Posted by Kripi Malviya
This piece is part one of a two-part series.
In the last couple of years there has been a surge of research about the prevalence of mental health issues in India and people who would usually have ignored the issue all together are having to sit up and notice. We are beginning slowly to change the ‘mental health issues are a weakness’ rhetoric and trying to empower persons with mental health issues to seek help. There has been an almost singular focus on spreading awareness that is saying ‘it’s okay to need help’ and how people can support others who have mental health issues. What is missing is the lack of expectation for mental health providers to also be accountable for this gap between people needing mental health services and professionals providing these services.
In addition to the issues of fear, shame and lack of trust that stops people from seeking that help; the mental health professional community has a huge part to play in why people don’t approach them. There is a lot of good work being done in the field of awareness and trying to motivate people going through mental health issues to seek therapist’s services; however what we are not fully considering is the role of the service provider. I believe that all mental health professionals, whether they be medically trained or otherwise, are fully aware of this gap in services (only second to the people who need these services); yet many seem far less prepared to come out of their practices and show concern for this issue.
There are a lot of reasons why mental health professionals in India are difficult to approach. Firstly, the hierarchy that exists in the medical profession places psychiatrists above psychologists and counsellors. This carries an implication that ‘medicines are all that works and talking therapies are a secondary and weaker option.’ For a country that places a lot of trust in the doctor-patient power dynamic and therefore approaches mental health professionals with the same ‘I am broken, please fix me’ perspective; it is usually received with the attitude of such professionals that ‘my answer is the ONLY right answer’ and this is very dangerous. Not only does it not communicate to the client or patient what their choices are but it actively takes their power away in their time of vulnerability.
It is the responsibility of the medical mental health professionals to be transparent to the client about their strengths and limitations as practitioners; only when the mental health medical professionals allow themselves to acknowledge the boundaries of their service and collaborate with other mental health professions can there be a service provision that is not based on ‘this is MY client and I must not share them with anybody, even if it is more helpful if I refer them to a psychologist or counsellor’. This also results in medications prescribed for longer and longer periods of time with very little conversation with the client about what they really need. Of course there is no denying the expertise of the medical profession, or the fact that people do benefit from psychopharmacology but that should not be used against the best interests of the client.
Mental health issues are never one dimensional; therefore a practitioner’s attempt to single handedly provide support for all needs of the individual is not only a rejection of the various specialisations in the field, it also robs the client of the availability of best practice and the continuum of care. Sadly, the financial benefit that comes from pharmaceutical companies to medical professionals by continually prescribing medication coupled with insecurity of them losing clientele and therefore income can come in the way of genuine patient care. Although there is a growing number of counsellors, psychologists and psychotherapists in the country providing evidence based therapeutic approaches, the need is to equalise the benefit of psychotherapy and psychiatry and to understand they need to work together, as practised in various other countries.
Read part two here: The Abyss of Mental Health: The Responsibilities of the Professional (Part 2)
Kripi Malviya is psychotherapist and poet who loves living on islands. She is the founder and co-creator of TATVA which is an emotional wellness organisation based in Goa, India (more here).
Featured Image Credit: Screw Loose by Lee Bermejo