conceptualization of queerness, and collectives and organizations was an binary and heterosexuality.¹ Being the Mariwala Health Initiative was could affect a client’s life (such as to acknowledge that therapy is not attempt not just to support ongoing pathologized and medicalized by a foregone conclusion, given their Section 377 of the Indian Penal Code, insulated from the surrounding media efforts within these communities, but the “Psy” disciplines2 (those related recent partnership success with the when it was still in place) within landscape and politico-legal rhetoric. to help these efforts grow and reach to the study of mind and behavior – QACP (Queer Affirmative Counselling therapy, so that clients were aware more queer-trans people. including psychology, psychoanalysis, Practice) project. of potential repercussions. They also psychiatry, psychiatric social work, sometimes touched upon uplifting political foundation psychiatric nursing) has meant With PSP, the attempt was to develop news reports for their clients, such as While the purpose of this article is that when both the mental health and deliver a curriculum with inputs Taiwan’s legalizing of gay marriage. not to spell out the history of peer establishment and traditional kinship from both, MH and the specificities of Many participants spoke of how, counseling within queer communities systems have been unaccepting or queer-trans life experiences. The four though theoretical knowledge was in India, it is worth noting that much violent, peer counselors have been a trainers each brought their political important, a working familiarity with has happened in this area over precious alternative resource. perspectives, queer-trans lived queer pop culture and TV shows several decades – largely carried out experiences, and training in therapy was also relevant to therapy. They Aparna Joshi is Assistant Professor Farah Maneckshaw is a therapist and with scant resources, and deserving Furthermore, in creating this course, to the course design. spoke of having recommended and Centre Chairperson at the School freelance journalist who writes about MH of its proper place in the archives of we are saying that the marginalized, shows, and so on, to clients, so that of Human Ecology, TISS, Mumbai. A concerns from a socio-political lens. She queer activism in the country. in this case the historically PSP brought together intention (of the latter might have more points practicing psychotherapist, she has has a Master’s in Applied Psychology pathologized, might take from the peer counseling as a conscious of identification and understanding worked with NGOs implementing MH (Clinical) from TISS, Mumbai. The primary This piece aims briefly to discuss discipline not just skills and values, choice and not simply as a with respect to their sexuality or service programs in clinical, community, theoretical orientation she uses is the the process of developing a PSP but also the subversive possibilities consequence of community gender. Queer media seemed to and institutional settings, conducted narrative paradigm. She has experience course and its content, in the its knowledge and perspectives offer. “membership”), knowledge (with provide alternative scripts to the trainings with different stakeholders on working with a wide variety of clients in process challenging the clinical the lived experiences of queer-trans widely prevalent hegemonic cis- MH-related issues, and is currently Project hospitals, NGOs, and schools. hold over counseling while seeking envisioning a Peer Support Practice persons as its source), and skills and heterosexual discourses. ¤ Director of two MH-related field action projects accountability from informal modes (PSP) course values (as acquired through formal she initiated at TISS: Sukoon and iCall. of offering support. In 2019 Sappho For Equality (SFE), a systems of training in counseling).3

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When both the mental health establishment and traditional kinship systems have been unaccepting or violent, peer counselors have been a precious alternative resource.

experience as resource not just pathologized queer-trans trans persons suggest that peer In what ways can we stay in our peer support in the queer-trans Peer counseling is about lending identities but have also medicalized counseling in these communities locations and engage with MH communities has repeatedly hope and strength through empathy the costs of living these stigmatized will endure, by default if not through systems on our own terms as shown, healing and growth is not that comes from shared experience, identities. Against the given backdrop training. subjects that anyway carry the weight the monopoly of Psy disciplines; it and providing role-modeling and of scarce MH resources and of the history of pathologization never was. ¤ possibilities for living non-normative lives. oppressive mental health systems, and finally, a note of caution within these disciplines? Can we keep it is abundantly clear that there is an Before concluding, it is imperative MH support out of the hegemonic PSP is built on the premise that our ever-present need for peer counseling to acknowledge that this form of MH establishment? Even though the shared experience is our resource. for queer-trans persons. “affective labour”4 is a contentious axes of marginalization are different, The “Self” is the most important “tool issue. Besides the fear of what are the lessons we can learn of the trade”. This is very different The PSP course uses content from essentialization, apprehensions have from critical disability studies and from claiming to draw the necessary queer realities to teach the skills been raised regarding inclusion, mad studies in their journeys of know-how and credibility solely from and values components from Psy citizenship, and co-option. These are challenging the ‘Psy-complex’?5 one’s training; it is experience, rather disciplines. valid concerns that deserve more Peer counseling carries the risk of than discipline-based expertise, as discussion and debate. becoming a project involved in the knowledge. Deconstructing discipline- Another advantage of teaching “governance of ‘similar others’”.6 How, based expertise may eventually lead skills and values in peer work is that In the shift from “movement” to finally, do we continue to preserve us to recognize its embedded values this acts as a moderating factor “model”, we also worry that peer and promote the subversive potential and hidden agendas – its instinct against the essentializing – the support/counseling should not of peer counseling in queer-trans to make individuals conform to homogenizing and, thereby, the become an auxiliary service – a communities? normative ideas of what is normal- reduction, oversimplification, even route for bringing persons with MH abnormal. For instance, queer people distortion – of experience, which is a challenges into the realm of the I believe these questions may, continuing to see ex-partners as point of controversy in user-survivor mainstream MH establishment. again, best be answered by the support systems, or having close movements across the world. We have seen this happen in the communities in question that bonds with them could, within a case of western countries with peer routinely experience erasure, Pooja Nair (ciswoman, pronoun: she): has normative framework, be seen as Ethics also forms a vital component counseling for those who were discrimination, and more overt forms worked for over a decade as a researcher, “enmeshment” or as difficulty in of the course, allowing us to address formerly institutionalized because of of violence. documentation consultant, trainer and “moving on”, without perceiving how the critical areas of boundaries and various psychiatric diagnoses. now an independent psychotherapist. shared marginalization, as well as the of power dynamics that exist in any How, then, will queer communities To me, the theme of ‘Beyond She has an MPhil and has worked in the scarcity of validation in other spaces, relationship where one is a seeker of in India engage with these questions Clinical Contexts’ speaks not areas of feminist theory, gender, sexuality, might make an ex-partner a valuable support that another provides. It is of co-option? I think about this every just about loosening the grip violence and child sexual abuse. Currently support person. important to raise ethical issues, and time a peer counselor asks, ‘How will of social institutions over lives, doing her PhD, Pooja as a queer identified engage in dialogue to find our way I know when to send a community but simultaneously reimagining MHP engages with an anti-oppressive relationship with clinical knowledge through them, because the various member to a trained/qualified spaces as those where possibilities framework in her practice and is faculty The mainstream systems have unique challenges faced by queer- psychologist or psychiatrist?’ for healing exist in plenty. As with the QACP certificate course

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How and where is the COMMUNITY in mental health constructed and Contexts how does POWER operate there? Is community a space for MUTUAL CARE? How do we situate practices of mental health, care and support in non-clinical spaces? It is critical to explore how mental health may be rooted in social, political and cultural contexts or, in current events. Which spaces approach mental illness as a familial, biomedical, individual, or collective responsibility? What are sites of COUNTER NARRATIVES?

Care Communities Counter-narratives Lived Realities

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HUMAN RIGHTS Relocating Mental Health Conversations to Native Queer Subcultures in India

The Hijra community as a site and

source of care BY Aritra Chatterjee

subcultures in India embody safe This article attempts a culture- At present, few same-sex lovers spaces in a metaphorical as well sensitive conversation about queer in India find resonance with as literal sense. They operate mental health in India outside identifications like “lesbian”, “gay”, beyond the Eurocentric “homo- urban-metropolitan-elitist spaces, “homosexual”, which may all carry normative” purview of queerness beyond Pride, pink consumerism, and multiple meanings, connoting (the superimposition of heterosexual Western vocabularies. It endeavors upper class, white, and Western1 ideals and constructs onto lesbian to build conversations around and therefore inaccessible to and gay identities)3 and, significantly, non-metropolitan, ethnic queer many. Social movements, queer/ resist tight binary taxonomies. subcultures which may not replicate trans advocacy, and local NGO the pigeon-hole categories of frameworks – the “civil society”2 – In the literal sense of “safe space”, LGBTQ, but have deep ethnographic may also adopt such terminology Dutta4 mentions the growth implications in reimagining queer MH to satisfy urban middle- or upper- of formalized spaces in the beyond clinics. class consciences. However, in geographical margins of West Bengal doing queer mental health in the – shelters and drop-in-centers, ethnic queer subcultures: “civil” way, a bulk of narratives where queer bodies may seek solace margins within margins and community setups may run from discrimination and violence, These subcultures exist at unique the risk of invisibility, resulting and engage in community- and overlaps of class, religiosity, region, in dialogue, access, and movement-building activities. gender, sexuality, and kinship. outreach lacunae. They prompt culturally appropriate, In the metaphorical sense, these intersectional approaches to MH, subcultures introduce various forms that are missing in dominant Psy- traditional subcultures: safe spaces of transgression into the non- discourses. They also raise questions for the non-metropolitan and less metropolitan sociocultural milieu, about centers and margins of power privileged serving eventually to normalize them in the context of deliberations, Functioning as counter-cultures in the public gaze. outreach and allocation of resources within a hetero-patriarchal

ILLUSTRATION: ARAVANI ART PROJECT ART ARAVANI ILLUSTRATION: pertaining to MH. superstructure, ethnic queer

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Functioning as counter-cultures within a hetero-patriarchal India, ethnic queer subcultures embody safe spaces in a metaphorical as well as literal sense.

factors for wellbeing offered by mentorship from community elders;20 The daily hard-hitting realities of rich emic entry points for imagining native taxonomies for queer sexualities and practices native queer subcultures increased access to more cruising poverty, stigmatization, violence, community wellbeing. Indian queer male-bodied individuals hailing from rural or socio- Nanda15 points out that many spaces and dwelling grounds within widespread societal neglect and the need for intersectoral economically marginalized sections are popularly classified as: queer community members “heteronormative zones”21 – informal discrimination, constant migration engagement seek assimilation within the Hijra meeting spots in parks, railway (not only away from natal homes, kothi the effeminate male (with feminine dressing, NGOs and local community action community (“samaj”) for shelter, stations, or residences of other local but also to a “clandestine” “cultural speech, behavior)5 who is penetrated networks could play a significant livelihood, and the chance to live trans/queer people;22 emotional family”, or from one identity to role in introducing MH care out their sexual selves. Against a support of peers as well as financial another)27 form such a major part dupli the effeminate man who penetrates as well as interventions which focus on dealing backdrop of multiple psychosocial assistance, and protection against of their existence that individuals is penetrated with structural oppressions and on stressors, these subcultures have violence;23 the preservation of queer may seldom have the time, energy, resilience-building in native queer a great deal to offer: regional/ culture in art forms – such as launda or indeed luxury to contemplate pareekh the “masculine” man (in behaviour, speech, and subcultures. Beyond clinics, MH vernacular vocabularies for self- naach (boy’s dance), the traditional their mental health. This is reflected dress),6 with whom kothis pair as lovers7 could be addressed through NGOs’ identification in terms of parallel erotic dance performances by in the remarkable degree of service advocacy with police, attempts sexualities and/genders; secret, effeminate adolescents, usually seen under-utilization, except for formal to reduce violence, and links with Hijras are the most visible queer subculture that potently intersects code language that helps maintain at marriage celebrations.24 Dutta also SRS consultations.28 Survey-and- health services.30 This role might understandings of gender and sexuality. privacy, discreetness, distinctiveness, speaks of how regional theatrical questionnaire-oriented computations be expanded to include provision and aids in navigating familiar but forms like Shiv-Parvati plays, shong of MH might fail to take on board known as Aravanis in South India of nutrition, basic necessities such often hostile environments;16 scope and bisahari pala, provide limited their particular situations, and they as shelter and clothing, community for connecting with like-minded social sanction for male bodies to may thus get conveniently left out of Hijras centers, outpatient care, acute individuals through identity-based enact female roles in mythological or epidemiological accounts. hospital admissions (advocacy for known as Kinnar/Khusra in North India.8 resonance, as well as collective folk tales.25 Kalra and Shah,29 in studying the allocation of wards), rehabilitation resistance and struggles – fostering native queer subcultures and mental health of 50 self-identified and vocational programs to preserve “we-feeling”, for instance the lifelong The Hijra identity is ethnically transvestites, and intersex community mental health Hijra individuals, observed that the wellbeing. bond of reciprocity in the guru imbued with the idea of “tritiya individuals.10,11,12 The best way to Native queer subcultures are nested participants had fairly good self- (teacher/leader)-chela (follower) The fact that the special MH needs panthi”, or “tritiya prakriti” – the understand the gender identity of a in a quagmire of psychosocial esteem, explainable as due to their relationships in the Hijra samaj,17 or of this population can be addressed third gender, or third nature.9 Hijra individual is through an emic stressors, being subject to multiple subcultural assimilation. This finding the camaraderie and sisterhoods by intersectoral collaboration across Close observation reveals the approach, through the individual’s structural oppressions as they must motivate MHPs to identify the among chelas under the same guru;18 law, social work, health services, Hijra community as comprising self-determination.13 lie at different interacting axes various factors that help override self-expression and exploration in and public policies needs to be multiple identities, such as: of marginalization. Especially, marginalization and preserve self- Through embodying a symbolic a relatively affirmative framework, recognized, and used to inform effeminate gay men (zenanas/ the exclusion of native queer esteem for community members. protest against the “binarizing” of which includes a recognition and practice. For instance, Pehchan (a khada kothis, who may or may subcultures (for instance, Hijra- Other coping strategies that emerged gender, Hijra cultures decolonize appreciation of personhoods – such program that aims to strengthen not cross-dress), transsexuals kothi-trans identities) from formal included talking to other Hijras, Western psychiatry’s pathologizing as the feminine names adopted by community systems and provide (usually male to female), labour and education translates visiting religious places, meditating, of gender non-conformity.14 individuals or given to them by their access to health, legal, and social into their vulnerability to violence.26 music, movies, substance use – all guru-ma;19 peer counseling and services for MSM and trans-Hijra

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SERVICE DELIVERY

Rebuilding Therapeutic Spaces Unlearning old frameworks: Towards populations across India) has shown for endless possibilities and how collectivization and gender- digressions. a less one-sided practitioner-client affirming approaches are useful 2. The term “subculture” as used in increasing service access and BY Safvana Khalid here to refer to a subversion of relationship demand for MH services.31 ¤ “normalcy”/the dominant societal questioning the comfort zone the environment of psychiatric difficult at times. However, along AUTHOR’S NOTES: standard in any form that unites As a mental health therapist as well hospitals, institutions, and asylums. with these hardships came some like-minded individuals and 1. “Queer” as a term encompasses as a therapy service user, I must In my own short experience as a ease. Working alone meant looking facilitates a sense of identity.32 any form of sexual and gender confess that hospital settings have mental health professional, taking a for answers within, as opposed non-conformity and is a disruptive, 3. There is a preponderance of the been my safety net – as familiar hard look at my own work allowed to searching in the world outside, diverse and plural lens for looking male-assigned body in native places on which I can fall back in me to identify certain areas that which pushed me to develop a sense at phenomena, leaving scope queer subcultural formations. This the midst of hardships, discomfort, needed “softness” and rebuilding, of autonomy, and it fostered my has important ramifications for uncertainty, confusion. It is the for me to be able to emancipate the growing intuition as a therapist so engaging with the sexualities and assurance of an established system therapist within. that I was not relying on conscious transgressions of female-assigned that has made my work easier, reasoning alone. Gradually, I began bodies in non-metropolitan India, allowing me to follow a standard building security in the absence of to rely less on my formal education, which has not been taken up in pattern of working in therapy, which systems and to use my personal situation to the context of the present article. includes a list of dos and don'ts The internalization referred to was explore the struggle and challenges However, it is to be noted that and derives from a collection of sustained for me because it often that online counseling presented and the Hijra samaj does consist of well-researched manuals. With this served the function of personal continues to provide. Most of the MH Chhibris – who are female-assigned kind of learning and training, there protection. Becoming aware of this frameworks I had been taught were individuals with “fake” Hijra is no doubt that I had internalized allowed me to make the crucial inspired by Western concepts such identities.33 the systems that informed most decision to unlearn the psychiatric as Cognitive Behavioral Therapy and of my therapeutic decisions. Yet I system, fuelled as it was by power Behavioral Therapy, rooted in ideas EDITOR’S NOTE: now believe that such established dynamics and “I-know-better” of individual psychology and ableism The views expressed on the Pehchan Aritra Chatterjee (pronouns: she/they) is psychological systems do not really attitudes. Eight months ago, I that were proving ineffective in my program do not represent the views an MPhil trainee of Clinical Psychology allow for inclusion, or for diversity decided to start online counseling context. Recognising their limitations of MHI and we are cognizant of valid at the University of Calcutta. Their of thoughts and actions, but merely from my residence. As exciting allowed me to look for answers community critiques of the Pehchan primary research interest lies in the area tolerates these. as it was, I struggled to make outside the system, and opened new program. of LGBTQHIA+ mental health care with adjustments. There were logistical gates for me: I gleaned information a social justice focus. Their access to For the work of individual MHPs to difficulties, and instead of working from social, political, historical and mental healthcare spaces, both as service be informed by values of inclusion with colleagues I was now working intergenerational contexts that user and as aspiring professional, has and diversity, and intersectional alone. Initially, I found it hard to strike began informing my practice. These been experientially coloured by their GSM concerns, collective efforts are a balance between my personal contexts had always been present, (gender and sexual minorities) identity. required that focus upon changing and professional lives – it is still but were often sidelined in the work

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Most of the MH frameworks I had been taught were rooted in ideas of individual psychology and ableism that were proving ineffective in my context.

environment; yet they are crucial space to a solitary digital one gave many stakeholders. It includes arise, however, when the manner of because they reveal to us the ways in me an opportunity to sever the power working with individuals to dismantle evolution and inclusion comes from which mental health is a public health structure based on notions of experts biological, psychological, social, the very structures that are prone to concern and not solely an individual/ and their subjects, and helped me political, generational, and historical discriminate against and stigmatize individualized phenomenon. make room for vulnerability in my constructs. Rigid and formal mental users: hospitals being made the My initial fears and insecurity about practice. For instance, when clients health institutional structures primary dispensers of mental working alone pushed me to reach asked, ‘How are you?’ I would act as barriers to the free flow of healthcare often works against out for support, in the absence of respond with a generic ‘Good’ or creative thought; their hyper-focus openness and diversity. the walls of hospitals and asylums, ‘Fine’, but of late, I am being more on “objectivity” relegates subjective in the work that I do. I gained a honest about how I really am thinking and action to the peripheries. It was this very lack of, or inability to sense of security with the help of the feeling. I have also learned to ask for The creative journey to mental health nurture, diverse spaces and voices mental health community and their forgiveness when I fumble, or have and wellbeing is not, and should not within the dominant institutional affirmations, and through paying forgotten to send a client a helpful be, limited to empowerment, but setting, that had prevented me from attention to lived realities while article I had promised. I believe must aim for an emancipation that thinking and working through its honouring individuals and scrutinizing seeing me as vulnerable, too, makes allows for diversity in treatment and obstacles and limitations. the contexts that contribute to clients feel safer about expressing in structures, for voices of change developing and maintaining mental themselves, and articulating distress, to flourish, and for many truths to Only when the dominant MH systems illness. more freely. coexist in harmony. Such a process begin to embrace a diversity of involves breaking free of old systems, spaces, along with fresh techniques shifting the power: from fear to I strongly believe that the foundation reforming old ideas and finding new and ideas about healing from both vulnerability of a safe space for service users pathways, speaking a new language service users and providers (and not Institutional structures and systems as well as service providers creates which is vulnerable, honest, radical view these as threats), will we be wield power, which may result an environment that helps dissolve and freeing. A lack of such diversity able to initiate justice in care work. in service users being afraid to power and embrace vulnerability. and openness does little for individual Only when we look at vulnerability communicate honestly. Hospitals Such spaces provide greater agency and systemic growth. as one of the guiding sources of and asylums tend to perpetuate to service users, which is essential power will we learn to let go of the these power hierarchies, along with for self-determination – and discovering new tools to dismantle heroic qualities associated with and Safvana Khalid is a practicing a reliance on the “curing” capacities facilitating greater levels of self- old structures expected from MHPs. Only when I psychologist, service user, and Research of their MHPs. As a mental health determination ought to be one of the Many clinical spaces, too, are allow myself the discomfort of new Fellow at SPIRIT (Suicide Prevention and professional myself, I realise how collective goals of the mental health consciously evolving, with efforts methods and approaches will I push Implementation Research Initiative), a these sanctioned systems left me community. being made to branch out into myself to acknowledge, accept and mental health program implemented with little room to acknowledge, community settings, classrooms, embrace diversity, and move towards by CMHLP (Centre for Mental Health accept and express my own the freedom to think creatively digital spaces, and to move gradually creating spaces to promote the Law and Policy) in Gujarat. Her interests vulnerabilities within their confines. The journey of emotional healing towards deinstitutionalization and healing that service users seek. ¤ include neurodiversity, child healthcare, The shift from the physical hospital is a creative process that involves greater social inclusion. Problems gender equity, health and social justice.

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SERVICE DELIVERY What Kind of Interventions Do We Need Now?

varying results, mainly positive. Poetry and healing: beyond clinical Participants might claim, ‘Don’t know BY Jhilmil Breckenridge what it is, but I feel so much better options after writing!’ I suggest that poetry The time will come in particular, helps make sense of This is an essay on how it is — sexual violence, domestic violence, writing trauma, feeling better trauma, opening a door to light. imperative, especially in these times, mental health, and more.4 One of my In the 1990s, James W Pennebaker In my project on Whittingham, to look at the arts as therapy to heal recent projects5 involved unearthing started publishing results from the When, with elation we used historical prompts about a wounded psyche. I focus on the information from the Lancashire clinical trials he had been conducting: Whittingham Asylum8 to create new science behind therapeutic writing, Archives on one of the largest his team invited participants whose writing, poetry and songs by service using the Pennebaker model,1 and asylums in Europe, Whittingham health markers – such as blood You will greet yourself arriving users living in Guild Lodge, an NHS working specifically with poetry. Asylum, and using historical tidbits pressure, whether they were grieving, (National Health Service) secure Reading as well writing poetry is along with the lived experiences in distress, and so on – were mental health facility in the grounds discussed, with examples that of service users and their families, individually noted, and who were At your own door, where the old asylum stood. In India, include experiences of writing trauma including prisoners in a secure then placed in writing cubicles in we currently create therapeutic and healing from the process. unit here in Lancashire to create a lab. Participants were separated writing sessions through ‘The fresh writing. The result of these into groups that wrote about In your own mirror Listening Circle’ – Bhor’s peer support The time will come workshops were startling, politically general topics like the weather, or a circles. when, with elation charged, and powerful. walk, and others that wrote about you will greet yourself arriving significant and traumatic events And each will smile not so irrational after all at your own door, in your own mirror Poetry and creative writing may in their lives. They repeated this Trauma is a strange beast. It is a and each will smile at the other’s be used as therapeutic tools, and activity for at least 15-20 minutes on heaviness in your limbs, an itching welcome. become powerful interventions to five consecutive days. The results At the other’s welcome just under your skin where you can’t – from Love After Love by Derek create change and affect public revealed that the health markers of reach, the IBS in your gut, the hair Walcott2 perceptions. Another UK-based those who wrote on general topics falling out in handfuls. Trauma loves project worth mentioning here is the showed no significant changes, while to stay in parts of your body where poetry and creative writing as 60 Voices project,6 which showcases those writing on distress or trauma therapy and medication can’t shift – from love after love by derek walcott2 medicine how art and writing have helped experienced improvements in both it. And although I benefited greatly In a recent interview I gave to Lapidus people through illness; I believe such physical and mental health over the from my pony-tailed psychotherapist International,3 a charity in the UK for projects can lead change and give next six months.7 in New Delhi during the worst times writing and wellbeing, we discussed us alternatives to clinical options to of my marriage, I can truly say it is how writing and wellbeing is often heal from distress. Of course, the In my work as a poet, activist, is to take poetry as therapy into important tool in helping people heal poetry that has set me free.9 perceived as soft and fuzzy, but how link between poetry and medicine is and founder of a mental health small groups dealing with distress, from trauma, or perhaps make more I use it to deal with hard-hitting stuff ancient: Apollo was the God of both charity based in New Delhi, Bhor or into psychiatric institutions and sense of living with their distress, When I began the course, I found poetry and medicine. Foundation, one of whose mandates prisons, I use Creative Writing as an or cope. These sessions have had that I related better to contemporary

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SERVICE DELIVERY Making Your Days Matter, to the Very End poets: Warsan Shire’s work resonated am a member, includes writing with Supporting journeys through with some aspects of my own life; refugees, the elderly and families, BY Sonalini the feeling that I was not enough, not and also new ways of engaging with Mirchandani pretty enough, not woman enough. stories and poems. The Reader,13 home-based care Anne Sexton’s confessional poems a charity, takes shared reading to gave me an insight into the heart and spaces like palliative care homes An issue of ‘The Economist’1 quality of life – that most people seek transformative in many ways. Dr minds of women with feelings like and other communities to improve mentions a small Buddhist temple palliative care very late, because the Armida Fernandez, former Dean, mine: ‘But suicides have a special wellbeing, reduce social isolation and in a cherry tree-lined path in Tokyo, concept is mistakenly associated LTMG/Sion Hospital, and Founder, language./ Like carpenters they want build resilience. Universities are also where prayers to baby Buddha only with end-of-life care. Besides, SNEHA, who set up a home-based to know which tools. /They never increasingly conducting seminars, ask for two wishes to be granted palliative care in India caters mainly program in Mumbai, avers that ask why build.’10 And the joy of Faiz: workshops and conferences on – a long, spry life, and a quick and to cancer patients, although it is ‘physical suffering can be assessed my current attempt to learn Urdu is Writing and Wellbeing (I attended painless death. A good life is often well recognized that pain relief – and dealt with to a great extent a transformative quest taking me one such at Glasgow University last discussed; a good death rarely physical, emotional, spiritual – can with medications . . . however, closer to my Muslim grandmother, year), with MHPs, service users and spoken about. The silence that be provided for a wide spectrum of psychosocial and spiritual suffering now dead and gone, except that I writers coming together to talk about surrounds conversations about conditions, such as cardiac failure, of both the patient and caregivers sense her fragrance leaning into me, the not-so-mystical connections how we pass on arises from our neurological illnesses, and others. is more challenging; it often needs holding my hand as I read. between writing and wellbeing. discomfort with confronting our as much attention. Depression, own mortality, and uncertainty about the need for psychosocial support anxiety, confusion, anger and Although we cannot speak of specific poetry and our lives where such conversations could in home-based palliative care frustration are some of the issues poems for specific illnesses, consider As Audre Lorde says: ‘Poetry is lead. However, if quality of death At the core of palliative care lies the our counselors deal with (personal that in her memoir, ‘Black Rainbow’, the way we help give name to the indicators are to be believed, we don’t concept of total pain management. communication, June, 2020). Rachel Kelly describes the effects nameless so it can be thought. The die very well in India. In its Quality of Going beyond physical pain, this of repeating lines from George farthest external horizons of our Death index,2 a study of 80 countries approach recognizes that patients shifting focus: from the Herbert’s poem ‘The Flower’: ‘In those hopes and fears are cobbled by ranked India among the 15 worst are not mere objects of ‘treatment’, disease to the person moments of the day when I held our poems, carved from the rock countries to die in – and yet, India but human beings who respond It is clear, then, that efforts to relieve hands with Herbert, the depression experiences of our daily lives.’14 Jhilmil Breckenridge is Founder, Bhor has given the world one of the finest to compassion, heartfelt care, and distress cannot be complete without couldn’t find me. It felt as though the Foundation, India. She is a poet, writer, examples of quality palliative care at the beneficial effects of affirmative shifting the focus from the disease poet was embracing me from across Poetry, both reading and writing, and activist working in the areas of the community level, with the state beliefs. In India, although such to the person. And this can best the centuries, wrapping me in a offers support and therapy to trauma, mental health, and domestic of Kerala, which has a mere 3% of services are still nascent, some of be done by empathetic listening, cocoon of stillness and calm.’11 affected people around the world. violence. She teaches Creative Writing the country’s population, providing the most heartening initiatives may rarely possible in the environment Of course, people also read poetry and Therapeutic Writing in the UK, and more palliative care services than be found in the area of home-based of a hospital or OPD, where the In the UK, there is considerable for pleasure. In my own case, poetry takes poetry as an intervention into the rest of India put together. palliative care. As a core member pressure of waiting patients and the focus on expressive writing, as helped me feel at home again in my prisons and psychiatric facilities in the UK of a multi-disciplinary team that alienation of the surroundings can be well as reading. The mandate of breath, in my body. ¤ and in India. It is unfortunate – given the attends to the patient at home, overwhelming, both for the patient Lapidus,12 an organization of which I significant difference it can make to the counselor’s role is seen to be and for family members. Avani Bhatia

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The psychosocial support made for a better management of physical symptoms as well as of emotional turmoil, and ultimately for a peaceful passing

time for the patient, her husband end-of-life care – as distinct from who often need to be reminded that and daughter to come to terms with having such conversations in the when there’s no cure, the task hasn’t COMMON PSYCHOLOGICAL PROBLEMS AND SOCIAL the reality of the prognosis, and artificial setting of the clinic, while ended; there is always care that CONCERNS FOR PALLIATIVE CARE PATIENTS to open the door to palliative care also avoiding the need for seriously can, indeed must, be provided. ¤ services. The psychosocial support ill patients having to travel. that the entire family then received There is, however, another aspect made for a better management of to be considered, in the context of Researchers who interviewed palliative care patients as part of a Chennai-based physical symptoms as well as of providing such services at home. As study3 found that the 5 most common psychological problems were: the emotional turmoil that they were Dr Jayita (personal communication, all experiencing, and ultimately for June 15, 2020) explained, ‘Some 96.7% 95% 93.3% 91.5% 85% a peaceful and dignified passing. challenges are quite unique to our Feeling sad Fear of Unpredict- Lack of Fear of social and cultural context. Our metastatis ability of the pleasure physical future suffering Dr Jayita Deodhar (personal patients live in restricted space, communication, June 15, 2020), sometimes within one room, leading Professor and Psychiatrist, ad hoc to congestion and lack of privacy The same study identified the 5 most prevalent social concerns as: officer-in-charge of the Department which is so important when one has of Palliative Medicine, Tata Memorial to verbalize emotional concerns, 93.3% 61.7% 56.7% 53.3% 46.7% Hospital, offered her own insights on fears and anxieties. Stigma is another Loneliness Lack of Difficulty Finding others Difficulty support from talking about unreceptive finding how the provision of psychosocial barrier. Our patients have sometimes others their illness, when talking someone to support in a home-based setting for requested us to park our hospital desire to not about their confide in bother others illness palliative patients makes a marked vehicle at a distance from their home, difference, as compared to services so that neighbours don’t get to know in an out-patient department. She that the doctor and nurse from the believes that a home care team hospital are attending the patient, as (personal communication, June 15, transitions, and dignified dying’. Her other caregivers, producing great visiting the patient in their own ours is a well-known cancer hospital.’ Sonalini Mirchandani, a former civil 2020), consulting psychotherapist role doesn’t end with the passing degrees of psychosocial distress. It environment gets useful glimpses Given the value of psychosocial servant, is a health communication associated with the home-based care on of the patient; bereavement is not unusual for families to refuse into the patient’s real-life situation – support in home-based palliative specialist. She led the India Country provided by Romila Palliative Care counseling is an important aspect to accept the diagnosis, or to keep including caregiver burdens, family care programs, we need to keep Office of Johns Hopkins University (Mumbai), shared her experience of of the care she then provides. hoping results were wrong. Avani dynamics and other aspects of the working to generate awareness about Center for Communication Programs, working with terminally ill patients Bhatia (personal communication, home setting. The counselor is able such services, and highlighting the before founding The Communication and their family members. A key Tonia C Onyeka, in a review4 of June 15, 2020) also spoke about to spend time on understanding and quality outcomes they can provide. Hub, a pan-India network of development turning point, she finds, is when five cases of patients with cancer, engaging with the family of a young exploring patients’ care preferences, And this has to be done across communication professionals, in 2007. denial changes to acceptance, reported that the cancer diagnosis woman diagnosed with metastatic engaging with them in shared all stakeholders, not just patients Sonalini is passionate about palliative leading to what she describes is a situation that affects not just the cervical cancer, where it took decision-making in their own milieu, and families but also, importantly, care, and is a founding member of the as ‘miraculous and peaceful patient but also family members and counseling over a long period of such as planning and preparing for healthcare practitioners themselves, Mumbai Palliative Care Network.

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RESEARCH 'Knife of Insight'

Experiences of toxic work cultures BY Lorelle and the process of recovery Mariel Murzello

wellbeing at the workplace: institutions or in the social or over time that led them to label their background to a study corporate sectors, in Mumbai, workplace as toxic. As an example The World Health Organization Vadodara, Gurugram, and Delhi. of toxicity in their work culture, one (WHO) defines health as ‘not merely participant pointed to the design recognizing toxicity in the workplace the absence of disease’. While the of the workspace that made for an Sociologists and anthropologists diagnostic categorization of mental isolating experience: people faced have moved beyond geography to illness has helped understand illness their computer screens toward the define culture. The culture of the conditions and effective treatment, wall, and rarely had the chance to workplace may include everything it has failed to encapsulate the turn to look at each other, given from its physical space to its work essence of mental health beyond their workloads; another spoke ethic, communication patterns, these categories – that, for instance, of how timers on the desktop hierarchical structures, and written it is a spectrum, on which we might made her feel ‘less human, more and unwritten codes of conduct. move up and down, multiple times in machine’. Yet others described The Affective Events Theory4 helps our lives.1 It is important to note that organizations rife with workplace us understand how the culture both, the social model of disability bullying, or people talking behind or environment of the workplace and the wellbeing perspective, view each other’s backs, or one team might bring about a negative or “dysfunction” as inhering not within receiving monetary preference and a positive emotional response the individual but in the environment. credit for their work over others. in the individual. I intend, here, Recovery, then, is not “recovery from” to emphasize a participant-led Some people also recounted having the debilitating/distressing condition delineation of “toxic work cultures”, spent a significant amount of time but, rather, a non-linear process while drawing attention to how struggling with distress before that looks beyond the “clinical” as it individuals assimilate this external seeking support, which they did not seeks to understand people’s hopes, “toxicity” into their narratives. receive. It is interesting to note the dreams, possibilities, and potential.2,3 role power plays in perpetuating Participants assessed work culture It was with this latter framework of bullying. A few participants spoke toxicity based on previous job wellbeing in mind that I set out to of unethical leadership, and being experiences, ideas gleaned from understand people’s experiences humiliated by their bosses – social media, and from their peers of “toxic workplaces”. The 10 including being subjected to remarks – often seeing job experiences participants of my qualitative about their weight, or deteriorating as toxic and exploitative only in study, in the age bracket of 24- mental health. There were also hindsight. Most agreed that while 32 years, narrated their work narratives of emotional manipulation “toxic” could be an overall “vibe”, it trajectories as interns and/or through reminders about “how was a culmination of experiences

ILLUSTRATION: MIRA F MALHOTRA F MIRA ILLUSTRATION: full-time employees in educational much they owed the organization”.

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One participant used the term supportive, loving, friendly team and out to be. Another participant said mental health as part AUTHOR’S NOTE: The title of the “enmeshment” for the toxicity in a non-corporate work atmosphere that while he constantly second- of workers’ rights article is taken from the Maggie her workplace. “Enmeshment”, that contributed greatly towards guessed himself, he also knew that Importantly, while participant Rogers song, ‘The Knife’, and is as a term derived from family helping her heal from the effects the industry he was in was going narratives featured self-blame and used here to highlight the struggles, systems theory, describes close-knit, of a previous job’s toxic work through a slump, and things going shame, they also featured hope, learning, recovery, and resilience of entangled relationships that lack environment. Several participants wrong could not be entirely his fault. resilience, even gratitude. Some the participants in the author’s study. boundaries.5 The participant talked had gained significant insights into Others spoke of supportive work participants were grateful for having of how interaction with colleagues just what degree of convergence teams, good friends outside work, the privilege of an escape route; in public-social spaces, long work between the personal and the hobbies, and their will not to give others for insights into levels of hours, and the emphasis on an professional was likely to be harmful. up as integral to their coping. Some negativity gained from previous “informal” atmosphere (to diminish even talked about how accessing work experiences; yet others coping, recovery, agency, resilience hierarchy) made it impossible for therapy had equipped them with the for having good mentors, and Participants referenced physical her to distinguish clearly between tools to cope with their situations. friends who helped them cope. as well as mental health concerns. her work life and personal life and, Some individuals, interestingly, talked Although participants referred to time Hope played a particularly significant consequently, her work self and about factors in other areas of their playing a role in their healing, the role in participants’ recovery — personal self. This was echoed lives that made them feel as they baggage of negative experiences still while they did not expect any by another participant’s memory did. For instance, one person spoke weighed heavy on their shoulders. workplace to be ideal, they definitely of how, at one point, her life was of how her lack of self-worth didn’t Many mentioned their resolve to hoped to find support through actually was just her work. Another emerge only from a workplace that draw firmer boundaries between the good colleagues, good mentors, participant spoke about how the questioned her every move, but also personal and professional. While and work that was aligned with work-life boundary was further from seeing her peers and friends monetary expectations and clarity worker rights and mental health. diminished by her boss, who ensured reach (age-determined) milestones about their own roles helped some employees worked seven days a These personal accounts of in their personal and professional people deal with workplace toxicity, week, and encouraged them to journeys of recovery from toxic lives. A constant replay of self-doubt there were others who spoke of rent homes closer to the office. workplaces bring to light the was, however, very much part of the constant struggle to remain necessity of a mental health and Interestingly, participants’ most people’s experiences of toxic authentic to themselves – with wellbeing discourse at, and for, responses to these various levels of workplaces. One person recalled one participant pointing out how, the workplace, and underline how enmeshment were not necessarily how what I refer to as the “knife of with work that required emotional crucial it is to view this within Lorelle Mariel Murzello has a Master of negative. Some spoke of going insight” came to her much later – it reflexivity, there was no way the the ambit of workers’ rights. ¤ Arts in Social Work in Mental Health from out of their way to volunteer, was only when she quit her toxic personal and professional could TISS, Mumbai, and has been working and doing different things in the job and met people who had been neatly be placed in separate boxes. in the education space since 2017. Her organization because they were through similar work experiences research interests include mental health, fresh from college and wanted to that she realized she had never culture, and gender studies. learn. One participant described a been the “problem” she was made

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LIVED EXPERIENCE An Invisible Intersection: Mental Healthcare for the Deaf Community A realization crucial to building a Deaf- inclusive society is that living in a non- signing world can be more disabling BY Madhumitha Venkatarama, Snehal than the experience of being Deaf Sujit Padhye

The 2011 Census of India,1,2 tells During our conversations with the NHS in the UK,10 is committed us that the country has roughly professionals,6,7,8,9 who work to providing MH services to the 1.2 million people with disability in with the Deaf community, and Deaf and their family members, hearing, and 1.6 million people with with mental health professionals and promoting respect for Deaf disability in speech, with considerable and institutions, we rarely came culture and sign language. overlap. According to The Rights of across any MH practitioners Persons with Disabilities Act, 2016,3 equipped to communicate with However, no such facilities are hearing disability includes the deaf the Deaf community, beyond available in India, where the stigma and hard-of-hearing. This article informal career or marriage associated with both mental attempts to throw light on the lack counseling, and mentoring. health and disability causes their of availability and accessibility of intersection to remain largely mental healthcare for this population Worldwide, there is significant neglected. Even the law governing (hereafter, “the Deaf community”). research done by psychologists mental health and disability is silent that addresses ways of providing about the mental health needs of The Mental Healthcare Act 20174 psychotherapy for Deaf clients the Deaf community. Besides, the upholds the right of every person and the role of interpreters in Deaf general tendency is to assume that

LHOTRA to access mental healthcare counseling, and emphasizes the the Deaf have the same requirements without any discrimination based importance of these MH caregivers and manifest MH issues in the same F MA F on disability. Yet, with only 250 knowing Deaf culture. There are way as hearing individuals, and certified sign language interpreters also organizations that offer thus need no specialized services and 9000 psychiatrists,5 and counseling for the Deaf community, other than the support of assistance no clear data on the number of including some governments, like (live captioning, sign language counselors, such care is barely the Government of Wisconsin. The interpretation, and so on). However,

ILLUSTRATION: MIR A ILLUSTRATION: accessible for the Deaf community. National Deaf Services, part of our research indicates that such

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Interpreters for Deaf people are often family members, which can make it difficult for the Deaf to communicate freely with MH professionals.

assumptions may not always be freely with MH professionals with respect to confidentiality experience of mental disorders essential, including advocacy for a valid. To work effectively as an MH about their sources and feelings and other ethical considerations, for Deaf persons may differ widely percentage of GDP to be allocated professional in this area calls for a of distress – may in fact intensify the differences between regular from those of other people, and towards the education and healthcare greater understanding of Deaf culture distress. Having MH professionals conversation and counseling. thus it is imperative to construct requirements of the Deaf community. – which includes social, historical, from the Deaf community The second part of the strategy better informed psychometric Such funds could be used for psychological, rehabilitative, linguistic also becomes challenging, as points to the need to create a Deaf scales that can be employed facilitating inclusive education in sign and cultural representation. Such professional boundaries may Affirmative Counseling Practices to run clinical examinations for languages in schools and hospitals;14 professionals need to work, first, on become difficult to maintain. course for MH professionals appropriate treatment plans. generating employment opportunities their own biases with regard to the so that they acquire a better for Deaf persons; encouraging Deaf community. Our research also recommendations: mental understanding of the Deaf world. Special training for sign language research and innovations in suggests that people who can hear healthcare support for The content of such a course could interpreters: It would be beneficial technology using artificial intelligence and speak often believe Deaf persons the Deaf community include the basics of the language to have persons with sign language to design assistive techniques (like have qualities which mark them out Developing a mental health and communication, building literacy and with knowledge of the the sign-to-text converting glove).15 as different in other ways, like being affirmative ecosystem for the Deaf cultural competence, addressing ethics of the counseling relationship particularly virtuous, or constantly community calls for a two-fold personal biases, and aspects of to assist Deaf people during their Media and culture are of critical grieving over their hearing disability. strategy: working on MH awareness working with interpreters.12,13 sessions. If an interpreter is used, significance for this enterprise. for Deaf persons, on the one hand; their being trained in aspects of Having stage shows of various Mental health problems in the Deaf inculcating awareness of Deaf A better MH ecosystem that literal interpretation, confidentiality kinds, and series and films and community are similar to those culture amongst MH professionals, makes counseling more accessible and objectivity becomes necessary. news programs on TV, in sign experienced by other minority on the other. The former arm of such for the Deaf community might A close examination and review of language, with live captioning or communities: some of the major a strategy would involve enabling comprise the following measures: this triangular relationship would with interpreters rooted in Deaf concerns are substance dependency, education for Deaf persons on Establishing alternative schools of also foster stronger therapeutic culture, would not only add colors suicidality, trauma related to intimate aspects of mental health, while counseling or psychotherapy that alliances. It is important, also, of entertainment and information partner violence, abuse by known and striving to remove the associated are more visually-oriented could to be aware of the fact that sign to the lives of Deaf people, but also Madhumitha Venkataraman is an unknown persons, unemployment taboo. Given how “dumb” and be useful. Besides art therapy, languages are diverse and may make for a society that is more experienced HR professional, Diversity or underemployment, isolation “mute” have been used as belittling mindfulness techniques based on differ in different parts of India. inclusive of the Deaf community. and Inclusion Evangelist, and a counsellor. and segregation, low self-esteem, expressions, the Deaf may already the use of the other senses, and As the founder of Diversity Dialogues, her fear of the external environment.11 be dealing with deep experiences of alternate mediums such as chat- Amendments are needed to the This article outlines some initial dream is to see a more inclusive world. We perceived a deep absence of stigma. It would be necessary, also, to based apps might prove particularly Rights of Persons with Disabilities steps towards mental healthcare empowerment, and concomitant equip family members, teachers and helpful. Having members of the Deaf Act and the Mental Healthcare Act, for the Deaf community and Snehal Sujit Padhye is a mental health loss of autonomy, for the Deaf interpreters with a basic knowledge community pilot and design specific so as to incorporate guidelines for does not purport to discuss the professional (clinical psychologist and community in India. Interpreters and understanding of MH, and to interventions might well enhance accessibility of mental healthcare intersectionality of identities counselor), an independent researcher, for Deaf people are often family set up peer support and emotional the efficacy of such therapies. for people with all kinds of of the Deaf community with and a teacher at heart. Her ambition is members, which can make it difficult first aid mechanisms – for which Designing psychological assessment disabilities, including Deaf persons. other minority groups. ¤ to explore hitherto unexplored areas in for the Deaf to communicate it would be crucial to emphasize, scales: As highlighted earlier, the Mobilizing funds is, of course, mental health.

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SERVICE DELIVERY Creating Safe Spaces within Legal Settings personal lives to court.’ Both women as relational journeys. Litigants’ and being able to prove it loudly. and men reported feeling helpless concerns vary, from individual mental Here, her internal process, her A model for individual, couple BY Dr Aparna Joshi, when the marital futures they had health-related issues to matters experiences, everything mattered. and familial counseling for Dr Amrita Joshi, Ipsita envisaged faded away. While conflict regarding reconciliation or separation. She felt heard. Over the course of Chatterjee, Sadaf Vidha, and separation were described as At this point, it becomes important to a year, she went on to have a trial painful in themselves, the courts acknowledge the power asymmetry period living with the husband she matrimonial litigation Chinmayee Kantak often further compounded the agony. prevalent in Indian marriages.5 The wanted to divorce, and then deciding Procedural delays and uncertainties counselors are careful to foreground the marriage was not working. Since how Sukoon came about While family courts across the need for a safe space made individuals feel stuck and women survivors’ resilience, taking they had tried everything – individual MH centers in India typically operate Maharashtra have state appointed in court premises lost. The legal process also brought into account the systemic nature of sessions, couple sessions, learning from clinics in hospitals and other marriage counselors, the dominant Those who approach courts for financial burdens, while negatively violence and of other marital conflicts new ways of communicating, institutional spaces, which often discourses of gender, power, decisions about their marriages affecting employment opportunities. that litigants bring into the room. setting boundaries with extended makes approaching them difficult, sexuality and marriage that underlie often have no space to process their Women survivors of domestic family – she was finally able to given social stigma and financial Litigants walking into the Sukoon marital conflicts and violence emotional upheaval. As one litigant violence risked retraumatization let go from a place of peace and capacity concerns – besides the room at any of the centers have against women2 are not necessarily said: ‘I went through depression for a because of court interrogations and resolve, rather than uncertainty. under-acknowledged power of either been self-referred or referred challenged within existing counseling year. I felt lonely, sad, scared . . . and having to encounter the estranged social structures like marriage by a judge, or a marriage counselor. Sukoon provides a unique space services. Therefore, there was a need would cry often. I also tried to commit spouse. Courts often become sites to affect emotional wellbeing. A common thread tying all clients for many litigants like R, because it to establish counseling services in suicide and felt a sense of anger/ of re-triggering old wounds, including Marriage is considered sacrosanct together, no matter what the referral does not privilege heteronormative family courts to address marital frustration that my husband does not childhood abuse, maltreatment in Indian culture, overall, and its sourc, is confusion, either about why standards like family interference. conflicts and related distress from understand me and my problems.’ by natal and marital families or dissolution unthinkable. Most they’ve been sent there (‘How is this Clients have said they prefer Sukoon a psychosocial perspective, taking larger systemic inequalities. individuals and families approach Emotional distress related to different from marriage counseling?’) to private practice counselors existing power dynamics on board. marriage with this belief. separation and decision-making Against such emotionally volatile or how to process the overwhelming as they feel the latter often fail These ideas helped us, in 2018, to is markedly high; there is also the backdrops, Sukoon aims to create emotions caused by their personal to understand cultural power The Family Courts Act (1984) establish Sukoon, a field action frustratingly time-consuming nature a safe space for litigants. Sukoon’s loss or grief, and move ahead. dynamics, even blaming them created a space for couples to find project of Tata Institute of Social of the court process.3 The litigants’ counselors use an empathetic for the problems they face. legal solutions to interpersonal When R, a 33-year-old woman, came Sciences, Mumbai. Sukoon provides personal lives entering the public approach, informed by values issues,1 establishing “Family Courts” to Sukoon, she appeared numb. With The counselors at Sukoon are free counseling services in legal sphere also causes significant of social justice and feminism, to ensure rapid resolutions to her consent, and after explaining trained in various schools of therapy settings – using a gender-sensitive, social stress – their marital conflicts to create a space within court marriage and family conflicts. It the role and scope of Sukoon, the – cognitive behavioural therapy, strengths-based, and intersectional are now open to scrutiny. Social premises where litigants feel was a revolutionary Act because it counselor conducted a grounding feminist therapy, narrative therapy, feminist lens that foregrounds stigma is a common experience for comfortable being vulnerable, recognized the culturally delicate activity with her. Some minutes couple and family therapy, arts-based financial and geographical access to marital litigants in societies deeply and articulating their distress. nature of such issues, and the Family later, when she felt more stable, therapy, dance movement therapy, quality MH care. Sukoon is currently invested in marital permanence.4 Courts were envisaged as spaces how Sukoon works the client spoke of how the space and so on. They strive to join in the based in five spaces in and around attuned to family needs. They were ‘Coming to family courts is extremely With Sukoon’s trained counselors, was so different from others in the client’s distress and build trust; help Mumbai, including two Family Courts even set up in premises distinct stressful. Nobody wants to come litigants are able to explore and court complex. In other rooms, what clients work through their concerns and the Mumbai High Court. from other civil and criminal courts. here, nobody wants to drag their navigate their individual as well mattered was the truth, the fact, using psychological and behavioural

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SERVICE DELIVERY

interventions; attempt to reduce position has changed, cultural change through a lens of shame. Our hope interpersonal tensions; and support will take time. In a country where is that by being present where family couples in arriving at common family is still seen as a fundamental conflicts play out, Sukoon might support, easing concerns of terms, and negotiating their lives in unit (unlike the individual, as in some catch those who fall through the time, distance, and costs,3 not the aftermath of the court case. other cultures), MH concerns arising cracks between the clinic at one end only must such interventions from familial distress are still viewed and “family as best” on the other. ¤ Mental Health be mindful of individual client a model for growth and replication resource constraints, they must Over the two years of its existence, also remain aware of cultural Sukoon has served more than 500 contexts and community needs. individuals, couples and families Helplines through one-on-one or couple/ Dr Aparna Joshi, Co-Director of Sukoon, Ipsita Chatterjee, Programme Coordinator expert-speak or peer-speak? family sessions, and more than is Assistant Professor, School of Human at Sukoon, has a Masters in Applied ‘All helplines, irrespective of 1300 litigants in group therapy Ecology, TISS, Mumbai. Her areas of Psychology (Specialization in Clinical Potential for subversion whether they are serviced by lay sessions. In terms of outcomes: interest and expertise include gender Psychology) from TISS, Mumbai. Ipsita counselors (paid or voluntary), or by clients were found to have and mental health, violence against also has a small private practice, and professional MH personnel, work on gained stress management skills; BY Raj Mariwala women, couple and family therapy, and provides psychotherapeutic services to some common principles.’4 These some acquired the objectivity to ethics in psychotherapy. A practising children, adolescents, adults, couples and principles may reflect knowledge empathize with partners; many the helpline as a mental health space and lay-counselor-based models. psychotherapist for 19 years, she has families facing psychosocial distress. from psy-disciplines such as active learned to set boundaries; there Dominant images of mental health Some questions arise in the also worked with NGOs to implement MH listening skills, psychological first were several instances of shifts include a therapist's sofa; perhaps a process: how does a phone line service programs in clinical, community Sadaf Vidha, Senior Counsellor at Sukoon, aid, knowledge of trauma, resilience, in parenting behavior. Sukoon has mental health hospital. Such images or chat box become a safe space and institutional settings. has a Masters in Applied Psychology cognitive behavioural therapy also worked towards sensitizing are emblematic of pivotal power to communicate distress? Can (Specialization in Clinical Psychology) principles.5 Definitions of stress or over 350 court staff, judges relations in the psy disciplines – such services address problems Dr Amrita Joshi, Co-Director of Sukoon, from TISS, Mumbai, and has done courses resilience might hinge on ideas of a and marriage counselors, and between expert and user, or inherent of discrimination and exclusion was Assistant Professor, School of in Queer Affirmative Counseling Practice “normal” derived from the clinical; yet with over 100 stakeholders to in the clinic. However, technology due to marginalization? How Human Ecology, TISS, Mumbai. She and Arts-Based Therapy. In her private MH helplines differ from traditional sensitize the legal justice system too is ushering in newer sites much does the heritage of psy- also has a private practice, and provides practice, she works across populations on clinical spaces in some critical ways. to mental health concerns. for MH practice – online spaces, disciplines with its more medicalized individual psychotherapy, group therapy, a range of concerns, including unique life artificial intelligence (AI), text lines approach to distress, influence Sukoon’s indigenously developed couples counseling (pre and post-marital, stressors for queer clients. Helplines offer possibilities for (that offer support via texting) such alternative sites of MH care? counseling model offers scope for and divorce) and family counseling anonymous help-seeking – allowing and, of course, phone helplines. its replication across legal settings services. She is experienced in dealing Chinmayee Kantak, Senior Research callers a sense of control. While this Phone lines are accessible to in India. Until the Mental Healthcare with stress, panic attacks, low self- Assistant at Sukoon, has a Masters is partly dependent on their ethics Samaritans, the first ‘crisis line’, people across geographies and Act, 2017, it used to be automatically esteem, grief, trauma and abuse, divorce, in Applied Psychology (Specialization and confidentiality policies, helplines begun in 1953, used volunteers communities.2 However, access assumed that the family as an addiction, body image issues, and in Clinical Psychology) from TISS, do circumvent some of the stigma to offer support, along with non- may depend on gender, age, socio- institution had the best interests of depression. Mumbai. Chinmayee also has her own around physically accessing clinical judgmental and empathetic economic status. While telephone the individual at heart; families were private practice, where she works with spaces. The caller also has some listening.1 Helplines have since counseling has enabled quick and seen as a person’s obvious guardians adolescents, adults and couples, using a power, knowing they can disconnect proliferated, using both expert-led relatively inexpensive psychosocial and caretakers. While the legal gender-sensitive and inclusive lens. and end the interaction at any point.

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While some telepsychiatric and/or with traditional MH knowledge resources, as peer support is confidentiality of the KLL helpline compounded by most practitioners experience, the binary of traditional, professionally staffed MH helplines bases as well as knowledge seen as critical. This centering of is crucial, given the profound in the state following traditional clinical knowledge and that of may use talk therapy to meet goals from the lived experiences of knowledge beyond traditional MH social stigma in Kashmir around clinical paradigms that are not queer expertise through experience. It of diagnosis, prognosis, intervention, marginalized communities. Specific allows iCALL to be accessible to a going to a psychiatric setting.8 affirmative. Such institutionalized must be pointed out here that psy thereby mirroring the clinic, many examples from the Indian context range of marginalized communities In the context of long-term violence, transnegativity and homonegativity expertise is coded with privilege, others aim mainly to assist and could help us explore how some that may find mainstream KLL creates a safe space as render psychosocial support even neoliberal approaches and support, share information, offer a helplines inculcate both systems. helplines uninformed with respect the counselors are all Kashmiri more precarious and inaccessible.9 mainland hegemony – of especial safe space for expressing distress, to their specific concerns. themselves, and share their relevance to KLL and Ya_All.11 provide interim comfort – and iCALL: a national helpline clients’ lived experience of ongoing Against this backdrop, Ya_All, an referrals if needed. Such a space run by psychologists Kashmir Lifeline conflict. Further, given that the LGBTQ+ Allies Youth Network/ While helplines may not yet offer of care versus treatment marks an The iCALL (Initiating Concern for All) While many helplines are instituted institutional, bureaucratic response Collective, runs a helpline operating fully-fledged counter-narratives from important departure from the clinical Psychosocial Helpline was set up in in times of humanitarian crisis, to the widespread trauma has in English and Meitei, based in the MH arena, they do hold exciting mainstream. Peer-run helplines 2012 to provide free, professional, Kashmir Lifeline (KLL) is a permanent been biomedical, with an over- Imphal. Besides the helpline, Ya_All possibilities for the subversion of epitomize this approach, and cannot psychosocial counseling via phone, helpline that services a region beset reliance on medication, KLL’s referral also does crisis support work for dominant tropes in the psy-disciplines be assumed to be merely “task- email or chat to persons from across by long-term conflict, and is the system to their own centers, NGOs, individuals in distress. Its center is – foregrounding individuals and their shifting” or providing only basic India in need of emotional support, world’s most militarized zone. There hospitals and other support systems accessible to helpline callers who contexts even as they retain core services. Rather, helplines run by with an emphasis on making MH is a grave shortage of MH resources has been noteworthy. The KLL may want to meet face-to-face, or tenets of ethics and accountability. ¤ peers with lived experience can be accessible for socioeconomically in the Kashmir Valley. Apart from model demonstrates the effective access community. The peer support highly effective in ways the clinical marginalized persons, survivors of the lack of services, access to care use of both traditional clinical and provision of community space may not be. For example, LGBTQIA+ violence, and communities that have is affected by a variety of factors, systems of knowledge and peer play crucial roles. Members handling helplines, and youth MH or substance faced historical discrimination. including harsh winters, curfews. knowledge to address psychosocial the helpline have acquired training use helplines staffed by peers, rely on and the perpetual threat of violence. support in a region of conflict. through MHI’s Queer Affirmative knowledge from both individual and The team, comprising qualified Counselling Practice course and/ collective lived experiences of social professionals with a Master’s in KLL was founded in 2009 in Kashmir Ya_All or its Peer Support Practice course, contexts and unique life stressors. Psychology, receive additional with the aim of addressing MH Manipur is home to a significant and use skills and guidelines from training in areas such as substance needs using both conventional and LGBTQIA+ population that is largely psy-disciplines that enable boundary- However, peer-based helplines could use, queer affirmative counseling alternative therapies.7 Staffed by a invisibilized. LGBTQIA+ youth with setting, staff well-being, and the encounter challenges in terms of practice, kink affirmative MH, sexual team of Kashmiri psy professionals privilege may migrate out of the ability to challenge any essentializing boundary setting, confidentiality, and reproductive health, sexual providing services in Urdu, Kashmiri state; others have few options. The of LGBTQIA+ experiences.10 further training, supervision, self- harassment and violence against and Hindi, KLL has a toll-free number multiple oppressions that Manipuri care, besides being adversely women. Many of the trainers to enable free and consistent access youth routinely face include a heavy negotiating traditional affected by having to engage with come from a locus of relevant to psychosocial counseling and military presence by and conflict with and peer expertise Raj Mariwala is the Director, Mariwala mainstream and possibly oppressive lived experience. The extensive trauma support, especially during the hegemonic mainland. Besides These various helpline models Health Initiative and also a board member institutions and services.6 The referral system that iCALL uses curfews and restrictions on net the scarcity of MH services, and illustrate their potential for MH work of Parcham, a nonprofit that serves critical need remains, to engage also connects callers to community connectivity. The anonymity and poor public transport, the situation is that is able to traverse, through adolescent girls through sports.

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LIVED EXPERIENCE Mental Stress: The Toiling Class in

Slums BY Rupali Jadhav

How customs and traditions, offer hope and comfort with words like ‘Krishna’s birth comes in the songs and rituals play a role time of Kans. Sleep, baby, sleep, sleep.’ Which means that the divine child Krishna brings good hope in these bad times of the demon no awareness or access deal with their mental stress, and Kans (Krishna slays Kans in the I was born in Kashewadi slum despair? I have observed two well-known mythological tale). of Pune, in a Dalit family. So common ways in which people I have closely observed and relieve mental stress. First, without Marriages are seen as the happiest been part of everyday life and physically harming the body. Second, of celebrations. Even if people do events in slums. I am neither an in which they hurt themselves not have money, more importance academician nor holding a PhD, emotionally and physically. is given to joy than to showing off but I have ample experience. wealth. In the marriage house, there sound and music for is continuous singing and music, “Mental illness” is something that life’s milestones from the commencement of rituals people are completely unaware Caste, class, gender, religious till the end. Before the wedding, the of, in the slums. They don't know customs and superstitions, all night-long Jagaran Gondhal takes mental health is like physical health. have a deep impact on a person’s place. A woman and some men sing It is surprising for them that there everyday life. Sometimes these may and dance; one person performs are doctors or counselors to help show ways to deal with despair. with a flaming torch. They pray to people with mental issues get For example, whenever there is the deities to stay calm, and invite

SHRIDHAR well. And if some few educated a new birth in a family, the whole them to participate in the general persons know about psychiatrists community enthusiastically takes happiness. The performers are all or counselors, they cannot get part in the rituals. In her seventh from Dalit or marginalized castes. treated due to lack of money. month, the Dohale Jevan ceremony The women performers, called A NIRANJANI SHRIDHAR NIRANJANI A is organized for the mother-to-be. “Murali”, are dedicated to god, and Mental illness means “madness” – She sits on a swing, and people can never marry; their duty is to that is the common understanding sing traditional songs to cheer her worship, and to sing the holy songs. of people in slums. up, and feed her nutritious food to keep her happy. After the birth, After death, too, music remains One may question: if people in the a naming ceremony is held for central. Family members sing slum do not know mental illness the newborn. Such rituals bring collectively in a monotonous

ILLUSTRATION: SHRUJAN ILLUSTRATION: can be treated, then how do they everyone closer, and the songs

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Music and art drain out despair, sowing new seeds of hope to rejuvenate our lives. Folk art makes life more bearable.

rhythm, narrating the life story of the art drain out despair, sowing new devotees ask for guidance – about explored in detail at another time. In be strong in the slum, there is no deceased. Women, men, everybody seeds of hope to rejuvenate our lives. rectifying their mistakes, family general, I am referring to alcoholism question that the quality of life is weeps loudly, which helps people disputes, problems at work, and so and other kinds of substance abuse poor. Until basic human needs like possession and mental healing to express their grief, as a bhajani on. The possessed individual then – common harmful substances food, shelter, clothing, work, and The most fascinating thing during mandal or hymn group beside the advises them: to gift a chicken; that the young people, especially, health are ensured, a negative impact my childhood was “angat yene” dead body sings songs explaining to leave a lemon and coconut at are drawn to, include ganja, charas, on mental health is inevitable. ¤ (possession, when a god or how birth and death are inevitable. a crossroads intersection. Those tobacco, gutkha, whitener – as goddess enters a human body). who experience possession are well as the addictive viewing of Take the name of God, People gather around to worship usually deeply troubled individuals: porn. Many of these addictions are Leave urges behind the possessed person, believing transgender persons, or women known to cause physical and mental This is the touch of Fate they are worshipping the god. They and men who lack social respect harm, including deaths – often Why cry, always? sing, play musical instruments, and and may be suffering or in despair. due to inadequate medical help. It’s Fate, it’s Fate, it’s Fate. . . dance for hours. These songs and

dance are all related to the religious I have observed how, once someone Slums develop their own culture. If one roams around a slum, morning idea of possession by a deity. becomes possessed, family Living in a slum needs an or evening, one can hear loud music members and others bow and Cheer the Goddess Yedeshwari! understanding of it's psychology, emerging from every household. touch the person’s feet, admit to Victory to Goddess Bhawani! and its cultural nuances. The dense Romantic songs, DJ songs, being afraid of them, and speak to Full moon day is happiest for me! populations make cooperation devotional music. People connect them with great respect. This can In the village we shall worship necessary; and the collective bonds with the heroes or heroines of these be helpful for both, the possessed The idol of Goddess Ambe with pride! that are seen during festivals and songs so deeply, they enter a virtual person and the others participating other occasions fulfil people’s world. During power cuts, we used to in the event: the person with a god or Even as a child, I noticed how the needs for actual support as well bang plates, glasses, spoons, while goddess inside themselves is treated deities possessed only the bodies as for a sense of community. The singing together. These fantasies, with a dignity and respect which of people who lived in the slums, more marginalized communities sounds, and the togetherness, all they may not receive otherwise; not the bodies of people living in express their identities and help to set aside personal pain. those with personal anxieties upper class, upper caste areas like emotions through creating their In the slum, all festivals – Ganpati, are comforted by the illusion of Sadashiv Peth. All the worshippers, own symbols and celebrations. Rupali Jadhav has worked for over a Navratri, Christmas, Diwali, communicating with a divine power too, were from economically lower decade on issues of gender, caste, class, Moharram, Sankranti, Holi, Mangala who will now set things right. In this classes and marginalized castes. The slum is also a goldmine of as a member of the Maharashtra-based Gaur, Dhulivandan, Rangpanchami, way, both sides are able to achieve artists. Folk art makes life more cultural group Kabir Kala Manch. She has and more – as well as the Birth a state of mental relaxation. The belief is that once a god or bearable, at some level. Besides a Master’s in Social Work, and is currently Anniversaries of greats like Dr goddess has entered into a body, the variety of visual and musical pursuing a course in Women’s Studies. Babasaheb Ambedkar, Annabhau the other way the person is directly connected forms, today we have rappers and Rupali uses poetry as a medium for her Sathe, Shivaji Maharaj, are closely The second type of mental stress to the deity, and can therefore other rich new expressions. activism; she also composes and sings associated with music. Music and relief I mentioned may be best solve people’s problems. So the Finally, while collective feeling may songs about social justice issues.

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WHAT sort of tangible ALTERNATIVE CONSTRUCTS Engage are being built? How much do medical understandings of distress influence spaces that are not the asylum or the clinic? What are the ROLES of certain spaces in MEDIATING EXPERIENCES of distress? What makes a healthy space? How do surroundings influence thoughts and feelings? This final section highlights some IMPLEMENTATION and EXPERIENCES around building different LANDSCAPES and exploring the role of space in Implementation experiences of mental health. Operations Practices Services

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CAPACITY BUILDING Teachers as Agents of Change

Tealeaf: Mansik Swastha teachers renegotiate traditional roles and relationships as they become BY Emma O’Brien, Choden delivery agents of Mental Health Dukpa, Juliana Vanderburg, (MH) care in a school setting The Tealeaf team

‘What help can I give? We know how teacher workflow. Appropriate MH ethnically distinct part of West hard she is working...’ care for younger children can help Bengal – its only hilly region. to build their social and emotional Most, but not all, aspects of ‘The people who are helping the life skills, support future mental state administration fall under children are more learned than us.’ well-being, and may reduce the the separate authority of the extent of future disability. Evidence- Gorkhaland Territorial Administration. — PARENTS based therapy lies at the core of this Regional marginalization, the intervention, guided by the WHO complex governance structure, Many primary school teachers Mental Health Gap Action Program.1 and the absence of Panchayati Raj already support students with MH By incorporating targeted MH care institutions bring challenges in the difficulties and significant behavioural for students throughout the day, the implementation of development challenges. While the intervention care becomes ongoing, situated and schemes here. discussed here shifts care to a community-based, rather than being community-based setting, it remains provided only in expert-led, clinical Tealeaf is being implemented in embedded within the school as an settings. 20 rural low-cost private schools,

TRA institution. Understanding how power expanding to 60 schools by 2022. operates within the school, and in the A randomized controlled trial We have chosen to work in private community, is key to our evaluation of to evaluate the efficacy of this schools, given their increasing this intervention. intervention is under way, along with role in the education sector. These an embedded ethnographic study of schools fulfill education needs and the intervention process. aspirations in rural areas where Tealeaf: Mansik Swastha (Tealeaf) government schools are distant, or reimagines MH care for primary context not functioning well. Official data school children by integrating it into Darjeeling is a geographically and on Darjeeling is sparse, but our ILLUSTRATION: MIRA F MALHO F MIRA ILLUSTRATION:

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In becoming delivery agents of MH care, teachers must renegotiate existing dynamics while gaining a better understanding of their multiple, intersecting positionalities and roles.

4 Love and affection experience suggests that private extremely encouraging. situated position of authority. When their child’s education, teachers school enrolment is at the high end Training participants saw their sharing their experiences, they are often disempowered within of the nationally estimated range of teaching role as one of community described a clear social distance the school environment, subject to Talking with the child 30% to 50%.2,3 Additionally, private service or social work. These between themselves and their the strict control of school owners schools are excluded from existing teachers are poorly paid, most students' families. Even the language and principals. Some teachers Better relationships with school health interventions, with earning Rs 1,500 to Rs 3,000 monthly. that teachers use is typical of the were actively discouraged from caregivers teachers having little access to ways in which the Darjeeling middle communicating with parents. In ongoing training and support. Thus, school as a site of class distinguishes itself from the becoming delivery agents of MH Listening to the child their students are at risk of being left mental health care less educated, or those seen as less care, teachers must renegotiate behind. While the Tealeaf intervention shifts sophisticated.5 existing dynamics while gaining a Physical exercises / care delivery to a community-based better understanding of their multiple, Activity teacher knowledge and attitudes setting, it remains embedded within Teachers often had the impression intersecting positionalities and roles. about mental health institutions that have their own that parents did not care or were not Medicine The majority of teachers who power dynamics: between teachers interested in their child’s education. unlocking change: improved attended our one-week training in and children; teachers and parents; ‘Parents feel that sending their relationships 2020 believed that both school and teachers and school principals. child to the school is their only Changing language used, Changing our expectations community had a role to play in Care plans depend on teachers and responsibility, and after that the establishing new relationships managing MH challenges. They were parents co-operating to achieve the teacher is supposed to take care of and challenging bias cannot all be clear that such care should not be best outcome possible for children everything.’ accomplished in a one-week training. Food and diet confined to far-off “experts”, and that in the program. Yet the traditional Ongoing mentorship and support is, families should not have to manage perception of teacher as “expert” What teachers perceived as a lack then, a core component of Tealeaf. Vitamins and tonics without support. The teachers’ does not necessarily align with a of care, or disinterest, was in many Workshops with principals and top four ranked responses about collaborative approach to MH care. instances an expression of trust parents also help to bridge gaps. Prayer what helps children with MH health Teachers, too, may have their own in the teacher’s abilities. Parents By modelling supportive behaviour care needs were all relation- and biases and assumptions, which who were not highly educated felt and good communication skills, and interaction-based, rather than deriving need to be challenged if they are themselves ill-equipped, and were providing suggestions for parent Hospital from a medical understanding, as in to effectively support children and handing all responsibility for their interactions, Tealeaf initiates a larger the graph seen to the left. deliver this type of care. child’s development over to the shift in relationships in the wider Distracting the child school. By encouraging relationships community. Only a small minority of training power structures and class based on shared goals of supporting Herbal medicine participants (7%) felt that the role dynamics and caring for the child, such gaps Following the intervention, a teacher of certified professionals was Despite their willingness to support between teachers and parents may explained how her perspective about crucial. The larger recognition of children and families, and their view be minimized. a child’s challenging behaviour the importance of community of themselves as “social workers”, While parents might view teachers changed: 0% 25% 50% 75% support, on the other hand, has been teachers inevitably have a culturally as the ultimate authorities regarding ‘. . . we realized that we need to 69 | REFRAME '20 REFRAME '20 | 70 ENGAGE

SERVICE DELIVERY A Home Away from Home

observe and find out the root cause documentation and analysis of this for the (child’s) behavior. . . we got to intervention will further explore how Creating a space of care to provide know that the child couldn’t do the differences in power, including those homework or study at home because related to class, status, age and mental health support for children, there was no electricity at home. This gender, impact its effectiveness. ¤ way we became aware.’ adolescents and their families in BY Giselle Dass, Rini Sinha With improved communication, Sri Lanka. parents feel more empowered to engage with the school, and teachers ‘No, I’m not going in there!’ screamed by psychologists Giselle Dass and needs in low-resource settings are to empathize with the complex a young child diagnosed with Suhaila Shafeek-Irshard, began to often ineffective in dealing with challenges faced by the children Asperger’s, who was scheduled track the landscape of care in Sri these challenges holistically.2 Getting and their families – thus being for an appointment at a MH clinic Lanka, it realized that for children, adolescents to open up about their better placed to understand the links where psychologist Giselle Dass was adolescents, and their families, issues and seek help requires the between child behaviour and mental Emma O’Brien is a Research Juliana Vanderburg is a third-year practicing at the time. The outburst MH care was available only at use of creative methods, and an health. Communications Coordinator at DLR doctoral student in the School Psychology was triggered by the board outside overstretched and under-resourced interdisciplinary approach that Prerna. She did her Masters in Social program at the University of North the clinic that read ‘Psychological hospitals or private clinics. The includes ways of supporting the conclusion Policy Research from University College Carolina at Chapel Hill. She has a BSc Services’. This incident helped Giselle services were primarily psychiatric, families. Task-shifting MH care to classroom Cork, 2015, after graduating with Law and in Psychology and Spanish and MSc in realize how simple details such as focused on prescribing psychotropic building a home teachers is a potentially powerful French. Her varied experience includes Psychology from Tulane University, and the text on a signboard hold the medication. While fear, shame, cost, The CAFS team realized that approach to embedding such care program and policy work in maternal currently serves as a research assistant potential to make service users feel and the pervasive stigma associated children and adolescents needing in the school and community, and health, abortion rights, environmental for several projects focused on evaluating comfortable – or uncomfortable– in with MH issues were barriers psychosocial support did not respond closing the care gap by providing protection, migration, and children and school-based interventions designed to a space. for many people, the biomedical well to typical clinical spaces in children with the much-needed MH young people. promote student mental health. emphasis suggested that the social ‘Was that a relative who just spotted overburdened hospitals. What could support they may not otherwise dimension of mental distress was me?’ ‘What will people say?’ The a doctor do about the complex receive. While teachers are trained to Choden Dukpa is a Research Associate The Tealeaf team is a group of doctors, being ignored. odour of disinfectants clogs the stressors embedded in their family identify, and provide targeted support at DLR Prerna. She has a Masters from non-profit professionals, public health nostrils, there’s the stark white of Such an approach may prove life, their experience of schooling, or to, children showing signs or at risk Tata Institute of Social Sciences, Mumbai. professionals, researchers, social workers claustrophobic corridors, paperwork, particularly problematic when it their uncertain futures? A shift was of mental distress, it is evident that A former Young Professional at BRLPS, and teachers. We come from NGOs, questions, and more questions… comes to children and adolescents. indicated – from the clinic to a space these skills are already being used JEEViKA (Govt. of Bihar), she worked universities, health systems, and school doubts might well crowd the mind 10-20% of adolescents experience that felt more inclusive and secure – more widely – increased community on women empowerment through rural systems. The intervention and research of anyone who visits a hospital in Sri MH challenges, and half of all mental which led CAFS to develop a space engagement and relationship-building entrepreneurship development. In her are co-funded by Mariwala Health Lanka to seek MH support. disorders begin before the age of based on the concept of “home”. have already extended far beyond those current role she leads qualitative and Initiative and the University of North 14.1 However, the clinical health children receiving targeted support. quantitative research activities in child Carolina. When the team at Child, Adolescent The CAFS-run “home” is a child- system’s responses to adolescent Over the next three years, our mental health. and Family Services (CAFS), led and youth-friendly community hub

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Caring is about acknowledgement, concern, affirmation, assistance, responsibility, solidarity and all the emotional and practical aspects that enable life

where a range of multidisciplinary be discussed and worked through For the team at CAFS, it is precisely professionals provide psychosocial safely, facilitating a more effective through this crafted culture of care AN ENVIRONMENT OF CARE care to adolescents and children, treatment and management of MH that their clinical work gains efficacy. and their families, across class and issues. Yet it raises a set of critical questions: What details make the CAF (Child, Adolescent and Family Services) ethnicity. As deciding to reach out How might we replicate this kind of This building of a space of care has for support is a crucial step for any caring space, if it is so dependent on space effective? required particular attention to the individual living with MH issues, it the work of specific people within it? material culture of treatment. The is important that their next set of How might we measure or evaluate team is constantly ‘tinkering’5 with interactions take place in a caring its impact? The CAFS team are the space, literally and conceptually, non-intrusive Clients book through appointments; there is never a waiting queue; nor is there any obvious environment that helps sustain the working through such questions inviting in certain service providers, signage – so if a client is dropped off, it is not apparent where they are going. decision to pursue treatment. during their 12-month collaboration adding small details to the interior, 1 with UK-based support organization spaces of care shaping interactions with clients and Ember. Their answers may well offer The problem with MH service with each other. Unless one looks learnings that resonate across MH provision is not always one of supply, closely, one might miss this caring welcoming When someone arrives, they are offered a cup of tea; they may use the open kitchen, relax in the disciplines and contexts. ¤ it may well be one of demand.3 and careful labour. common social space, join discussions at the communal table, take time out in the calming room; or play in People living with MH issues don’t the sensory room; and the care-provider coming to the reception area to receive the client is a simple gesture 2 necessarily perceive the need for that creates an immediate sense of equality, a first step in dismantling the power differential. clinical services, or they are deterred by stigma, or by the power dynamic between clinician and patient. secure When clients meet any of the range of care providers, it is in private consulting rooms; and CAFS can be seen as a space of confidentiality is assured. care, where high quality psychosocial 3 services may be accessed beyond Giselle Dass, Founding Director at Rini Sinha is a Communications Officer the clinical setting. “Caring is Child, Adolescent and Family Services with Ember, an organization based about acknowledgement, concern, (CAFS), holds a BSc in Psychology in London that supports MH-related affirmation, assistance, responsibility, and Counselling and an MSc in Child innovations. She is currently pursuing closeness The CAFS space is also nurtured through the visible, familial closeness among staff members. 4 solidarity and all the emotional and and Adolescent Mental Health (King’s her Masters in Development Studies practical aspects that enable life” College, London). Besides psychological from IDS, University of Sussex, UK. note Kleinman and van der Geest.4 assistance to vulnerable individuals She also holds a Masters in Mass Indeed, the CAFS home is a haven, a and families in varied settings, her work Communication from Jamia Millia Islamia, belonging The CAFS team themselves treat the space as one of belonging. The core elements of care, love sanctuary, which allows an individual experience includes project development, India, and has worked as a journalist and and mutual support are reflected not only in the services provided but also in team interaction – their mutual just to be. It is also a space that’s implementation and management. She communications consultant in India. 5 synergies helping to create an accessible mental health ecosystem. both welcoming, and private and is currently pursuing a PhD in Population secure, where intimate concerns can Health Sciences.

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SERVICE DELIVERY An Approach to Dance Movement Therapy (DMT)

A mental health intervention

that moves beyond the clinical BY Dr Sohini Chakraborty, paradigm Rhea Kaikobad

the Dance Movement Therapy are inextricably linked, and that Sampoornata draws on principles process creative, body-based, and non- of global DMT practice, adapting Clinical mental health services verbal methods of expression are them to the social development are generally characterized by an powerful means of self-articulation sector in India. It incorporates exclusive focus on mental illness. and exploration4 – as well as elements of Indian dance and This tends to reduce the individual inclusive, moving as they do beyond movement (for instance, folk dance to a diagnosis, with treatment being specificities of language. circles, meditation, and the classical directed entirely by professionals.1 By navarasa or nine emotions).7 Its the Sampoornata approach contrast, alternative approaches to recognition of contextual causes The Sampoornata (fulfilment) MH tend to be aimed at the wellbeing of distress, group-based sessions, approach to DMT was established of the individual as a whole.2 Clients’ and low resource requirements by Kolkata Sanved, an NGO working self-expression is recognized as make it suited to social development for the healing, empowerment crucial, because they are the experts work, especially with marginalized and wellbeing of marginalized when it comes to their own lives communities. communities (with a strong and contexts. Such a focus on the emphasis on gender justice). Kolkata Sanved implements client may be found in the Dance Sampoornata evolved through Dr Sampoornata in collaboration Movement Therapy (DMT) process. Sohini Chakraborty’s work in the with partner organizations (other DMT is defined by the American area of trauma healing for gender- NGOs as well as governmental Dance Therapy Association as ‘the based violence survivors through the agencies) in Child Care Institutions psychotherapeutic use of dance and medium of dance and movement. and community settings. DMT movement to promote emotional, Five survivors were trained as sessions, each facilitated by two social, cognitive and physical DMT practitioners and, in 2004, DMT practitioners, are conducted integration of the individual, for Kolkata Sanved was founded by Dr with groups of 10-20 participants, in the purpose of improving health Chakraborty along with the survivor- weekly two- hour slots or monthly and well-being’.3 The field of DMT practitioners.5,6 full-day workshops.8 acknowledges that body and mind ILLUSTRATION: MIRA F MALHOTRA F MIRA ILLUSTRATION:

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While clinical practice often sets up a power hierarchy between expert and patient, the DMT practitioner-participant relationship moves beyond this

a body-based holistic process The earlier stages help to create income, gender, social exclusion, The goal of Sampoornata is the directions by practicing body-based rape in an institution, practitioners The body is the seat of the core awareness and peace within the and social support (besides emancipation of the participants.20 empathy.23 facilitated residents’ exploration of self; it is through the body that we body, laying the foundation for others) are instrumental in shaping Apart from deconstructing ways to protect oneself when feeling The Sampoornata approach24 perceive, act, and interact with the deeper, process-based work. The mental health.17 Recognizing oppressive norms, it enables defenceless.25 focuses on training DMT practitioners world.9 Our ways of holding our opening ritual is meant to make this, Sampoornata locates the participants to acquire confidence, from marginalized communities. conclusion bodies are shaped by social norms.10 participants feel grounded in the source of the problems not in the enhancing their creativity and self- Through the DMT Leadership Sampoornata is a relatively new DMT uses body awareness and present and with the group. The individual but in social experiences expression. It encourages them to Academy of Kolkata Sanved, approach within global DMT and movement exploration as starting warm-up enables them to recover of oppression and marginalization. negotiate their way through current individuals with experiences of mental health praxis. It creates a new points to understand and build energy, so that they can dive into the Oppressive norms may have oppressive realities to choose marginalization are trained as DMT pedagogy for healing and wellbeing: wellbeing of all aspects of the self.11 deeper process of using movements affected participants both through their own paths.21 They also have practitioners and change-leaders. a body-based approach embedded in The Sampoornata approach to DMT to explore, and go on a journey with, internalization and external pressure. access to social support from their Therefore, Sampoornata is shaped a community-focused, rights-based enables holistic engagement through the self. The relaxation and healing For example, it is observed that peers in the sessions, and from not just by academic knowledge but perspective. Since the major resource an integration of the five selves: touch stages are designed to calm many female participants are initially the DMT practitioners whose non- also by lived experience, which deeply required is the body, and the process physical, emotional, intellectual, the body and mind. Reflection and hesitant to move freely because judgemental, empathetic relationship enriches the model. Practitioners can be done in groups, Sampoornata social, spiritual.12 The central part feedback help participants to think they have internalized patriarchal with participants is essential to the can draw experiences from their can be made available in low- of the DMT session is movement- and speak about their experience, norms that tell them to restrict their process.22 DMT practitioners are own milieus to demonstrate how resource settings, thereby increasing based activity, in which participants thus enhancing the body-mind movements – norms that have also able to link participants to other to navigate oppressive contexts. access to mental healthcare for have the space to move as they want connection – and also providing the been reinforced externally, through supportive resources and networks For example, after an incident of marginalized communities. ¤ without being judged. This enables a facilitator with indicators for next community pressure. The role of (such as NGOs that offer vocational connection with physical sensations steps to be taken. The underlying DMT, here, is to enable participants to training). in the body, as well as with emotions. focus on wellbeing is reinforced deconstruct such internalized norms: centering the participant’s lived Group-based activities help connect through a strong emphasis on the sessions create a safe space in experience to the social self. Afterwards, participants’ existing strengths and which participants explore different While clinical practice often sets up Dr Sohini Chakraborty, Ashoka Rhea Kaikobad is a Project Coordinator participants provide verbal feedback resources. A sense of feeling positive kinds of movement and get in touch a power hierarchy between expert Fellow, sociologist, dance activist, at Kolkata Sanved, and is currently about their movement experiences, and strong also emerges; through with their own preferences and and patient, the DMT practitioner- and dance movement therapist, is the training to become a Dance Movement thereby integrating the intellectual the sharing circle, and activities built choices, without feeling the pressure participant relationship moves Founder/Director of Kolkata Sanved, Therapy practitioner. She has an MA in self.13 around peer bonding, DMT groups of social norms.18 This becomes a beyond this. The therapeutic space and a pioneer of Dance Movement Development from Azim Premji University. may evolve into support systems.15 first step towards empowerment. For A DMT session in the Sampoornata is co-created by both, and the role Therapy in India and South Asia. The Her research and practice interests are The synergy between all these instance, one trafficking survivor said curriculum consists of eight stages: of the practitioner is to enable the Sampoornata approach has been primarily focused on the interconnections aspects helps to build a deeper that DMT gave her the physical and opening ritual; warm-up; need- participant’s self-expression. The developed under her leadership. She is of gender and mental health, feminist sense of interconnectedness, thereby emotional confidence to assert her based DMT activity; relaxation; participant is at the centre of the an International Working Committee practice, and mental health as social integrating the spiritual self.16 right to speak in court;19 another DMT healing touch; group discussion process, and directs the progress Member of Rise Learning Network, justice work. trainee, who was assigned male but and feedback through a reflection freedom from restrictive norms of the sessions. The facilitator and Chair, Status and Development, identifies as female, found the space circle; debrief; and closing ritual.14 Social determinants such as shapes activities according to these World Dance Alliance, Asia Pacific. to express and define her gender.

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RESEARCH Communities of Practice and Women’s Mental

of practice in supporting women’s how they managed their mental Secondly, the women felt they Health mental health in low-income settings. health. They spoke of community had gained from having access to in the sense of communities of social relationships predicated on women’s understandings of practice – referring to groups in unity and solidarity, as distinct from Looking beyond geographically “community” in low-income settings which ties develop between members the given relationships of family and This analysis is based on a study through regular conversations about kinship. There was reflection BY Saloni Atal defined community as supports of a community education project matters of common concern.9 In on how, prior to working at set up by the NGO Muktangan to the context of the present study, Muktangan, they had been embedded defining “community” in community women in marginalized and extreme that psychosocial aspects of improve the quality of educational such communities of practice had solely within their “communities mental health settings,2 the notion of community “community” life, including social provision in mainstream government evolved through the professional of birth”, with their patriarchically The mental health and psychosocial itself is slippery. It might refer to a support networks, degrees of social schools in Mumbai. The case study development activities and group organized families placing them needs of women in low-income bounded geographical location; or cohesion and collective self-efficacy, was built around interviews and discussions participants have as in subordinate positions to men. settings of the Global South have to the culture, practices or ideals have significant bearing on women’s focus group discussions with 20 teachers: they spoke of how these Working with the NGO had enabled gained increased attention with shared by a group of people; even MH. It has been found,5 for instance, teachers and other frontline staff at communities, cultivated over the them to cultivate communities the rise of the Movement for to religious or political ideologies that high levels of perceived trust Muktangan – women recruited from years while working at Muktangan, of their own choosing, building Global Mental Health (MGMH). As or positions.3 The bulk of existing within communities is positively the same marginalized communities had given them access to alternative networks with other women in similar part of MGMH’s efforts to scale work on community MH with regard associated with management of as their students. The author forms of association, and benefited situations. The unconditional up services in limited resource to women remains situated within HIV-related distress among women. conducted telephonic interviews their mental health in three significant support they gained from these settings, communities are viewed as a biomedical discourse, in which Scholars have also found,6 on the with participants, given the COVID-19 ways during the pandemic. relationships allowed them to mediators of MH, with community “community” refers to a place, or a other hand, that social connections crisis. Due to the implementation confront unequal relations of power engagement being recognized as a physical space, where the delivery may actually add to distress of measures such as physical mental health outcomes during the in their own lives and to overcome key locus of action.1 While MGMH of mental health support services among women in resource-poor distancing, this crisis presents an coronavirus crisis feelings of social isolation and frequently invokes the need for can be coordinated.4 From a service settings, through the obligation unusual opportunity to understand Several participants said that while constraints, as well as negotiate greater community involvement, delivery perspective, such a view to provide support to others in the psychosocial relevance of physically distanced from each gendered oppression. understandings of “community” of communities is pragmatic, given the community. Some social and community in supporting women’s other and from their organization, vary among stakeholders. The that health services are distributed community psychologists therefore MH.8 The interviews sought to they remained connected to their Finally, through these multifarious ways in which the term district-wise, and mental health argue that research studies and understand the meanings participants feminist values and identities, from communities of practice, is used, particularly in relation to the practitioners (MHPs) allocated to intervention programs need to attached to “community”, both in the which they drew a sense of power participants reported having an promotion of women’s MH, makes regions based on population levels complicate understandings of the context of the pandemic and beyond, and agency within their households. enhanced capacity for reflection action at this level a complex process within defined geographic areas. term community.7 Few studies on and the role of these communities in Many spoke of recognizing their and problem-solving. Additionally, that requires further exploration. women’s MH in the Indian context, supporting their mental health. own contributions to their families’ they felt empowered during the Exclusively place-based however, have focused on examining wellbeing, and being able to assert time of crisis by being able to share Although it is widely established understandings of community may, community from a psychosocial The women participants tended their own needs and preferences their worries and concerns, and that community promotes and however, obscure relational and perspective. In the present article, to emphasize social and relational during the present challenging collectively find solutions. supports emotional wellbeing among social aspects. Evidence suggests I examine the role of communities aspects of community in discussing circumstances.

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SERVICE DELIVERY

communities of practice as a more than geographical backdrops psychosocial resource for women for interventions. Programs of Farmer suicides are a stark example The Muktangan case study research and intervention must adopt Seeding of poverty-induced distress that demonstrates how community more expansive and psychosocially- underlines the need to go beyond operates powerfully at a psychosocial oriented understandings of the clinical settings. In Marathwada, level in women’s lives. For the ways in which community contexts 11,995 farmer suicides were officially women in this specific setting, shape women’s opportunities for Wellbeing recorded between 2015 and 2018,1 their communities of practice had MH and, crucially, of the agency and with Osmanabad district alone supported more empowering self- resilience of women in marginalized accounting for 34%. Unlike other representations and social identities, settings. This would mean viewing districts in Maharashtra, Osmanabad wider social networks and solidarities communities as experts in their own in Drought- suffers from chronic drought. Year with other women, and an improved right, as agents in the promotion of after year, the effects of climate change capacity for collective problem- their own MH, and as crucial partners on their crops, unpredictable markets solving. These communities had in decision-making – for instance, and mounting debt take an immense played an important role in helping about biomedical treatment. Prone Regions toll on farmers’ mental health. them cope with the social, economic and health-related stressors Broadening our concepts of Despite a significant number of presented by the coronavirus crisis. community is of particular agrarian schemes2 by the government importance in the current pandemic to alleviate farmer debt, and the Social and community psychologists context. Given the likelihood A psychosocial approach to working presence of four agricultural suggest that communities of practice that measures such as physical universities and 150 colleges in the constitute “social capital” for women distancing will continue into the with distraught farming communities region that might offer knowledge in marginalized contexts, who future, studying and leveraging resources, farmer suicides are may lack access to other forms of diverse forms and experiences of BY Ara Johannes increasing. Those tasked with economic and political capital.10 community, such as communities furthering the problematic assumption reducing their number understand of practice, becomes essential Saloni Atal has an MPhil in Social and structural factors that such distress can be effectively little about the situation on the The present study has broad for optimizing women’s mental Developmental Psychology, and is a PhD The association between mental understood or managed through ground. Women farmers, invisible implications for community- wellbeing, which may be better student and Gates Scholar at, Cambridge. health, poverty and social exclusion a diagnostic, expert-led, recovery- and unaccounted for, continue to based MH work for women in served by policies and interventions She is researching the effects of socio- — although well-established — still focused, bio-medical approach. Mental be left out of these conversations. socioeconomically marginalized aimed at strengthening community political and cultural contexts on women fails to influence MH discourse distress arising from challenging Existing state interventions and settings. As noted earlier, definitions social networks rather than in marginalized settings in South Asia. substantially. Distress caused by life circumstances such as poverty, development programs lack MH of “community” in such initiatives through the increased availability Saloni’s recent paper in ‘Transcultural the everyday hardships of poverty systemic social exclusion, structural components, focusing largely on debt tend to de-emphasize social and of psychological therapies or drug Psychiatry' explored Indian women slum continues to be pathologized and violence, and discrimination, cannot reduction, which — though crucial relational aspects, using the sole lens treatments alone. ¤ resident's use of the idiom “tension” to medicalized, putting the onus for it be addressed solely through medical — is only one of the many steps of place to view communities as little describe their psychological distress. on the affected individual, besides diagnoses and interventions. needed to mitigate farmer distress.

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a community-led a much-needed resource for these rural youth member able to identify that year. Six months later, he got families across the district have conclusion psychosocial approach communities, and a lifeline for farmer distress and proficient in addressing in touch to say that the combined benefited from this community- Shivar’s model validates how The failure to stem farmer suicides in families in distress. The community- it, through counseling or advocacy, harvest had earned him Rs 2,50,000, based psychosocial approach communities are a valuable resource the region could be attributed in part based network of 700 trained or both. The aim is to stitch together and he could now repay his loan. to alleviate farmer distress. for themselves. The lived expertise to this bifurcated response: on the one individuals has its ears to the ground, a support network encompassing of the volunteers enhances the hand, a purely developmental approach and a place within each household. farming families across the district. Besides training community members mitigating lockdown distress: cultural relevance of Shivar’s (debt reduction); on the other, a bio- These volunteers go door-to-door, in identifying signs of distress and leveraging a pre-existing lifeline psychosocial programs. Their medical and clinic-based approach. enquiring about distress: providing ‘In 2018 we got a call from the disseminating information about With communities living in this drought- approach shows us how voices A more nuanced approach would psychosocial first-aid; imparting headmaster of one of the schools we agrarian schemes, Shivar Foundation prone region routinely experiencing like those of women farmers and consider the community as a resource, information on available government had recently visited. A 6th Std boy who also runs a psychosocial helpline high levels of distress, farmers already farmers with experiences of mental and center the voices of user-survivors. schemes; enabling households in had heard our talk on signs of distress for farmers. Callers are invited to on the brink were further burdened distress are crucial, and must be Such a community-led approach debt to access cash support, credit, had told him that his father had been visit the Foundation’s Farmers’ by COVID-19 and the nationwide foregrounded. The model exemplifies would foreground the ‘subjective and farming equipment. Moving displaying these signs for several Friends Centers to discuss their lockdown. Earlier, the Foundation's how community resilience may be perceptions and experiences of those away from providing MH services weeks. We immediately contacted the issues in more detail. The helpline helpline would receive 250 calls a built and safeguarded from within. ¤ within low-income communities whose through clinical settings that prioritize family and discovered that the boy’s and centers are also managed by month, but since the lockdown this voices are often marginalized.’3 the voice of the ‘expert’ MHP, Shivar father had stopped communicating community-based volunteers. number has almost doubled. The relies on the lived expertise of its with family members, spent hours lockdown was imposed just as farmers Shivar Foundation, a volunteer-driven community-based volunteers. MH thus by himself, seemed upset, and had ‘In 2017, we received a call from a were getting ready to sell their harvest. non-profit, models this psychosocial becomes community-led rather than lost all interest in farming.’ (ibid.) sugarcane farmer who had sold his They had also been awaiting the loan approach to local farmer distress. external or outsider-led, encouraging harvest to a Solapur-based sugarcane waiver list that was to be announced. Volunteers all fit the basic criterion of practices of inclusion and support, As part of their intervention, trained company but hadn’t been paid. He had being from farming backgrounds. while advocating for social justice. volunteers counseled the farmer, written many letters to government To mitigate the lockdown’s impact, and tried to understand the reasons officials, to no avail. He had a loan he Shivar’s volunteer network swung into ‘Someone from a farming family a cadre of trained lay counselors underlying his distress — which needed to pay back, and had had to action, enabling access to markets knows what the issues are, knows Shivar volunteers receive training included a Rs 1,50,000 loan, and no sell his wife’s jewelry to do so. He had in Pune and Mumbai where farmers Ara Johannes is a Communications about farmer distress in an intimate, on policies and schemes through access to finance to purchase seeds, already attempted to take his own life were able to sell their crops at a profit. Manager at Mariwala Health Initiative personal way. They don’t need to be workshops, refresher courses and or to pay for his children’s education. twice, prior to calling our helpline — and Besides harvest distribution, Shivar has and holds a Master’s in Health and given any background orientation on ongoing modules. They also learn to With the farmer, the volunteers made a was on the verge of a third attempt. Our also been engaged in providing COVID- Non-Profit Communications from Johns how or why farmers are distressed. identify signs of distress and provide six-month agricultural plan that would volunteers intervened, were able to get related information and distributing Hopkins University, and a Bachelor’s in They also have a bigger stake in basic counseling. Once trained, leverage his six-acre land holding district officials to resolve the case, and safety equipment. Shivar was able Anthropology. She has over a decade resolving this distress... after all, these they pass on their knowledge and and enable him to repay his loan and the farmer received his money.’ (ibid.) to anticipate how farmers would be of work experience in communications are their own communities.’ (Hegana V., psychosocial training in community pay for his children’s education too. affected, and to respond appropriately. for development organizations across personal communication, 1 June 2020) centers as well as in schools and They connected him to a university- Shivar’s volunteers bring to the sectors, including maternal and child colleges – so as to have, in each run seed distribution scheme, and table lived expertise that is culturally health, women’s rights and strategic The Shivar volunteers, then, constitute household, one trained and informed he planted jowar and green peas appropriate and relevant. Over 1,500 philanthropy.

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We work with OUR PARTNERS to nurture a MENTAL HEALTH ECOSYSTEM with multiple STAKEHOLDERS – INDIVIDUALS, COMMUNITIES, Partners ORGANIZATIONS, AND – not least – POLICY MAKERS and GOVERNMENT. We engage with our partners not only with FUNDING SUPPORT but also through TRAININGS, KNOWLEDGE SHARING, and NETWORKING, to build ORGANIZATIONAL CAPACITIES. Innovation Insights Philanthropy Challenges Lived Realities

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States and Union Territories where partners have operated during FY Primary 2019-20. This includes top 10 states Demographic of no. of calls received by iCall during Impact the FY 2019-20: Snapshot TOTAL REACH OF OUR 55,014 Map Maharashtra Karnataka MHI goals include reaching out to PARTNERS West Bengal Kerala and making mental health accessible women Orissa Manipur to marginalized populations and Delhi Madhya Pradesh communities. To bridge the mental health Uttarakhand Andhra Pradesh care gap for persons facing structural Gujarat Tamil Nadu oppression — it is even more important 949 Chattisgarh Rajasthan to provide psychosocial interventions and Kashmir Punjab supports. lgbtqia+

GENDER

9,811 987 RELIGIOUS MINORITY DISABILITY 11,686 sc/st/obc / 12,027 indigenous youth & tribal

AGE CASTE

416 ECONOMICALLY VULNERABLE

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94,805 PERSONS MHI uses a 360 degree approach comprising of 5 The 5 pillars to support quantum change and encourage innovation, scalability and Pillars capacity building. 75,843 PERSONS

awareness effective service Lack of information delivery PRESENTATIONS combined with stigma Overall, there is minimal around mental health access to mental health + PUBLICATIONS inhibits persons with services, which are marked 13 mental health needs from by both poor availability approaching friends, as well as poor quality. family and mental health Accessible, holistic, rights- PERSONS

professionals for support based services in multiple 1,90,833 and care. delivery formats need to be made available to all. 12,797

references & linkages research capacity-building Strong linkages need to A thriving and responsive Building the capacity of be forged between mental mental health ecosystem individuals, organizations, health service providers, must rest on a support PERSONS communities and and allied services base of research that institutions, through concerned with livelihood, documents and records training and knowledge 7,388 health, gender, sexuality, context and community- sharing, is of critical education, legal support, as specific experiences in the importance. well as government welfare field, along with evaluating schemes. the efficacy and impact of a variety of interventions. sum of persons persons sum of impacted

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Partners Anjali Anubhuti

As of June 30th, MHI works with 20 partners on 22 projects, in 11 PROJECT / INITIATIVE voices janamanas mental health justice & empowerment in higher languages with communities, education institutions and governments for service delivery, advocacy, NATURE OF PARTNER deinstitutionalisation, capacity STATE & CIVIL SOCIETY building, community mental health, law and policy, LGBTQIA+ and youth LOCATION West Bengal West Bengal Maharashtra mental health. DETAIL Voices began as a response The Janamanas Community Health 4 out of 10 students in India to the food and water scarcity, Program, in partnership with urban experience depression, and there is inadequate healthcare, and human municipal wards, aims to create one suicide hourly. Those dealing partners are rights violations in mental health community hubs for access to with multiple marginalizations – of institutions. It is an institution- mental health, with a special focus on caste, gender, class – are particularly Activists based capacity building program women and adolescents. vulnerable. Yet educational that redesigns services, centering a It currently operates in five institutions are ill-equipped to Service Providers human-rights approach. Its replicable underdeveloped localities in Kolkata, deal with mental health issues. model can be adopted by different through kiosks managed by trained Anubhuti’s program seeks to redress Researchers state governments. women from the community. The this situation. A rights-based, project includes counseling of family intersectional, feminist module trains that affect state & civil Voices also works to relocate members, advocacy for inclusive school teachers to counsel students, society at these levels persons with mental illness, who urban planning, awareness camps, and enables specialist referrals if face continuing hostility and stigma, and a three-month training in mental required. ‘Mann Mela’ (a mental Government back in their communities – through health, the self and rights, gender and health fair) is held to encourage capacity building, empowering sexuality, and society and leadership. students, families, and communities Institutions participants to speak up for their to seek help. rights, and livelihood skills.

Communities

Please refer to the Framework Diagram on pages 49-50

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Anubhuti Bapu Trust Basic Needs Bhor Burans India Foundation

PROJECT / INITIATIVE community mental seher community mental project reclamation community mental health project health and development health project

NATURE OF PARTNER

STATE & CIVIL SOCIETY

LOCATION Maharashtra Maharashtra Odisha & Maharashtra New Delhi Uttarakhand

DETAIL This program is implemented in Through its Community Wellness BNI seeks to bridge the gap between Bhor Foundation centers the lived Uttarkashi in northern India is a rural communities marginalized by Centres, this model service program government and communities experiences of persons with mental area with no MHPs and no access to their caste, and minority religious links development, disability, by strengthening community MH illness, while advocating for a social psychotropic medications through or Adivasi identity – all with large communities, and mental health. services, and building the capacity lens to view trauma and healing. public services – forcing people populations of unemployed youth Seher envisions sustainable of existing community-based Project Reclamation, its two-day to travel long distances to access and daily wage workers, whose psychological health through organizations to address the needs 2019 festival on MH, human rights treatment. Burans has supported multiple mental health stressors are community development, and the of those living with mental illnesses and neurodiversity, had screenings over 1,000 people with psychosocial compounded by oppressive social creation of caring communities by and psychosocial disabilities. The and discussions, drumming, creative disability in the region, and facilitated systems. Committees comprising building on their inherent emotional program, spanning five districts writing and open mic events, and access to care through its home- community members are trained resources. It fosters conversations across Odisha and Maharashtra, “listening circles” for the sharing of based program. The project works to provide basic counseling and about well-being within low-income connects persons living with mental experiences of mental illness and through Community Health Action referrals, while striving to enhance communities in Pune via informal illness to state MH care, reintegrates physical disability. The theme was groups, sensitization workshops, and mental health awareness and street corner meetings and group them with families and community, ‘Sexuality, Disability and Challenging programs in two district blocks for advocate with area authorities for sessions inside homes. The program enhances awareness through Ableist Policies’, foregrounding voices social and financial inclusion, youth development-related concerns. aims to prevent distress, and provide trainings, and links with disability from queer, tribal and Dalit, and other resilience, violence-free communities, The increased use of services, and support for those with psychosocial and health movements to sensitize marginalized communities. and to increase the MH knowledge reductions in stigma, point to the disabilities, while ensuring specialized media, police, and the judiciary. and skills of women. program’s efficacy. services for diverse mental health needs.

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Centre for DLR Prerna iCALL Iswar Mental Health Psychosocial Sankalpa Law and Helpline Policy

PROJECT / INITIATIVE atmiyata capacity building program, Mental Health Care Act 2017

NATURE OF PARTNER

STATE & CIVIL SOCIETY

LOCATION Gujarat & Maharashtra Pan-India West Bengal Pan-India West Bengal

DETAIL Atmiyata trains and develops the India’s current Mental Health Care DLR Prerna’s community-based A psychosocial helpline, iCall offers Iswar Sankalpa primarily serves capacity of two tiers of community Act (MHCA) represents a paradigm programs in the Darjeeling Himalaya free professional and confidential homeless persons in Kolkata. volunteers to provide support and shift in mental health care, promoting region focus on water access, health counseling in nine languages Viewing homelessness as both counseling to persons with emotional a rights-based approach towards and sanitation in rural schools, fair via email, telephone, and chat, leading to and exacerbating stress and common mental persons living with mental illness. trade practices in tea plantations, to individuals in distress. Callers psychosocial disabilities, it runs an health disorders. Volunteers have Some of its content is new to sustainable agro-ecology, and are assured of patient listening, Urban Mental Health Program to smartphones loaded with awareness- various stakeholders, including managing human-wildlife conflict. confidentiality, and consistent, reduce stigma, enhance access to building films they share via those entrusted to implement or Its TeaLeaf project trains primary sustained support. Besides its MH services, and build community Bluetooth; and are trained to facilitate safeguard its provisions. Workshops schoolteachers to deliver MH care counseling services, iCall conducts and support networks – working access to pensions and other social explaining the relevant aspects through therapeutic interventions sessions on mental health concerns in tandem with existing primary benefits. In instances of severe are therefore held for paralegals, with their students during school and related strategies for a wide health centers to enable affordable mental illness, Atmiyata leverages MHPs, caregivers, service users, and hours — enabling children in these range of stakeholders, and has mental health care for vulnerable, the District Mental Health Program government authorities. A Code of low-resource settings to receive directly trained more than 5000 marginalized communities. It also through referrals to public mental Practice publication was created, and such care continually, and in familiar counselors and mental health carries out inclusive measures for healthcare facilities, and district a mobile app for stakeholders – to be environments. The model strives to professionals through its capacity- homeless persons with psychosocial hospitals, as well as to relevant contextualized according to location. de-medicalize MH, as distinct from building efforts. disabilities through community district authorities. “treatment”, providing seamless and shelters, livelihood training, and practical care. sensitization programs.

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Kashmir Mann Centre Raahi Resource Cell Schizophrenia Lifeline for Individuals for Juvenile Awareness (KLL) with Special Justice Association Needs (RCJJ) (SAA)

PROJECT / INITIATIVE study for high court arts based therapy

NATURE OF PARTNER

STATE & CIVIL SOCIETY

LOCATION Jammu & Kashmir Maharashtra Karnataka Maharashtra Maharashtra

DETAIL Years of conflict have fueled Through skill training and vocational The LGBTQ+ collective Raahi works RCJJ was set up with the objective SAA, Pune, began as a caregivers’ unaddressed levels of trauma and support, Mann enhances the extensively with persons in crisis on of working on the social and legal organization for persons living distress in Kashmir. KLL provides employability of young adults MH-related issues stemming from concerns of Children in Conflict with mental illness, particularly psycho-educational services, from low-socio-economic and their identities — collaborating with with Law (CICL) using a rights- schizophrenia, and for their family employing integrative, organic marginalized communities who are allies to provide shelter, legal and based approach. The mental members. It runs a Day Rehabilitation care protocols designed to provide living with Intellectual Disabilities medical support, as well as MH care. health of a child deemed to have Centre, besides public awareness comprehensive MH support to and Autism. Its year-long caregivers’ It also strives to sensitize family committed legal offences is crucial initiatives and advocacy campaigns, clients. KLL’s is a two-pronged support program includes counseling members, educational institutions, – institutionalized children routinely and offers an Art-Based Therapy approach: it's care-based services, sessions, and transition plans to government bodies and MHPs about deal with violence, uncertainty, (ABT) program for persons with for those living with MH issues, equip families and caregivers with the realities of those marginalized separation from family, besides mental illness – music, singing, include a free and confidential phone information about available resources by gender and sexuality. Raahi's changes in food, clothing, and living painting, clay work, dance, drama, helpline, face-to-face counseling at and coping strategies – aiming to MH program includes trainings with conditions. RCJJ’s Help Desks in yoga, gardening, cooking, embroidery, their Srinagar clinic, and outreach improve the quality of life for both, various groups and community Observation Homes help children tailoring, sports, aerobics – alongside centers at government hospitals the adult living with disability, and organizations towards building a (and their guardians) navigate counseling services. ABT has in three districts; it's preventive family members/caregivers. This strong network and system for crisis through the Juvenile Justice system, been proven to better mood and services aim to reduce stigma and intervention equips caregivers to intervention for these marginalized while enabling children to interact cognition, boost confidence, improve build awareness around MH in support the adult with disability communities. with family members, and referring communication, and to enhance communities. towards greater independence. health concerns to specialists. therapeutic outcomes. Currently, RCJJ is conducting a qualitative research study to highlight existing gaps in the system for CICLs, and advocate for better provisions and policies.

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Shivar SNEHA Sukoon Ya_All: Youth Foundation Network

PROJECT / INITIATIVE adolescent nutrition, counselling in family courts peer counseling center for sexuality, and mental health LGBTQI youth

NATURE OF PARTNER

STATE & CIVIL SOCIETY

LOCATION Maharashtra Maharashtra Maharashtra Manipur

DETAIL Shivar Foundation works in a SNEHA (Society for Nutrition, Sukoon provides free counseling Manipur lacks queer affirmative MH Maharashtra district that has a Education And Health Action) within Family Court premises in care services. Stigma, discrimination, particularly high incidence of farmer works to improve the health and Maharashtra, with a gender-sensitive, bullying, isolation – these factors suicides, to address the lack of MH nutrition of vulnerable women and rights-based, non-pathologizing increase the risk of depression, and welfare services by providing children living in urban settlements, approach. Most cases relate to substance abuse, and suicidal psychosocial support and referral through training, capacity building, marital discord, child custody, ideation among queer adolescents services to debt-trapped farmers and advocacy within communities maintenance, and restitution of and youth. The youth-led Ya_All and their families. The Foundation and with public health systems and conjugal rights. The project strives collective works to enable easy connects farming families to healthcare providers to address to help individuals and couples access for queer-identifying youth to government agencies in charge of gender-based inequalities. Its EHSAS resolve conflicts amicably, devise information and services in health, welfare schemes for distressed program focuses on adolescents future plans, and makes referrals to education, and sexuality. At its health farmers – and advocates for (and other young people in the other psychosocial services when resource hub/drop-in center, queer- effective service delivery and policy 10-21 age group), via sessions on needed. Sukoon aims to work with friendly counselors and peers provide implementation. It employs a model health, gender equity, sexuality, the court ecosystem, including free MH services to queer youth, that mobilizes peers to address employability, and creating support judges and staff, to build sensitivity, for whom the center also serves farmers’ needs through a local, structures in homes, schools, and represents a replicable model of as an informal space to interact. volunteer-based network. and communities by sensitizing counseling services in a legal setting. parents, community members, schoolteachers, and healthcare staff. The program includes counseling services, and referrals to public mental healthcare facilities.

99 | REFRAME '20 REFRAME '20 | 100 Glossary

ABLEISM is a pervasive system of dignity and human rights that are often at risk HETEROPATRIARCHY is a socio-political sexual orientation, ability) may intersect A mental health ecosystem will help support without working towards realizing discrimination and exclusion that of neglect and abuse in mental hospitals. system that favours and maintains power and interact with each other, affecting the foster a culture of constant interaction, their rights, or providing support in return. oppresses people who have mental, of those who are cisgender men and those health and overall well-being of an individual. dialogue and networking between DEINSTITUTIONALIZATION refers to actively POST-MODERNISM refers to the late 20th- emotional, and physical disabilities. Deeply who are heterosexual, by maintaining that For instance, a lesbian woman with a these varied groups of stakeholders. promoting non- discriminatory and inclusive century movement in Western philosophy rooted beliefs about health, productivity, such identities are the norm. Individuals, motor disability will experience oppression stay and care facilities for persons with NEOLIBERALISM is an economic and characterized by an acute sensitivity to the beauty, and the value of human life organizations, and institutions can all stemming from not just her gender but will mental health issues and / or disabilities political ideology that favours the concept role of ideology in asserting and maintaining combine to create an environment that support this system by centering voices also on her disability and sexual orientation. and supporting them to lead their lives as of free market, and privatization over political and economic power; broad is often hostile to those whose physical, from these identity locations, and buying An intersectional understanding of mental they deem fit. Institutions are characterized government and social welfare models scepticism, subjectivism, or relativism; emotional, cognitive, or sensory abilities into the ideology of the status quo. health ensures that stakeholders understand by segregation and no respect for bodily and a general suspicion of reason fall outside the scope of what is currently that there are many sites of oppression and NOSOLOGY is a branch of medical rights and personal space of the users. HETEROSEXISM & CIS-HETEROSEXISM defined as socially acceptable. all of them, singularly or as a sum of a few sciences that is concerned with POSTSTRUCTURALISM refers to the late Deinstitutionalization aims to change that. are systems of discrimination that marginalized identities, affect an individual’s classification of diseases. Alternatively, 20th-century literary and philosophical BIOMEDICAL APPROACH TO MENTAL oppress identities other than heterosexual EMIC APPROACH is an approach to studying access, choice and rights to mental a list of disease classifications. movement characterized by the belief that all HEALTH is an approach towards mental and cisgender, on the basis of the human culture which focuses on the people health systems. aspects of human experience (social norms, health issues based on a disease- assumption that heterosexual and PATERNALISM is a system or relationship of the culture in question. Also known as the rituals, values, identities) are informed by or prevention model that prioritizes the use cisgender are the norm and are the LIVED EXPERIENCE is used to describe in which authorities hold the power to “insider” approach to anthropology, the emic even created by the language we use, and its of medication for treatment and situates identities most valuable to society. the first-hand accounts and impressions make decisions, or promote a particular approach uses the words, thoughts, and implications for power structures in society. mental health issues in the ‘brain’ while of living as a member of a marginalised thought process for others, often under the beliefs of members to understand their culture. HINDUTVA is an ideology which holds and ignoring experiences of abuse, poverty, or oppressed group. It’s a recognition stated objective of benefiting the others. PSYCHOSOCIAL is the connection between a advocates for the establishment of India as a racial, caste and gender inequalities. ESSENTIALISM is a theory which holds that that is attentive to feelings, bodily states, person and their environment, interpersonal Hindu state; an ideology seeking to establish PATHOLOGIZATION refers to a) branding an individual, object, community, institution, interactions and identities that tend to be relationships, community and cultural CASTEISM is a system of oppression based the hegemony of Hindu way of life. This persons with mental health issues as ‘ill’ or concept has innate and immutable devalued or ignored. ‘Lived experience’ can practices. Social context influences and on Hindu caste identities which privileges hegemony simultaneously serves to erase b) over-reliance on medication and ‘expert’ characteristics which define its existence. be used for giving voice and making the interacts with the psychological (emotions, Savarna identities (i.e. caste identities within and exclude non-Hindu Indians from socio- diagnosis of one’s mental health. This often invisible visible as a response to oppression. thoughts, feelings, reactions). Taking into the hierarchy, especially upper caste) and HEGEMONY is the social, cultural, political and economic representation. Such puts persons with mental health issues at This allows for focused acknowledgment account social, cultural, context factors discriminates against those outside of the ideological, or economic influence erasure and exclusion changes the manner risk of abusive, unethical and involuntary of how experience is influenced by wider as influencing a person's mental health system (i.e. Dalit and Bahujan identities). exerted by a dominant group in which citizenship, and therefore how treatments and forced institutionalization. social structures, and constructed socially. is critical in providing support and care. rights of citizens, are defined and protected. COMMUNITY-BASED INTERVENTIONS HETERONORMATIVITY is the individual, PINK CONSUMERISM /PINK CAPITALISM / Additionally, providing social supports or MENTAL HEALTH ECOSYSTEM refers to help implement a decentralized pattern institutional, and societal/ cultural HOMOGENIZATION is the process of PINKWASHING is a set of political and brand non-bio-medical interventions is essential creating a large mental health community of mental health care and services for beliefs and practices based on the reducing cultural diversity in a given marketing strategies that seeks to capitalize and can be preventative and/or curative in India, bringing together a diverse cross people with mental illnesses. They are belief that heterosexuality is the society or community by promoting a off of exhibiting solidarity with LGBTQIA+ in nature when it comes to mental health. section of stakeholders. This includes more accessible and responsive to needs only normal and acceptable sexual singular (often normative) ideology, beliefs, communities, and/or targeting LGBTQIA+ Such interventions are intersectoral such grassroots and community-based of the local community and reduce need orientation. Heteronormativity privileges customs, symbols, languages, etc. communities. Such displays of solidarity may as food security, water, housing, shelter, organizations, counsellors, psychologists, for costly inpatient mental health care heterosexuality and consequently or may not be followed-up or backgrounded education and sanitation but also legal INTERSECTIONALITY is an approach that psychiatrists, activists, researchers, delivered in hospitals. Community mental discriminates against other forms of by tangible support lent to LGBTQIA+ support and employment support. recognizes that multiple levels of oppression caregivers, user-survivors, policy health services promote social inclusion of sexual desire, expression or relationship, persons, and therefore can be seen as efforts (gender, race, class, caste, sexual identity, makers and governmental institutions. PSYCHOSOCIAL DISABILITY is defined persons with mental illness and uphold their often resulting in HOMONEGATIVITY. to capitalize off of a marginalized group’s

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by the United Nations Convention of to an individual or a group by way of social, political and economic institutions, Clinical Legacies and Counter-Narratives (2012). https://doi.org/10.1186/1747-5341-7-2 [27] Cohen, S. C. S. (2002). Folk Devils and Moral Panics: Thirtieth Anniversary Edition:2nd (Second) edition. Taylor Rights of Persons with Disabilities and possessing a durable network of more arising out of dominant ideas around gender, [1] McAvoy J. (2014) Psy Disciplines. In: Teo T. (eds) [15] Science Museum. (2018, June 13). A Victorian Encyclopedia of Critical Psychology. 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Current Research in Arts Medicine, 287-291. A Cappella CAET/2019/5/7 [10] Guerlain, M. A., & Campbell, C. (2016). From sanctuaries to prefigurative social change: Creating Books. [23] Sandel, S. L. (1993). The process of empathic health-enabling spaces in East London community [10] Thapan, M. (1997). Introduction: Gender and reflection in dance therapy, 98-111. Sandel, S. L., gardens. Journal of Social and Political Psychology, 4(1), Embodiment in Everyday Life. Thapan M. (Ed.). Chaiklin, S., & Lohn, A. (Eds.). Foundations of Dance/ 220-237. ISSUEEmbodiment: NO Essays on Gender and Identity, 1-34. Movement Therapy: the Life and Work of Marian Chace. Seeding Wellbeing in Drought-Prone Regions Oxford University Press. Delhi. Columbia: American Dance Therapy Association. SEPTEMBER 2020 [1] Venkateswarlu, B., Ahire, R., & Kapse, P. (2019). [11] Pallaro, P. (1993). Culture, self and body-self: Dance/ [24] Chakraborty, S. (2019). Transforming Lives Through Farmers Suicides in Marathwada Region of India: A Movement therapy across cultures. Bejjani, F. D. (Ed.). Dance Movement Therapy. [PhD. thesis]. Tata Institute of Causative Analysis. International Journal Of Current THECurrent MARIALA Research in Arts Medicine, HEALTH 287-291. A Cappella Social Sciences, Mumbai. India. Microbiology And Applied Sciences, 8(04), 296-308. Books. INITIATIVE JOURNAL [25] Rajan, A. & Bhogal, T. S. (2017). Looking Back and https://doi.org/10.20546/ijcmas.2019.804.034 [12] Chakraborty, S. (2019). Transforming Lives Through Forward: Kolkata Sanved Impact Evaluation Report. [2] Das, A. (2017). Farmers' suicide and agrarian crisis: Dance Movement Therapy. [PhD. thesis]. Tata Institute of [Unpublished report]. Kolkata: Kolkata Sanved. Social policy and public mental health. Indian Journal Social Sciences, Mumbai. India. Communities of Practice and Women’s Mental Health Of Psychiatry, 59(3), 398. https://doi.org/10.4103/ [13] Chakraborty, S. (2019). Transforming Lives Through [1] Campbell C., & Burgess R. The role of communities in psychiatry.indianjpsychiatry_138_17 Dance Movement Therapy. [PhD thesis]. Tata Institute of advancing the goals of the Movement for Global Mental [3] Thomas et al., (2018). Moral narratives and mental Social Sciences, Mumbai. India. Health. Transcult Psychiatry. 2012;49(3-4):379-395. health: rethinking understandings of distress and [14] Chakraborty, S. (2020). Featured counter-trafficking [2] Burgess, R., & Campbell, C. (2016). Creating social healthcare support in contexts of austerity and welfare program: Kolkata Sanved’s model Sampoornata. policy to support women's agency in coercive settings: reform. Palgrave Communications, 4(1). https://doi. Child Abuse and Neglect 100: 104169. https://doi. a case study from Uganda. Global public health, 11(1-2), org/10.1057/s41599-018-0091-y org/10.1016/j.chiabu.2019.104169 48-64. Glossary [15] Chakraborty, S. & Sen, M. (2019). Choreographing [3] Howarth, C., Cornish, F., & Gillespie, A. (2015). EDITORIAL TEAM SPECIAL THANKS CONTENT[1] Rauscher, ARNING L., & McClintock, Mentions J. (1996). Ableism changes: Narratives of resistance and healing. Creative Making community: Diversity, movement and ofcurriculum suicide, design.domestic In M. violence, Adams, L. A. Bell, & P. Griffen AraArts Johannes Education and Therapy 5(1), 51-61. doi:10.15212/ Devanshiinterdependence. Vaid In G. Sammut, E. Andreouli, G. Gaskell, caste-based(Eds.), Teaching violence, for diversity alcohol and social justice (pp. AnamCAET/2019/5/7 Mittra Saisha& J. Valsiner Manan (Eds.), The Cambridge Handbook of Social substance198–231). New use, York: ableism Routledge Priti[16] SridharLevy, F. (1988) Dance/Movement Therapy: A Healing Representations (Cambridge Handbooks in Psychology, ableist[2] Merriam-Webster. violence, child (n.d.). seual Hegemony. In Merriam- Art. Virginia: The American Alliance for Health, Physical pp. 179-190). Cambridge: Cambridge University Press. Raj Mariwala PHOTOS / IMAGES / ILLUSTRATIONS abuse,Webster.com homicide, dictionary. heteroseism, Retrieved September 16, 2020, Education, Recreation and Dance. doi:10.1017/CBO9781107323650.015 Smriti Nevatia Siddhesh Gautam pg 19 cisseism,from https://www.merriam-webster.com/dictionary/ abusive relation- [17] Manderscheid, R. W., Ryff, C. D., Freeman, E. J., [4] Jain, S., & Jadhav, S. (2009). Pills that swallow policy: Aravani Art Project pg 31 ships,hegemony lynchings and religious McKnight-Eily, L. R., Dhingra, S., & Strine, T. (2010). Clinical ethnography of a community mental health violence,[3] Duignan, seual B. (2020). violence, Postmodernism. Encyclopædia DESIGNEvolving definitions& PRODUCTION of mental illness and wellness. Shrujanaprogram inShridhar Northern pg India. 59 Transcultural Psychiatry, seism,Britannica. death Retrieved penalty, September natural 16, 2020 from: https:// StudioPreventing Kohl Chronic Disease: Public Health Research, 46(1), 60-85. disasterswww.britannica.com/topic/postmodernism-philosophy and disaster-related studioohlcomPractice and Policy (7)1, A19. http://www.cdc.gov/pcd/ PRINTED[5] Gregson, BY S., Mushati, P., Grusin, H., Nhamo, M., losses In the case of material issues/2010/jan/09_0124.htm. Schumacher, C., Skovdal, M., & Campbell, C. (2011). [4] Bourdieu, P., & Wacquant, L. P. D. (1992). An Invitation Print Palace beingto Reflexive triggering sociology. or upsetting, Chicago: University of Chicago [18] Kaikobad, R. (2019). Reconceptualizing Social capital and women's reduced vulnerability TYPEFACES 022 2687 2276 youPress can reach out to iCall at rehabilitation of female survivors of violence: the case to HIV infection in rural Zimbabwe. Population and Playfair Display by Claus Eggers Srensen 9152987821 or icalltissedu of Sampoornata model of dance movement therapy in Development Review, 37(2), 333-359. RobotoIndia. [manuscript by Christian submitted Robertson for publication]. PUBLICATION[6] Casale, M., Wild, DATE L., Cluver, L., & Kuo, C. (2014). The [19] Chakraborty, S. & Sen, M. (2019). Choreographing Septemberrelationship 2020between social support and anxiety among ICONSchanges: narratives of resistance and healing. Creative caregivers of children in HIV-endemic South Africa. Arts Education and Therapy. 5(1), 51-61. doi: 10.15212/ Psychology, health & medicine, 19(4), 490–503. https:// Courtesy The Noun Project PAPER CAET/2019/5/7 doi.org/10.1080/13548506.2013.832780 Institution by Popular Printed on Munen Polar Rough [20] Chakraborty, S. (2019). Transforming lives through [7] Campbell, C., & Cornish, F. (2014). Reimagining Community by Adrien Couet CREATIVE COMMONS dance movement therapy. [PhD. thesis]. Tata Institute of community health psychology: Maps, journeys and new GovernmentSocial Sciences, by Mumbai.u Luc India. terrains. Journal of Health Psychology, 19(1), 3-15. Fist by Maim Kuliov [8] Wenham, C., Smith, J., & Morgan, R. (2020). Attribution-NonCommercial- [21] Kaikobad, R. (2019). Reconceptualizing ShareAlike 4.0 International Medicalrehabilitation by Aybige of femalesurvivors of violence: the case COVID-19: the gendered impacts of the outbreak. The CC BY-NC-SA 4.0 of Sampoornata model of dance movement therapy in RECYCLABLELancet, 395(10227), 846-848. India. [manuscript submitted for publication]. [9] Kabeer, N. (2011). Between affiliation and autonomy: MAP [22] Chakraborty, S. & Sen, M. (2019). Choreographing navigating pathways of women's empowerment and FreeVectorMapscom changes: narratives of resistance and healing. Creative gender justice in rural Bangladesh. Development and Arts Education and Therapy. 5(1), 51-61. doi: 10.15212/ Change, 42(2), 499-528.

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JOB MHI Journal Reframe 2020 COVER INNER SIZE Closed 975 Vertical with spine indicated PRINT PROCESS Pantone 115U Blac K DATE 30102020 ReFrame, a journal by the Mariwala Health Initiative is a platform to challenge existing norms and explore diverse voices within the mental health space — expanding horizons

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